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Jarius S, Ringelstein M, Schanda K, Ruprecht K, Korporal-Kuhnke M, Viehöver A, Hümmert MW, Schindler P, Endmayr V, Gastaldi M, Trebst C, Franciotta D, Aktas O, Höftberger R, Haas J, Komorowski L, Paul F, Reindl M, Wildemann B. Improving the sensitivity of myelin oligodendrocyte glycoprotein-antibody testing: exclusive or predominant MOG-IgG3 seropositivity-a potential diagnostic pitfall in patients with MOG-EM/MOGAD. J Neurol 2024:10.1007/s00415-024-12285-5. [PMID: 38609667 DOI: 10.1007/s00415-024-12285-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein antibody-associated encephalomyelitis (MOG-EM; also termed MOG antibody-associated disease, MOGAD) is the most important differential diagnosis of both multiple sclerosis and neuromyelitis optica spectrum disorders. A recent proposal for new diagnostic criteria for MOG-EM/MOGAD explicitly recommends the use of immunoglobulin G subclass 1 (IgG1)- or IgG crystallizable fragment (Fc) region-specific assays and allows the use of heavy-and-light-chain-(H+L) specific assays for detecting MOG-IgG. By contrast, the utility of MOG-IgG3-specific testing has not been systematically evaluated. OBJECTIVE To assess whether the use of MOG-IgG3-specific testing can improve the sensitivity of MOG-IgG testing. METHODS Re-testing of 22 patients with a definite diagnosis of MOG-EM/MOGAD and clearly positive MOG-IgG status initially but negative or equivocal results in H+L- or Fc-specific routine assays later in the disease course (i.e. patients with spontaneous or treatment-driven seroreversion). RESULTS In accordance with previous studies that had used MOG-IgG1-specific assays, IgG subclass-specific testing yielded a higher sensitivity than testing by non-subclass-specific assays. Using subclass-specific secondary antibodies, 26/27 supposedly seroreverted samples were still clearly positive for MOG-IgG, with MOG-IgG1 being the most frequently detected subclass (25/27 [93%] samples). However, also MOG-IgG3 was detected in 14/27 (52%) samples (from 12/22 [55%] patients). Most strikingly, MOG-IgG3 was the predominant subclass in 8/27 (30%) samples (from 7/22 [32%] patients), with no unequivocal MOG-IgG1 signal in 2 and only a very weak concomitant MOG-IgG1 signal in the other six samples. By contrast, no significant MOG-IgG3 reactivity was seen in 60 control samples (from 42 healthy individuals and 18 patients with MS). Of note, MOG-IgG3 was also detected in the only patient in our cohort previously diagnosed with MOG-IgA+/IgG- MOG-EM/MOGAD, a recently described new disease subvariant. MOG-IgA and MOG-IgM were negative in all other patients tested. CONCLUSIONS In some patients with MOG-EM/MOGAD, MOG-IgG is either exclusively or predominantly MOG-IgG3. Thus, the use of IgG1-specific assays might only partly overcome the current limitations of MOG-IgG testing and-just like H+L- and Fcγ-specific testing-might overlook some genuinely seropositive patients. This would have potentially significant consequences for the management of patients with MOG-EM/MOGAD. Given that IgG3 chiefly detects proteins and is a strong activator of complement and other effector mechanisms, MOG-IgG3 may be involved in the immunopathogenesis of MOG-EM/MOGAD. Studies on the frequency and dynamics as well as the clinical and therapeutic significance of MOG-IgG3 seropositivity are warranted.
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Affiliation(s)
- S Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany.
| | - M Ringelstein
- Department of Neurology, Heinrich Heine University, Düsseldorf, Germany
| | - K Schanda
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - K Ruprecht
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - M Korporal-Kuhnke
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - A Viehöver
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - M W Hümmert
- Department of Neurology, Hannover Medical School, Hanover, Germany
| | - P Schindler
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - V Endmayr
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - M Gastaldi
- Neuroimmunology Laboratory and Neuroimmunology Research Unit, IRCCS Mondino Foundation National Neurological Institute, Pavia, Italy
| | - C Trebst
- Department of Neurology, Hannover Medical School, Hanover, Germany
| | - D Franciotta
- Neuroimmunology Laboratory and Neuroimmunology Research Unit, IRCCS Mondino Foundation National Neurological Institute, Pavia, Italy
| | - O Aktas
- Department of Neurology, Heinrich Heine University, Düsseldorf, Germany
| | - R Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - J Haas
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - L Komorowski
- Institute of Experimental Neuroimmunology, affiliated to Euroimmun AG, Lübeck, Germany
| | - F Paul
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - M Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - B Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany.
