The specific detection of IgA in immune complexes

An assay to detect IgA in circulating immune complexes (IC) using low avidity goat IgM antibody against human polyclonal IgA is described. The binding of this antibody to IgA coupled to Sepharose 6B is inhibited by IgA-containing IC. The specificity and sensitivity of this anti-IgA inhibition assay (a-IgA-InhA), was evaluated with aggregated purified immunoglobulins, sera of patients with Henoch-Schönlein purpura and normal human sera. Aggregated immunoglobulins of the IgA class, but not monomeric IgA, were reactive. Sucrose density ultracentrifugation showed that large IgA constituents (> 19S) were found only in the sera of patients with Henoch-Schönlen purpura. Both these sera and normal human serum contained smaller IgA components (between 7S and 19S), probably small polymers of IgA, which were reactive in this assay and interfered with detection of IgA-containing IC. Redissolved precipitates obtained from normal serum with polyethylene glycol showed reduced reactivity in the test, whereas the inhibitory activity of IgA-containing IC in sera of patients with Henoch-Schönlein purpura was retained in the precipitates. Precipitation of sera with polyethylene glycol allowed detection of smaller quantities of IgA-containing IC in patients with Henoch-Schölein purpura.     

Detection of IgA-class circulating immune complexes (CIC) in sera from patients with IgA nephropathy using a solid-phase anti-C3 Facb enzyme immunoassay (EIA)

The detection of circulating immune complexes (CIC) in sera from patients with IgA nephropathy is described. A solid-phase anti-C3 Facb enzyme immunoassay (EIA) was employed for detection of IgA-, IgG- and IgM-CIC in sera. The C1q-binding enzyme assay was also used for the detection of CIC in sera from these patients and healthy adults. Twenty-two patients with IgA nephropathy, 14 patients with other glomerular diseases and 19 healthy adults were examined by anti-C3 Facb EIA. The levels of IgA-CIC in sera from patients with IgA nephropathy were significantly higher than those in sera from patients with other glomerular diseases and healthy adults. CIC measured by the C1q-binding enzyme assay was detected in some patients with IgA nephropathy. The levels of serum IgA in patients with IgA nephropathy were significantly higher than those in patients with other glomerular diseases and healthy adults. However, there was no significant correlation between the levels of IgA-CIC in sera and those of serum IgA in patients with IgA nephropathy. There was also no significant correlation between the levels of IgA-CIC in sera and the degree of histopathological injuries in the patients. It is concluded that the solid-phase anti-C3 Facb EIA is useful for the detection of IgA-CIC in sera from patients with IgA nephropathy.     

Induction of Fc receptors for IgA on murine T cell hybridoma by human monoclonal IgA and by high molecular weight IgA in IgA nephropathy.

A reproducible immunocyto-adherence assay has been developed to study the modulation of Fc receptors for IgA (Fc alpha R), using a murine T cell hybridoma (T2D4), which expresses Fc receptors for all known isotypes of secreted immunoglobulins. By using sheep red blood cells coated with the hapten 2-4-6 trinitrophenyl (TNP), as indicator cells, and a murine monoclonal IgA (MOPC 315) antibody with anti-TNP activity, we were able to study the Fc alpha R on T2D4 cells. We found that: (a) murine Fc alpha R can bind human monoclonal IgA, and this binding is isotype specific since it was inhibited by human monoclonal IgA but not by human monoclonal IgG or IgM; (b) the expression of murine Fc alpha R is unducible by human monoclonal IgA, and this effect is isotype specific since it is not observed with human monoclonal IgM or IgG (c) sera from patients with IgA nephropathy can also induce Fc alpha R expression; by contrast, no induction was observed with normal human sera, (d) in one serum from an IgA-nephropathy patient, the inducer factor was characterized by affinity chromatography on anti-IgA-Sepharose and by gel filtration: high molecular weight IgA, probably IgA aggregates or immune complexes were recognized to be responsible for the induction of murine Fc alpha R expression.     

