The immunochemical characterization of mesangial IgA deposits.

Mesangial deposits of IgA are found in IgA nephropathy, Schönlein-Henoch purpura (SHP) and in some patients with alcoholic cirrhosis and systemic lupus erythematosus (SLE). In this study the authors characterized the mesangial IgA deposits in patients with the above diseases using antiserums or monoclonal antibodies to A1, A2, J-chain and secretory component (SC), and examined SC binding in vitro. SC was not present, J-chain was ubiquitous, and A2 was found (with the use of monoclonal antibodies) rarely but with equal frequency in all groups. The SC binding capacity of the deposits differed between the groups and was found in 13 of 16 patients with alcoholic liver disease, 3 of 4 with SLE, 1 of 10 with primary IgA nephropathy, and none of 6 with SHP.     

IgA nephropathy: characterization of the polymeric nature of mesangial deposits by in vitro binding of free secretory component.

IgA nephropathy, as Berger defined it, is characterized by mesangial deposits of IgA, which are easily visualized by immunofluorescence on kidney biopsies. The structure (mono- or dimeric) of these IgA has not been clearly defined so far. Fifteen renal biopsies were studied to find out whether these IgA are serum monomers, or are polymers from a different origin. This was done by tissue fixation in vitro of free secretory component, which was then visualized by immunofluorescence (IF). In all 15 cases, the IgA deposits were shown to lack bound secretory component, but were able to bind, specifically, with the free secretory component. The presence of J chain in these deposits was also evidenced by indirect IF. These findings favour the hypothesis that these immunoglobulins are polymeric.     

Genetic investigation in mesangial IgA nephropathy

HLA—A, B. C. DR, MB, Bf, Gm, Am, Pi and Km genes (and 12 erythrocyte genetic systems) have been analyzed and correlated with clinical or biological features in 88 mesangial IgA glomerulonephritis.
These data pointed out 2 gene frequency modifications: a significant MB1 specificity decrease in the total patient group and a significant Km I increase in the chronic renal failure mesangial IgA nephropathy subgroup.     

The ultrastructural morphology of the mesangial cell in IgA nephropathy

By means of electron microscopy, three types of mesangial cell change were identified in IgA nephropathy. They represented proliferative, phagocytic and resting mesangial cells. The proliferative mesangial cells were characterised by the presence of centrioles, numerous free ribosomes, well developed Golgi apparatus and SER. They were found in the proliferative forms of IgA nephropathy. Phagocytic mesangial cells had numerous spinous cytoplasmic processes, better differentiated RER and numerous dense bodies and lipid inclusions. They were found in all histological forms of IgA nephropathy. The resting mesangial cells were unusual and were occasionally present in cases with normal numbers of mesangial cells.     

IgA nephropathy with subendothelial deposits

Summary IgA nephropathy with subendothelial deposits in the capillary walls of the glomeruli (IgA type 2) was compared histometrically and clinically with IgA nephropathy without subendothelial deposits (IgA type 1) and membranoproliferative glomerulonephritis with subendothelial deposits (MPGN). Study cases consisted of 32 biopsies from 26 patients of IgA type 1, 25 biopsies from 20 patients of IgA type 2 and 31 biopsies from 27 patients of MPGN. Histological changes of the glomeruli consisted of an increase in the mesangial matrix and hypercellularity in the mesangium in both types of IgA nephropathy, and the degree of the changes was a little higher in IgA type 2 than in IgA type 1 (0.02<P<0.05). Mesangial changes of MPGN were marked as compared with IgA type 1 and IgA type 2 (P< 0.001). Histometry of the mesangium on the cases followed up showed that the degree of mesangial thickening increased with lapse of time in IgA type 2 and MPGN, whereas it remained unchanged up to 13 years in IgA type 1. Proteinuria tended to be mild in IgA type 1, moderate in IgA type 2, and marked in MPGN. The impairment of renal function was observed in 21.9% of IgA type 1, in 36.0% of IgA type 2 and in 58.1% of MPGN. IgA type 2 has been shown to be pathologically and clinically intermediate between IgA type 1 and MPGN. These results suggest that there is a clinicopathological overlap between IgA nephropathy and MPGN with IgA deposition.     

Mucin secreting cancer with mesangial IgA deposits

Subclinical immune complex glomerular deposits occurred in 20% (11 of 55) of cancer cases examined postmortem. Eight of 11 (72.7%) mucin secreting adenocarcinomas of lung, stomach, large intestine and pancreas showed glomerular mesangial deposits of IgA, with associated IgM and C3 in one-half of them. The glomerular morphology showed predominantly minimal or minor changes, and less frequently mesangial cell proliferation. None of the patients exhibited clinical evidence of glomerulonephritis. The nature of the antigen(s) in the paraneoplastic phenomenon was not defined, but there may have been environmental antigen(s) or specific immune response in the local population to explain the IgA deposition.     