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Liaskos C, Patrikiou E, Komorowski L, Tsigalou C, Tsirogianni A, Sakkas L, Bogdanos D. AB1165 THE ROLE OF MOLECULAR MIMICRY IN SARS-CoV-2 RELATED AUTOIMMUNE RHEUMATIC DISEASES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSeveral studies suggested that SARS-CoV-2 infection may induce autoantibodies related to autoimmune rheumatic diseases (ARD).ObjectivesTo determine whether polyclonal antibodies from SARS-CoV-2 uninfected patients with ARDs cross-react with SARS-CoV-2 and vice versa.Methods90 sera positive at high-titres for 23 common autoantibodies (all sera stored before 2018), were tested for reactivity against proteins of SARS-CoV-2 (spike protein S1, nucleocapsid NC etc) by ELISA and CMIA. Vice versa, 10 monoclonal antibodies against S1 protein (most of them against RBD) were tested for autoantibody reactivity by indirect immunofluorescence, ELISA, immunoblot and dot/line immunoassays coated with different antigens. Ten post-COVID sera with high titers of anti-Spike abs were tested by ELISAs for reactivity against various autoantigens related to ARDs.Results88 out of 90 samples (%), were totally unreactive to SARS-CoV-2 proteins; 2 sera, one anti-CCP and one anti-CENP reacted against S protein. All sera tested negative for neutralized abs against SARS-CoV-2. None of 10 sera from SARS-CoV-2 infected patients reacted with different autoantigens by molecular assays. None of the 10 monoclonal abs against S1 protein reacted with 23 different self-antigens. On HEp2 cells as substrate for IIF, 3 of the 10 monoclonal abs gave a low-titre coarse speckled pattern. No reactivity was found by IIFL using tissue substrates.ConclusionOur data do not suggest a dominant role for molecular mimicry and immunological cross reactivity as a trigger of autoantibodies related to ARDs.Disclosure of InterestsChristos Liaskos: None declared, Eleni Patrikiou: None declared, Lars Komorowski Employee of: emploee of EUROIMMUN Medizinische Labordiagnostika, Christina Tsigalou: None declared, Alexandra Tsirogianni: None declared, Lazaros Sakkas: None declared, Dimitrios Bogdanos: None declared
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Jarius S, Wilken D, Haas J, Ruprecht K, Komorowski L, Wildemann B. Parvovirus B19 and mumps virus antibodies are major constituents of the intrathecal immune response in European patients with MS and increase the diagnostic sensitivity and discriminatory power of the MRZ reaction. J Neurol 2021; 268:3758-3765. [PMID: 33770235 PMCID: PMC8463395 DOI: 10.1007/s00415-021-10471-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 11/30/2022]
Abstract
Background A positive MRZ reaction, as defined by intrathecal IgG production against at least two of its constituents, measles virus (M), rubella virus (R) and varicella zoster virus (Z), is detectable in ~ 63% of patients with multiple sclerosis (MS) and is currently considered the laboratory marker with the highest specificity and positive likelihood ratio for MS. However, M, R and Z are only the most well-established constituents of a broader intrathecal humoral immune response in MS.
Objective To identify additional anti-microbial antibodies inclusion of which in the classical MRZ panel may result in increased sensitivity without compromising the marker’s high specificity for MS. Methods We determined the antibody indices (AIs) for 11 viral and bacterial agents (M, R, Z, herpes simplex virus, Epstein–Barr virus, mumps virus, cytomegalovirus, parvovirus B19, Bordetella pertussis, Corynebacterium diphtheriae, and Clostridium tetani) in paired cerebrospinal fluid and serum samples from patients with MS and disease controls. Results A positive ‘classical’ MRZ reaction was found in 17/26 (65.4%) MS patients. The five most frequently positive AIs among patients with MS were M (76.9%), Z (61.5%), R (57.7%), parvovirus B19 (42.3%), and mumps (28%). Addition of parvovirus B19 and mumps virus to the MRZ panel resulted in an increase in sensitivity in the MS group from 65.4% to 73.1%, with 22% of the initially MRZ-negative patients exhibiting a de novo-positive response. The extended MRZ panel (‘MRZplus’) distinguished sharply between MS (≥ 3 AIs in 90% of all positives) and controls (varying diagnoses, from migraine to vasculitis; 0-1 AIs; p < 0.000001). The highest median AI in the MS group was found for parvovirus B19 (3.97), followed by measles virus (2.79). Conclusion Inclusion of parvovirus B19 and mumps virus in the test panel resulted in an increase in the sensitivity and discriminatory power of MRZ. Our results provide a strong rational for prospective studies investigating the role of extended MRZ panels in the differential diagnosis of MS.