Antibodies to polyclonal IgA,IgA1, and IgA2 and isotype-specific immune complexes in IgA nephropathy

The concentrations of serum IgG and IgM antibodies to polyclonal IgA (IgA_p), IgA₁, and IgA₂ were determined by enzyme immunoassay in 31 patients with IgA nephropathy and 30 healthy controls. Patients with IgA nephropathy had significantly raised concentrations of serum IgA compared to controls (Mann-WhitneyU test,P=0.001) and increased concentrations of conglutinin-binding IgA immune complexes (P=0.024). No differences in the median concentrations of IgG and IgM anti-IgA antibodies were found between the patients and the controls. In serum samples from healthy controls there was a significant positive correlation between IgM anti-IgA_p and IgA immune complex concentrations (P=0.05), which contrasted with the finding of an inverse correlation between IgM anti-IgA_p and IgA immune complex concentrations in patients with IgA nephropathy (P<0.05). In addition, the concentrations of conglutinin binding IgM immune complexes in serum were found to correlate with the concentration of IgM anti-IgA_p (0.010<P<0.025), IgM anti-IgA₁, and IgM anti-IgA₂ (P«0.005 for both) in patients with IgA nephropathy but not in controls. IgM anti-IgA antibodies may be important in augmenting the clearance of IgA immune complexes from the serum of patients with IgA nephropathy.     

Kinetics and fate of IgA-IgG aggregates as a model of naturally occurring immune complexes in IgA nephropathy.

The characteristic granular IgA immunofluorescent pattern in the kidneys of IgA nephropathy patients is consistent with immune complex pathogenesis. The possibility of a delayed clearance of IgA-containing immune complexes from circulation in IgA nephropathy patients is still under discussion. Since pure IgA immune complexes are probably nonphlogistic, (in contrast to IgG-containing IgA immune complexes), the in vivo clearance of a mixture of heat-aggregated IgA/G purified from pooled human sera was analyzed. The test probe was efficiently labeled with 123I and the time course of radioactivity was measured by a gamma-camera. Both the liver and the spleen were found to be involved in the disappearance of IgA/G complexes. Liver accumulation, which was markedly predominant, closely approximates a gamma-variate function which allowed determination of a mean transit time of 34.37 minutes, range 29.8 to 42.2, in 8 normal and 37.54 minutes, range 30.9 to 50.7 in 17 patients (p less than 0.04). At 2 hours, segmental gut accumulation was found, which demonstrated removal by hepatobiliary system as well. Compartmental analysis in patients indicated 3 major compartments represented by vascular bed, hepatobiliary and reticuloendothelial systems (including both liver and spleen phagocytes). Blood clearance rate, representing the final result of multiorgan removal of the test probe from the blood stream, was found to be significantly delayed in IgA nephropathy patients with a slope (0.035 min-1, range 0.019 to 0.052) significantly less negative compared with controls (0.047 min-1, range 0.038 to 0.053, p less than 0.01). This test probe was able to reproduce both removal routes (macrophages cells and hepatobiliary system) hypothesized for IgA-containing immune complexes in humans.     

IgA-containing circulating immune complexes in dermatitis herpetiformis, Henoch-Schönlein purpura, systemic lupus erythematosus and other diseases.

The sera of patients with dermatitis herpetiformis, Henoch-Schönlein purpura and systemic lupus erythematosus were examined for IgA-containing immune complexes using a newly described radioimmunoassay. The IgG Raji cell radioimmunoassay and the 125I-C1q binding assay were also used to detect IgG- and IgM- containing soluble immune complexes. IgA-containing immune complexes were found in the sera of twelve of forty-nine (24%) patients with dermatitis herpetiformis, four of six (67%) patients with Henoch-Schönlein purpura, and seven of ten (70%) patients with systemic lupus erythematosus. IgG- or IgM- containing immune complexes were also found in six of forty-seven patients with dermatitis herpetiformis, in one of six patients with Henoch-Schönlein purpura, and in nine of ten patients with systemic lupus erythematosus, by either the 125I-Clq binding assay or the IgG Raji cell assay. The finding of soluble IgA immune complexes in a high percentage of patients with systemic lupus erythematosus and Henoch-Schönlein purpura suggests that they may play an important role in the pathogenesis of these diseases. In contrast, their low prevalence in patients with dermatitis herpetiformis suggests that IgA-containing immune complexes may not play a major role in the pathogenesis of dermatitis herpetiformis.     