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Affiliation(s)
- S Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany.
| | | | - J Haas
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - K Ruprecht
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - B Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
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Tegtmeyer J, Probst C, Komorowski L, Zillikens D, Schmidt E, Goletz S. 062 Sera of patients with bullous pemphigoid and mucous membrane pemphigoid react with a C-terminal 246 amino acid stretch of BP180. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Emtenani S, Yuan H, Lin C, Pan M, Hundt JE, Schmidt E, Komorowski L, Stanley JR, Hammers CM. Normal human skin is superior to monkey oesophagus substrate for detection of circulating BP180-NC16A-specific IgG antibodies in bullous pemphigoid. Br J Dermatol 2019; 180:1099-1106. [PMID: 30315657 PMCID: PMC6462259 DOI: 10.1111/bjd.17313] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering skin disease. Two antigens have been identified as targets of circulating autoantibodies (autoAbs) - BP180 and BP230 - with BP180 being a critical transmembrane adhesion protein of basal keratinocytes of the epidermis. The noncollagenous domain 16A (NC16A) of BP180 is the immunodominant epitope in patients with BP, and anti-BP180-NC16A IgG antibodies (Abs) correlate to disease activity. Routine serological testing and follow-up of BP relies on indirect immunofluorescence (IIF) of serum Abs, commonly performed on monkey oesophagus (ME), and/or enzyme-linked immunosorbent assay (ELISA) testing on recombinantly produced fragments of BP180 and BP230 (BP180-NC16A, BP230-C/N). OBJECTIVES To determine if NC16A epitopes are well represented on ME substrate. METHODS Sera from different BP cohorts were tested by IIF on ME and normal human skin (NHS). To confirm findings, affinity-purified anti-BP180-NC16A/BP230 polyclonal Abs and recombinant anti-BP180-NC16A/BP230 monoclonal antibodies (mAbs) were used. RESULTS For sensitive detection of BP180-NC16A-specific IgG Abs, sections of NHS are superior to the widely used ME. Confirmation comes from polyclonal affinity-purified anti-BP180-NC16A/BP230 Abs, and by mAbs cloned from a patient with active BP. CONCLUSIONS Use of NHS is preferable over ME in routine IIF testing for BP. These results are of clinical relevance because anti-BP180-NC16A IgG titres are correlated to disease activity and detecting them reliably is important for screening, diagnosis and follow-up of patients with BP.
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Affiliation(s)
- S. Emtenani
- Luebeck Institute of Experimental Dermatology (LIED), University of Luebeck, Luebeck, Germany
| | - H. Yuan
- Dept. of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
- Dept. of Dermatology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - C. Lin
- Dept. of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - M. Pan
- Dept. of Dermatology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - J. E. Hundt
- Luebeck Institute of Experimental Dermatology (LIED), University of Luebeck, Luebeck, Germany
| | - E. Schmidt
- Luebeck Institute of Experimental Dermatology (LIED), University of Luebeck, Luebeck, Germany
- Dept. of Dermatology, University of Luebeck, Luebeck, Germany
| | - L. Komorowski
- Institute of Experimental Immunology, EUROIMMUN, Luebeck, Germany
| | - J. R. Stanley
- Dept. of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - C. M. Hammers
- Luebeck Institute of Experimental Dermatology (LIED), University of Luebeck, Luebeck, Germany
- Dept. of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
- Dept. of Dermatology, University of Luebeck, Luebeck, Germany
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Goletz S, Probst C, Komorowski L, Schlumberger W, Fechner K, van Beek N, Holtsche MM, Recke A, Yancey KB, Hashimoto T, Antonicelli F, Di Zenzo G, Zillikens D, Stöcker W, Schmidt E. A sensitive and specific assay for the serological diagnosis of antilaminin 332 mucous membrane pemphigoid. Br J Dermatol 2019; 180:149-156. [PMID: 30216412 DOI: 10.1111/bjd.17202] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Antilaminin 332 mucous membrane pemphigoid (MMP) is an autoimmune subepidermal blistering disease with predominant mucosal involvement and autoantibodies against laminin 332. Malignancies have been associated with this disease; however, no standardized detection system for antilaminin 332 serum antibodies is widely available. OBJECTIVES Development of a sensitive and specific assay for the detection of antilaminin 332 antibodies. METHODS An indirect immunofluorescence (IF) assay using recombinant laminin 332 was developed and probed with a large number of antilaminin 332 MMP patient sera (n = 93), as well as sera from patients with antilaminin 332-negative MMP (n = 153), bullous pemphigoid (n = 20), pemphigus vulgaris (n = 20) and noninflammatory dermatoses (n = 22), and healthy blood donors (n = 100). RESULTS In the novel IF assay, sensitivities with the laminin 332 heterotrimer and the individual α3, β3 and γ2 chains were 77%, 43%, 41% and 13%, respectively, with specificities of 100% for each substrate. The sensitivity for the heterotrimer increased when an anti-IgG4 enriched antitotal IgG conjugate was applied. Antilaminin 332 reactivity paralleled disease activity and was associated with malignancies in 25% of patients with antilaminin 332 MMP. CONCLUSIONS The novel IF-based assay will facilitate the serological diagnosis of antilaminin 332 MMP and may help to identify patients at risk of a malignancy.