Evaluation of the efficiency of two IgA immune complex assays

Two IgA immune complex assays, namely the anti-IgA inhibition of binding assay (a-IgA-InhBA) and the IgA polyethylene glycol assay (IgA-PEG assay) were evaluated using IgA aggregates (AIgA) of well defined sizes. AIgA was prepared by heat treatment. After ultracentrifugation the size of AIgA was found to be in a range between 7 S and 64 S. Five AIgA pools (greater than 64 S, 44-64 S, 24-43 S, 20-24 S and 9-19 S) and a pool of monomeric IgA were prepared to test the efficiency of the two assays. The IgA-PEG assay exclusively detected very large sized AIgA (greater than 64 S), whereas the a-IgA-InhBA detected also AIgA of intermediate size (9-19 S). The sensitivity of the latter assay was found to be size dependent. After ultracentrifugation of serum samples from patients with IgA nephropathy, IgA of large and intermediate macromolecular size was detected. It is concluded that the a-IgA-InhBA is useful for the detection of circulating IgA-containing immune complexes in IgA nephropathy.     

Detection of bovine serum albumin in the circulating IgA immune complexes of patients with IgA nephropathy

Alimentary antigenic challenge has been postulated to have a role in the genesis of IgA circulating immune complexes (CIC), resulting in mesangial IgA disease. In this study, we examined the relationship between bovine serum albumin (BSA) and IgA CIC in patients with IgA nephropathy. Of the 47 patients studied, elevated IgA CIC levels were found in 32% by the F(ab')2 anti-C3 and Raji cell enzyme immunoassays (EIA). Elevated IgA anti-BSA antibody levels were found in 9 patients, and there was a positive correlation between these levels and IgA CIC as measured in the Raji cell EIA (R = 0.60, P less than 0.001). In 4 patients with elevation of both IgA CIC and IgA anti-BSA antibody levels, solubilization experiments were done to demonstrate the presence of BSA antigen in the IgA CIC. Using the Raji cell EIA, the IgA CIC levels decreased significantly after preincubating the sera with serial concentrations of excess BSA. No corresponding effect was seen with human serum albumin used as control. Hence, BSA may be the antigenic stimulus in the formation of IgA CIC in selected patients with IgA nephropathy. The pathogenic capacity of these IgA-BSA CIC remains to be determined.     

Low molecular weight IgM in selective IgA deficiency.

Thirty-nine persons with selective IgA deficiency were studied. These comprised 27 subjects found by population screening and 12 by other means. Low molecular weight (LMW) serum IgM was sought in 28 of the 39 persons. Nine of the 28 (32%) had LMW IgM detectable by a sensitive gel filtration technique. Of 17 patients discovered by screening, five (29%) had LMW IgM. In the nine positive persons, LMW IgM constituted up to 17% of the total serum IgM concentration. Eight of the nine IgA deficient persons with LMW IgM, had clinical disease while associated disease in the entire IgA deficient population was less frequent. Serum immune complexes were demonstrated in five of seven subjects with LMW IgM using a C1q-dependent radioimmunoassay; four of these had immune complex associated disorders, three with polyarthritis and one with glomerulonephritis. Because circulating immune complexes are frequently detected in IgA deficient persons without disease, it is proposed that the presence of LMW serum IgM in IgA deficiency may be associated with disease due to the formation of specific pathogenic immune complexes.     

STUDIES ON GLOMERULAR IMMUNE SOLUBILIZATION BY COMPLEMENT IN PATIENTS WITH IgA NEPHROPATHY

A study of the solubilization of glomerular immune deposits by serum or complement in patients with IgA nephropathy is described. Renal biopsy specimens were obtained from 15 patients with IgA nephropathy. These specimens were incubated with fresh and heated sera from healthy adults or with lyophilized complement components, i.e., C3 and C4, at 37°C for one hour in plastic tubes. The sections were then stained with fluorescein isothiocyanate (FITC)-labelled anti-human IgA antisera and examined by fluorescence microscopy. Normal sera showed a marked capacity to solubilize the glomerular immune deposits characteristic of IgA nephropathy. The solubilization capacity was reduced after inactivation and absorption of sera with anti-human C3 antiserum. Lyophilized C3 or C4 did not show any ability to solubilize such deposits. It was concluded that the solubilization of glomerular immune deposits may require whole active (fresh) components of complement related to the alternative pathway. ACTA PATHOL. JPN.     

Studies on glomerular immune solubilization by complement in patients with IgA nephropathy

A study of the solubilization of glomerular immune deposits by serum or complement in patients with IgA nephropathy is described. Renal biopsy specimens were obtained from 15 patients with IgA nephropathy. These specimens were incubated with fresh and heated sera from healthy adults or with lyophilized complement components, i.e., C3 and C4, at 37 degrees C for one hour in plastic tubes. The sections were then stained with fluorescein isothiocyanate (FITC)-labelled anti-human IgA antisera and examined by fluorescence microscopy. Normal sera showed a marked capacity to solubilize the glomerular immune deposits characteristic of IgA nephropathy. The solubilization capacity was reduced after inactivation and absorption of sera with anti-human C3 antiserum. Lyophilized C3 or C4 did not show any ability to solubilize such deposits. It was concluded that the solubilization of glomerular immune deposits may require whole active (fresh) components of complement related to the alternative pathway.     

Aberrant synthesis of antibodies directed at the Fab fragment of IgA in patients with IgA nephropathies

The sera of 37 patients with IgA nephropathy (IgA NP) were assayed for levels of antibodies specific for the Fab fragment of homologous IgA, and the values obtained were compared to antibody levels in a panel of 26 normal volunteers. IgG antibody levels in IgA NP patients were significantly elevated over those of the controls (P less than 0.01); at the same time IgM anti-Fab alpha levels were significantly decreased when compared to the control panel (P less than 0.01). There was no correlation of antibody levels of either isotype with levels of circulating immune complexes; however, IgM antibody levels of IgA NP patients showed a significant negative correlation with severity of renal insufficiency.     

Increased concentration of serum IgA antibody to pneumococcal polysaccharides in patients with IgA nephropathy.

It has been postulated that IgA nephropathy (IgAGN) is caused by deposition within the glomerular mesangium of IgA polymers and IgA containing immune complexes which are overproduced in response to antigens presented at mucosal surfaces. To test this, the concentrations of specific antibodies to capsular polysaccharides from pneumococci, which are common commensal and/or pathogenic bacteria in the respiratory tract, have been measured. Sera from 35 patients with IgAGN, six with systemic lupus erythematosus (SLE), eight with membranous glomerulonephritis (MGN) and six with Goodpasture's syndrome (GPS), and from 20 controls (C) were assayed. The concentrations of IgG and IgA antibodies specific for each of five pneumococcal polysaccharides (serotypes 2, 7F, 9N, 14 and 23F) were determined by ELISA. The results from the SLE, MGN and GPS patients were pooled and used as a control group of patients with forms of nephritis other than IgAGN (patient controls, PC). Groups were compared using the Wilcoxon test or the Chi square test. There were no significant differences in the concentrations of IgG antibody to any of the serotypes between the IgAGN and normals, but the PC sera had significantly lower concentrations than either the IgAGN or normals. By contrast, there were no differences between the PC and C in the proportion with detectable IgA antibody to four of the serotypes, but this was significantly increased in IgAGN. There was insufficient IgA antibody to serotype 2 to detect in the assay system used. It is concluded that IgAGN patients have greater concentrations of IgA antibodies, but not IgG, to these pneumococcal polysaccharides, compared with normal controls or patients with other forms of nephritis.     

Serum IgA preferentially binds to cationic polypeptides in IgA nephropathy.