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Affiliation(s)
- S Goletz
- Lübeck Institute for Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - C Probst
- Institute of Experimental Immunology, EUROIMMUN AG, Lübeck, Germany
| | - L Komorowski
- Institute of Experimental Immunology, EUROIMMUN AG, Lübeck, Germany
| | - W Schlumberger
- Institute of Experimental Immunology, EUROIMMUN AG, Lübeck, Germany
| | - K Fechner
- Institute of Experimental Immunology, EUROIMMUN AG, Lübeck, Germany
| | - N van Beek
- Lübeck Institute for Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - M M Holtsche
- Lübeck Institute for Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - A Recke
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - K B Yancey
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, U.S.A
| | - T Hashimoto
- Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
| | - F Antonicelli
- Department of Dermatology, University of Reims, Reims, France
| | - G Di Zenzo
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
| | - D Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - W Stöcker
- Institute of Experimental Immunology, EUROIMMUN AG, Lübeck, Germany
| | - E Schmidt
- Lübeck Institute for Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
- Department of Dermatology, University of Lübeck, Lübeck, Germany
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Goletz S, Probst C, Komorowski L, Schlumberger W, van Beek N, Holtsche M, Recke A, Yancey K, Hashimoto T, Antonicelli F, Di Zenzo G, Zillikens D, Stöcker W, Schmidt E. 089 Sensitive and specific assay for the serological diagnosis of anti-laminin 332 mucous membrane pemphigoid. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lang B, Komorowski L, Adcock J, Waters P, Irani S. Intracellular and non-neuronal targets of voltage-gated potassium channel complex antibodies: Evidence for relative pathogenicity. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Goletz S, Probst C, Komorowski L, Schlumberger W, Zillikens D, Stöcker W, Schmidt E. 424 Cell-based immunofluorescence test applying recombinant laminin 332 for the serological differential diagnosis of pemphigoid. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.07.620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Krüger S, Fuhrmann T, van Beek N, Komorowski L, Fechner K, Zillikens D, Stöcker W, Schmidt E, Rentsch K. 335 Multicenter prospective study on multivariant diagnostics of autoimmune bullous dermatoses using the BIOCHIPTM technology. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.07.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Emtenani S, Johns J, Langenhan J, Komorowski L, Hundt J, Schmidt E, Zillikens D, Ludwig R, Hammers C. 370 Anti-desmoglein 3 autoantibodies cloned from the IgA1 repertoire of an IgA pemphigus patient are directly pathogenic, but not sufficient for disease induction. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.07.565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hahn S, Trendelenburg G, Scharf M, Denno Y, Brakopp S, Teegen B, Probst C, Wandinger KP, Buttmann M, Haarmann A, Szabados F, vom Dahl M, Kümpfel T, Eichhorn P, Gold H, Paul F, Jarius S, Melzer N, Stöcker W, Komorowski L. Identification of the flotillin-1/2 heterocomplex as a target of autoantibodies in bona fide multiple sclerosis. J Neuroinflammation 2017; 14:123. [PMID: 28645295 PMCID: PMC5481867 DOI: 10.1186/s12974-017-0900-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 06/13/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Autoantibodies, in particular those against aquaporin-4 and myelin-oligodendrocyte glycoprotein (MOG), aid as biomarkers in the differential diagnosis of demyelination. Here, we report on discovery of autoantibodies against flotillin in patients with multiple sclerosis (MS). METHODS The target antigen was identified by histo-immunoprecipitation using the patients' sera and cryosections of rat or pig cerebellum combined with mass spectrometrical analysis. Correct identification was ascertained by indirect immunofluorescence and neutralization tests using the target antigens recombinantly expressed in HEK293 cells. RESULTS Serum and CSF of the index patient produced a fine-granular IgG indirect immunofluorescence staining of the hippocampal and cerebellar molecular layers. Flotillin-1 and flotillin-2 were identified as target autoantigens. They also reacted with recombinant human flotillin-1/2 co-expressed