The observation of negatively charged IgA in the mesangium of patients with primary IgA nephropathy (IgA-GN) prompted us to study the charge of serum IgA in IgA-GN, Henoch Schönlein purpura (HSP), alcoholic liver cirrhosis (ALC), membranous nephropathy (MGN) and systemic lupus erythematosus (SLE). Since no abnormal distribution of IgA isoelectric points was detected by isoelectric focusing studies, we developed a sensitive charge-dependent assay using plates coated with either cationized BSA (cBSA) or poly-L-lysine. In 15 IgA-GN sera, the amount of IgA reacting specifically with cBSA (cBSA-IgA) was almost linearly correlated with the poly-L-lysine-binding IgA (r = 0.97, P = 0.0006), suggesting that both assays detect charge-dependent interactions and thus probably measure anionic IgA. Significantly high serum levels of cBSA-IgA were observed in 56% of IgA-GN patients and in 40% of ALC patients. In contrast, normal serum levels of cBSA-IgA were detected in HSP, MGN and SLE. Both, the mono- or polymeric IgA bound to cBSA in a patient''s serum studied. Contrasting with the presence of anionic IgA, no increase of cBSA-IgG was observed in IgA-GN. IgA rheumatoid factor (IgA-RF) assay showed high levels in IgA-GN (39%) and in ALC (25%). IgA-RF levels did not correlate with the amount of cBSA-IgA. When 18 patients with IgA-GN were tested after kidney transplantation, increased levels of cBSA-IgA and/or IgA-RF were found to be associated with the recurrence of mesangial IgA deposits in the graft. This suggests that both negatively charged IgA and IgA-RF may play a role in the recurrence of mesangial IgA deposits.     

Immunoelectron microscopic study of childhood IgA nephropathy and Henoch-Schönlein nephritis

Summary Renal biopsy specimens from 11 children with Henoch-Schönlein nephritis and 14 with IgA nephropathy were examined by immunoelectron microscopy. The distribution of IgA reaction product (RP) was found to be similar to that of the electron-dense deposits seen with conventional electron microscopy. Deposits of IgA-RP were present in the mesangium and in the subendothelial region of the peripheral glomerular capillary wall in all patients. Subepithelial deposits of IgA-RP were seen in 12 patients. Deposits of IgG-RP were rare and no deposits of IgM-RP were observed. Deposits of C3-RP were found frequently, although they were smaller and less extensive than deposits of IgA-RP. There was no significant difference between Henoch-Schönlein nephritis and IgA nephropathy with regard to immunoelectron microscopy findings. These observations suggest that Henoch-Schönlein nephritis and IgA nephropathy are both forms of mesangiopathic glomerulonephritis caused by immune complexes, mainly composed of IgA.     

Inhibition of neutrophil migration by serum IgA from patients with IgA nephropathy.

Previously we showed that patients with IgA nephropathy present high serum levels of polymeric IgA and that in vitro polyclonal stimulation of their peripheral blood lymphocytes results in the synthesis of a large amount of true polymeric IgA. The aim of this study was to determine if the serum of patients with IgA nephropathy was capable of suppressing the directional migration of human normal polymorphonuclear cells (PMN), as do the polymeric fractions of IgA myeloma. Incubation of controls' PMN with fresh or heat-inactivated patients' plasma impaired the casein-induced directional migration significantly more than incubation with controls' plasma. This inhibitory effect was closely linked to polymeric IgA fractions and to a lesser extent with monomeric IgA immune complexes. The removal of IgA by immunoadsorption from patients' plasma completely abolished the migration suppression observed on controls' PMN. These results suggest that the high serum levels of polymeric IgA observed in patients with IgA nephropathy, by inhibiting directional migration and phagocytosis of PMN, and probably monocytes, could facilitate the persistent circulation and renal deposition of immune complexes.     

IgA1 and IgA2 immune complexes in primary IgA nephropathy and Henoch-Sch?nlein nephritis.