in HEK293 cells, but not with the individual flotillins in fixed- and live-cell assays. Moreover, neutralization using flotillin-1/2, but not the single flotillins, abolished the tissue reactivity of patient serum. Screening of 521 patients, for whom anti-aquaporin-4 testing was requested and negative, revealed 8 additional patients with anti-flotillin-1/2 autoantibodies. All eight were negative for anti-MOG. Six patients ex post fulfilled the revised McDonald criteria for MS. Vice versa, screening of 538 MS sera revealed anti-flotillin-1/2 autoantibodies in eight patients. The autoantibodies were not found in a cohort of 67 patients with other neural autoantibody-associated syndromes and in 444 healthy blood donors. CONCLUSIONS Autoantibodies against the flotillin-1/2 heterocomplex, a peripheral membrane protein that is involved in axon outgrowth and regeneration of the optic nerve, are present in 1-2% of patients with bona fide MS.
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Affiliation(s)
- S. Hahn
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - G. Trendelenburg
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - M. Scharf
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - Y. Denno
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - S. Brakopp
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - B. Teegen
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
- Clinical Immunological Laboratory Prof. Dr. med Stöcker, Lübeck, Germany
| | - C. Probst
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - K. P. Wandinger
- Department of Neurology, University Medical Center Schleswig Holstein (UKSH), Lübeck, Germany
| | - M. Buttmann
- Department of Neurology, University of Würzburg, Würzburg, Germany
- Department of Neurology, Caritas Hospital, Bad Mergentheim, Germany
| | - A. Haarmann
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - F. Szabados
- Medical Laboratory Osnabrück, Georgsmarienhütte, Germany
| | - M. vom Dahl
- Department of Neurology, Ammerland Klinik, Westerstede, Germany
| | - T. Kümpfel
- Institute of Clinical Neuroimmunology, Ludwig Maximilian University, Munich, Germany
| | - P. Eichhorn
- Institute of Clinical Chemistry, Ludwig Maximilian University, Munich, Germany
| | - H. Gold
- Department of Neurology, Klinikum am Gesundbrunnen, Heilbronn, Germany
| | - F. Paul
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité Universitätsmedizin, Berlin, Germany
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité Universitätsmedizin, Berlin, Germany
| | - S. Jarius
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - N. Melzer
- Department of Neurology, University of Münster, Münster, Germany
| | - W. Stöcker
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
- Clinical Immunological Laboratory Prof. Dr. med Stöcker, Lübeck, Germany
| | - L. Komorowski
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
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Dammermann W, Polywka S, Dettmann I, Mindorf S, Komorowski L, Wehmeyer M, Schulze zur Wiesch J, Stöcker W, Lüth S. Development of autoantibodies against “rings and rods”-associated IMPDH2 in chronic hepatitis C genotype 1 infection during protease inhibitor based triple therapy in a “real life” cohort. Z Gastroenterol 2016. [DOI: 10.1055/s-0036-1597391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- W Dammermann
- Brandenburg Medical School, Center of Internal Medicine II, Brandenburg an der Havel, Germany
| | - S Polywka
- University Medical Center Hamburg-Eppendorf, Department of Medical Microbiology, Virology and Hygiene, Hamburg, Germany
| | - I Dettmann
- Euroimmun AG, Institute of Experimental Immunology, Lübeck, Germany
| | - S Mindorf
- Euroimmun AG, Institute of Experimental Immunology, Lübeck, Germany
| | - L Komorowski
- Euroimmun AG, Institute of Experimental Immunology, Lübeck, Germany
| | - M Wehmeyer
- University Medical Center Hamburg-Eppendorf, 1. Department of Medicine, Hamburg, Germany
| | - J Schulze zur Wiesch
- University Medical Center Hamburg-Eppendorf, 1. Department of Medicine, Hamburg, Germany
| | - W Stöcker
- Euroimmun AG, Institute of Experimental Immunology, Lübeck, Germany
| | - S Lüth
- Brandenburg Medical School, Center of Internal Medicine II, Brandenburg an der Havel, Germany
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Stefanou MI, Komorowski L, Kade S, Bornemann A, Ziemann U, Synofzik M. A case of late-onset, thymoma-associated myasthenia gravis with ryanodine receptor and titin antibodies and concomitant granulomatous myositis. BMC Neurol 2016; 16:172. [PMID: 27623618 PMCID: PMC5022226 DOI: 10.1186/s12883-016-0697-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Myasthenia gravis is an autoimmune neuromuscular disorder, which has only rarely been reported to co-manifest with myositis. The diagnosis of concomitant myositis in patients with myasthenia gravis is clinically challenging, and requires targeted investigations for the differential diagnosis, including EMG, autoantibody assays, muscle biopsy and, importantly, imaging of the mediastinum for thymoma screening. CASE PRESENTATION This report presents a case-vignette of a 72-year-old woman with progressive proximal muscle weakness and myalgias, diagnosed with thymoma-associated myasthenia and bioptically verified granulomatous myositis, with positive autoantibody status for ryanodine receptor and titin antibodies. CONCLUSIONS The diagnosis of concurrent myositis and myasthenia gravis, especially in the presence of ryanodine receptor and titin antibodies, should lead neurologists to adopt different treatment strategies compared to those applied in myasthenia or myositis alone. Moreover, further evidence is warranted that titin and, particularly, ryanodine receptor antibodies may co-occur or be pathophysiologically involved in myasthenia-myositis cases.
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Affiliation(s)
- M I Stefanou
- Department of Neurovascular Diseases, Hertie Institute for Clinical Brain Research & Center for Neurology, Tuebingen, Germany.
| | - L Komorowski
- Institute for Experimental Immunology, Affiliated to Euroimmun AG, Luebeck, Germany
| | - S Kade
- Institute for Experimental Immunology, Affiliated to Euroimmun AG, Luebeck, Germany
| | - A Bornemann
- Department of Neuropathology, University of Tuebingen, Tuebingen, Germany
| | - U Ziemann
- Department of Neurovascular Diseases, Hertie Institute for Clinical Brain Research & Center for Neurology, Tuebingen, Germany
| | - M Synofzik
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research & Center for Neurology, Tuebingen, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Tuebingen, Germany
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Scharf M, Miske R, Heidenreich F, Giess R, Landwehr P, Blocker IM, Begemann N, Denno Y, Tiede S, Dahnrich C, Schlumberger W, Unger M, Teegen B, Stocker W, Probst C, Komorowski L. Neuronal Na+/K+ ATPase is an autoantibody target in paraneoplastic neurologic syndrome. Neurology 2015; 84:1673-9. [DOI: 10.1212/wnl.0000000000001493] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 01/12/2015] [Indexed: 11/15/2022] Open
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Balint B, Jarius S, Nagel S, Haberkorn U, Probst C, Blocker IM, Bahtz R, Komorowski L, Stocker W, Kastrup A, Kuthe M, Meinck HM. Progressive encephalomyelitis with rigidity and myoclonus: A new variant with DPPX antibodies. Neurology 2014; 82:1521-8. [DOI: 10.1212/wnl.0000000000000372] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Stöcker W, Saschenbrecker S, Rentzsch K, Komorowski L, Probst C. [Autoantibody diagnostics in neurology using native and recombinant antigenic substrates]. Nervenarzt 2013; 84:471-6. [PMID: 23568169 DOI: 10.1007/s00115-012-3607-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Modern diagnostics for the determination of neurologically relevant autoantibodies are based on indirect immunofluorescence using tissue sections of the hippocampus, cerebellum and other tissues. For monospecific detection human embryonic kidney (HEK) cells transfected with different neurological antigens are used. Biochip mosaics are designed to give a quick overview and contain 20 or more substances positioned next to each other on a reaction field, which are incubated with the serum or cerebrospinal fluid (CSF) sample. Western blots based on cerebellum or hippocampus extracts or line blots containing defined recombinant antigens are used additionally. Initial investigations should always comprise the parallel analysis of all major antineural autoantibodies instead of performing only single parameter tests. Up until a few years ago autoantibodies against intracellular neuronal antigens were mainly investigated. Antibodies against structures of the neural cell surface, however, are much more frequently found, especially those against glutamate receptors (type NMDA).