The distribution of IgA subclasses in IgA immune complexes (IgA IC) in sera of patients with primary IgA glomerulonephritis and Henoch-Schönlein purpura nephritis was analysed. High levels of IgA IC containing both IgA1 and IgA2 subclasses were present in correlation with the phases of clinical activity. In these nephropathies the finding of IgA subclass distribution in IgA IC similar to that found in secretions may add further support to the hypothesis that IgA IC are of mucosal origin, albeit a primary derangement of the humoral immune system in these patients cannot be disregarded.     

Detection of IgA class circulating immune complexes bound to anti-C3d antibody in patients with IgA nephropathy

IgA class circulating immune complexes (CIC) were detected by solid-phase fluorescent enzyme immunoassay of F(ab')2 anti-C3d antibody in the serum of 52 patients with IgA nephropathy. Conglutinin (Kg) binding IgA class CIC were also measured, and results by these assays were compared. Kg binding IgA class CIC and anti-C3d binding IgA class CIC were detected in 27% and 44%, respectively, of the patients with IgA nephropathy. Either or both of the two were found in 65% of the patients. There was no significant correlation between IgA class CIC detected by these methods and serum IgA. Although all samples with a very high level of anti-C3d binding IgA class CIC did not also have a very high level of Kg binding IgA class CIC, there was a slight quantitative correlation between the 2 assays. Ultracentrifugation analysis showed that anti-C3d binding IgA class CIC were of various sizes between polymeric (21 S) and monomeric IgA (7 S), whereas Kg binding IgA class CIC were mostly monomeric IgA (8 S) with a minor component of heavy fractions (14 S). Both IgA class CIC fixed iC3b and IgA class CIC fixed C3d are present in IgA nephropathy. These observations suggest that the different types of complement bound to IgA class CIC have different roles in IgA nephropathy.     

Low antibody affinity restricted to the IgA isotype in IgA nephropathy.

Antibody affinity affects the handling and behaviour of immune complexes, and experimental studies have shown that animals which produce predominantly low-affinity antibody are prone to immune complex deposition resulting in glomerulonephritis. In order to investigate the potential role of antibody affinity in the pathogenesis of IgA nephropathy, affinity of both IgA and IgG antibody isotypes during secondary response to systemic immunization with tetanus toxoid was studied in 20 patients with IgA nephropathy. Patients with IgA nephropathy produced IgA antibodies of significantly lower affinity than controls (P < 0.001), whereas IgG antibody affinities were similar. Contrasting with controls, patients' IgA antibody affinity was inversely related to antibody concentration, with higher responders producing large amounts of low-affinity antibody. IgG antibody affinity increased with time, and maturation of IgG antibody affinity was similar in both controls and patients. IgA affinity in controls decreased with time, and this lack of IgA affinity maturation may explain the relative unimportance of IgA in normal systemic immunity. This temporal decrease in IgA affinity was not observed in patients with IgA nephropathy. The production of low-affinity IgA in IgA nephropathy may provide an explanation for the predominant deposition of IgA in this disease.     

Development of IgA nephropathy-like glomerulonephritis associated with Wiskott-Aldrich syndrome protein deficiency

Wiskott-Aldrich syndrome (WAS) is a rare X-linked disorder caused by mutations in the WAS gene. Glomerulonephritis is a frequent complication, however, histopathological data from affected patients is scarce because the thrombocytopenia that affects most patients is a contraindication to renal biopsies. We found that WASp-deficient mice develop proliferative glomerulonephritis reminiscent of human IgA nephropathy (IgAN). We examined whether increased aberrant IgA production is associated with the development of glomerulonephritis in WASp-deficient mice. Serum IgA and IgA production by splenic B cells was increased in WASp-deficient mice compared to wild-type (WT) mice. A lectin-binding study revealed a reduced ratio of sialylated and galactosylated IgA in the sera from old WASp-deficient mice. Circulating IgA-containing immune complexes showed significantly higher titers in WASp-deficient mice compared to WT mice. These results indicate that the increased IgA production and aberrant glycosylation of IgA may be critically involved in the pathogenesis of glomerulonephritis in WAS.