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Affiliation(s)
- W Stöcker
- Institut für Experimentelle Immunologie, Euroimmun, Seekamp 31, 23560 Lübeck, Deutschland.
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Blöcker IM, Dähnrich C, Probst C, Komorowski L, Saschenbrecker S, Schlumberger W, Stöcker W, Zillikens D, Schmidt E. Epitope mapping of BP230 leading to a novel enzyme-linked immunosorbent assay for autoantibodies in bullous pemphigoid. Br J Dermatol 2012; 166:964-70. [PMID: 22242606 DOI: 10.1111/j.1365-2133.2012.10820.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disease characterized by circulating autoantibodies against BP180 and BP230. For BP180, the NC16A domain has previously been identified as the main antigenic target in BP, while data about the diagnostic value of epitopes on BP230 were inconclusive. OBJECTIVES To identify the most appropriate epitopes on BP230 to be applied in a simple, sensitive, and highly specific enzyme-linked immunosorbent assay (ELISA) for routine detection of serum autoantibodies. METHODS Ten overlapping linear fragments covering the whole length of BP230 were expressed in Escherichia coli. Based on Western blot analysis with sera from patients with BP (n = 49) and healthy controls (n = 94), the diagnostic performance of the fragments was compared by receiver operating characteristics curve analysis. The BP230-C3 fragment comprising the C-terminal portion (amino acids 2326-2649) was subsequently applied in a novel ELISA. The operating characteristics of this ELISA were analysed by probing sera from patients with BP (n = 118), pemphigus vulgaris (n = 50), rheumatoid arthritis and other inflammatory arthritides (n = 170), and systemic lupus erythematosus (n = 56), and from healthy blood donors (n = 483). RESULTS Among all the fragments, BP230-C3 provided the best efficiency in serologically diagnosing BP by Western blot. An ELISA employing BP230-C3 revealed a diagnostic sensitivity of 56·8% and specificity of 97·6%. Its diagnostic added value amounted to 4·2% compared with the anti-BP180-NC16A-4X ELISA alone. CONCLUSIONS Recombinant BP230-C3 is a suitable target antigen for the detection of serum autoantibodies against BP230.
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Affiliation(s)
- I M Blöcker
- Institute of Experimental Immunology, EUROIMMUN AG, Lübeck, Germany
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19
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Damoiseaux J, Dähnrich C, Rosemann A, Probst C, Komorowski L, Stegeman CA, Egerer K, Hiepe F, van Paassen P, Stöcker W, Schlumberger W, Tervaert JWC. A novel enzyme-linked immunosorbent assay using a mixture of human native and recombinant proteinase-3 significantly improves the diagnostic potential for antineutrophil cytoplasmic antibody-associated vasculitis. Ann Rheum Dis 2008; 68:228-33. [DOI: 10.1136/ard.2007.086579] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Antineutrophil cytoplasmic antibodies (ANCA) with a C-ANCA or P-ANCA pattern are detected in ANCA-associated vasculitis (AAV). While in most patients with AAV a C-ANCA pattern is due to reactivity with proteinase-3 (PR3)-ANCA, some C-ANCA-positive sera do not react with PR3.Objective:The development and evaluation of a direct enzyme-linked immunosorbent assay (ELISA) for PR3-ANCA with increased sensitivity.Methods:A mixture of human native (hn) and human recombinant (hr) PR3 was used as antigen coating. The resulting ELISA (anti-PR3-hn-hr) was compared with ELISAs using directly coated hn-PR3 or hr-PR3, as well as with a hn-PR3 capture ELISA. Assay characteristics were determined in patients with AAV (n = 248), with special attention for those patients with C-ANCA (n = 132), as well as disease controls (n = 585) and healthy controls (n = 429). Additionally, for prediction of relapses serial samples of 46 patients with PR3-AAV were analysed.Results:At a predefined specificity of 99% both ELISAs containing hr-PR3 revealed a substantial increase in sensitivity. For the prediction of relapses by rises in PR3-ANCA titres the capture ELISA was most optimal (odds ratio 12.5). With an odds ratio of 8.9 the novel anti-PR3-hn-hr ELISA was second best.Conclusions:Owing to the very high sensitivity of the novel anti-PR3-hn-hr ELISA for the detection of PR3-ANCA in C-ANCA-positive samples of patients with AAV this assay has an excellent diagnostic performance. This feature is combined with a good predictability of clinical relapses in patients with PR3-AAV. These characteristics challenge the dogma that, for detection of PR3-ANCA, capture ELISAs are superior for diagnosis and follow-up.
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Habben C, Komorowski L, Maringgele W, Meller A, Niedenzu K. Boron-nitrogen compounds. 119. Reactions of boron heterocycles with pyrazole. Inorg Chem 2002. [DOI: 10.1021/ic00312a031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Komorowski L, Maringgele W, Meller A, Niedenzu K, Serwatowski J. Boron-nitrogen compounds. 125. Pyrazole complexes of three-coordinated boranes. Inorg Chem 2002. [DOI: 10.1021/ic00344a038] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Das MK, DeGraffenreid AL, Edwards KD, Komorowski L, Mariategui JF, Miller BW, Mojesky MT, Niedenzu K. Boron-nitrogen compounds. Part 117. Pyrazaboles of the type RR'B(.mu.-pz)2BRR' and related studies. Inorg Chem 2002. [DOI: 10.1021/ic00291a009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Komorowski L, Anemüller S, Schäfer G. First expression and characterization of a recombinant CuA-containing subunit II from an archaeal terminal oxidase complex. J Bioenerg Biomembr 2001; 33:27-34. [PMID: 11460923 DOI: 10.1023/a:1005668522801] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The branched respiratory chain of the archaeon Sulfolobus acidocaldarius contains a supercomplex, SoxM, consisting of a bc1-like subcomplex and a terminal oxidase moiety, including a subunit II analogous polypeptide, SoxH. However, the latter component has never been identified in preparations of SoxM. We demonstrate the presence of an mRNA transcript by Northern analysis. We succeeded in cloning and expressing the respective gene with truncated N-terminus by deleting a 20 AS membrane anchor, which resulted in a water-soluble purple copper protein, which was further characterized. The recombinant subunit II of the SoxM complex contains a correctly inserted binuclear CuA cluster as revealed by UV/vis and EPR spectroscopy. The protein is highly thermostable and displays a redox potential of +237 mV. In recombinant form, the metal interacts with cytochrome c as an artificial electron donor; the physiological electron donor is still unknown, since S. acidocaldarius does not contain any c-type cytochromes. The purple copper center of SoxM shows an interesting pH dependency with a pKa at 6.4, suggesting protonation of the Cu-ligating histidines. Further lowering the pH causes a reversible transition into another cluster form with concomitant liberation of one copper. It may thus provide a model for the study of cluster rearrangements in response to pH.
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Affiliation(s)
- L Komorowski
- Institute of Biochemistry, Medical University of Luebeck, Germany
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Komorowski L, Schäfer G. Sulfocyanin and subunit II, two copper proteins with novel features, provide new insight into the archaeal SoxM oxidase supercomplex. FEBS Lett 2001; 487:351-5. [PMID: 11163357 DOI: 10.1016/s0014-5793(00)02343-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The isolation of a fully functional SoxM terminal oxidase supercomplex from the archaeon Sulfolobus acidocaldarius has failed thus far and several of its constituents have only been predicted genetically, such as the small Cu protein sulfocyanin and the subunit II bearing a Cu(A) center. Here we report the recombinant expression of sulfocyanin and prove its transcription in Sulfolobus as well as its presence in the enriched complex. It reveals a redox potential of +300 mV and spectroscopic features that are characteristic of type I copper centers. It is highly thermostable and firmly attached to the complex by one putative transmembrane anchor. Surprisingly, subunit II is completely missing from the isolated complex and behaves as an easily dissociable constituent which is a unique case within the terminal oxidase family. Its loss into the soluble phase upon cell disruption can be considered the reason for the inactivity of the isolated membrane complex.
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Affiliation(s)
- L Komorowski
- Institute of Biochemistry, Medical University of Lübeck, D-23538, Lübeck, Germany
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Emerick DP, Nahm FC, Niedenzu K, Komorowski L, Lipinski J. Boron-Nitrogen Compounds 83 [1]. Experimental and Theoretical Studies on Monomeric Iminoboranes. Z Anorg Allg Chem 1980. [DOI: 10.1002/zaac.19804680107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Niedenzu K, M�ller KD, Layton WJ, Komorowski L. Bor-Stickstoff-Verbindungen, LXVIII [1]. Kernresonanzspektroskopische Untersuchungen an 1,3,2-Diazaboracycloalkanen und Phenylboranderivaten. Z Anorg Allg Chem 1978. [DOI: 10.1002/zaac.19784390113] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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