The role of mesangial complement in the hematuria of experimental IgA nephropathy

We sought to determine if codeposits of IgG and IgM and glomerular complement, observed in most cases of human IgA nephropathy, might be important for inducing hematuria. All combinations of three binary variables, the protein immunogen, the duration of oral immunization, and the protein used for intravenous challenge, were accommodated by eight groups of BALB/c mice in an active model of IgA nephropathy. Mice drank 0.1% solutions of either of two proteins for either 6 or 14 weeks, and then were challenged intravenously with either the same protein or the alternate protein. After 6 weeks, all mice had significant increases of serum IgA, IgG, and IgM antibody to the oral immunogen. At 14 weeks, IgG and IgM antibodies were reduced, presumably due to the onset of oral tolerance, but IgA titers persisted. Nearly all mice had mesangial deposits of IgA and oral immunogen. However, only mice immunized for 6 weeks and challenged with the same protein had significant IgG and IgM deposits (100%), C3 deposits (76%), and significant microhematuria. To distinguish between the role of IgG/IgM codeposits and C3 in the pathogenesis of the hematuria, we induced passive IgA nephropathy with immune complexes of monoclonal IgA anti-dinitrophenyl antibody, dinitrophenyl-bovine albumin as antigen, and one of two monoclonal IgG antibodies specific for dinitrophenyl; one of the IgGs fixes complement, the other does not. Despite comparable mesangial deposits of IgA, IgG, and antigen, only mice given immune complexes containing the complement-fixing IgG had glomerular C3 and hematuria. Furthermore, when mice depleted of serum complement via cobra venom factor were given immune complexes containing the complement-fixing IgG, no glomerular complement was observed and no hematuria ensued. We conclude that IgG/IgM codeposits in murine IgA nephropathy do not directly cause hematuria but do induce the deposition of complement, which is in turn required for glomerular injury.     

Glomerular electron-dense deposits in childhood IgA nephropathy

Summary An electron-microscopic study of the glomeruli was made on 154 children with IgA nephropathy and no evidence of systemic disease, in whom immunofluorescence microscopy had shown diffuse mesangial deposition of IgA. Mesangial deposits were observed in all but eight children. Subepithelial deposits were observed in 40 children and were almost always accompanied by both mesangial and subendothelial deposits. Subepithelial deposits were significantly associated with more severe clinical presentations, a worse outcome and more severe light microscopic glomerular changes. These observations support the concept that IgA nephropathy is an immune complex disease.     

Defective immunoglobulin A (IgA) glycosylation and IgA deposits in patients with IgA nephropathy

Defective glycosylation and immune complex (IC) formation may be of primary importance in immunoglobulin A nephropathy (IgAN) pathogenesis. The aim of this study was to determine whether defective IgA1 glycosylation might support renal deposition of IgA and disease activity. IgA was isolated from the serum of 44 IgAN patients and 46 controls and glycosylation analysed by ELISA using glycan‐specific lectins. IgA was measured by immunodiffusion and immune complexes by ELISA. IgA subclasses in IC deposits in kidney glomeruli were identified by immunohistochemical methods. A significant increase in N‐acetylgalactosamine (GalNAc) in terminal position (p = 0.02) observed in some of the IgAN patients, became more pronounced when sialic acid was removed from IgA1, indicating enhanced expression of α‐2,6‐sialyltransferase in patients compared with controls (p < 0.0001). Patients with defective galactosylation had lower serum IgA than other IgAN patients (p = 0.003). IgAN patients with both IgA1 and IgA2 glomerular deposits (21.7%) had increased GalNAc in terminal position (p = 0.003). Taken together, our results show that increased IgA glycosylation in IgAN associates with low levels of IgA, concomitant IgA1 and IgA2 glomerular deposits and poor clinical outcome.     

Occurrence of mesangial IgA and IgM deposits in a control necropsy population

Kidney sections were obtained from 200 consecutive control necropsies of patients who died of traumatic injuries, with no clinical history of renal disease or other organic disease discovered at necropsy. Mesangial IgA as the predominant immunoglobulin was found in 8/200 (4%) cases, with accompanying IgM in two of them; and IgM alone in two (1%) subjects. Deposits of C3 alone in blood vessels was observed in nine (4.5%) cases. The glomerular morphology was essentially normal or minor change only, with one case showing diffuse mesangial hypercellularity. The high incidence of mesangial IgA deposits in the local apparently healthy population may reflect some common feature of the antigen(s) or complex involved. They may be of environmental, dietary or infectious origin. It is possible that many of these "spontaneous" deposits in the glomerular mesangium may result from the clearance of circulating non-nephritogenic immune complexes.     

IgA肾病患者血清IgA1与正常人肾小球系膜细胞结合动力学研究

目的:观察IgA肾病(IgAN)患者血清聚合IgA₁(aIgA₁)与体外培养的正常人肾小球系膜细胞(HMC)结合动力学特征, 明确HMC上是否存在特异性IgA₁结合蛋白, 比较IgAN患者及正常人血清aIgA₁与HMC结合力的异同。方法:亲和层析提取血清IgA₁, 加热聚合并用[¹²⁵I]标记, 放射性配基结合法检测aIgA₁与HMC结合力, 用白蛋白、IgG及单体IgA₁(mIgA₁)作竞争抑制实验检测结合特异性, 用正常人及IgAN患者aIgA₁做交叉竞争抑制实验比较二者结合力。结果:正常人及IgAN患者aIgA₁与HMC的结合呈剂量依赖性和饱和性, 这种结合不被白蛋白、IgG阻断, 而被mIgA₁部分阻断, 二者解离常数Kd值分别为(4.3±1.2)×10^-7mol/L和(8.9±2.1)×10^-8ol/L, 差异显著(P<0.05), IgAN患者aIgA₁竞争结合HMC的能力显著高于正常人aIgA₁(P<0.01).结论:①HMC上存在特异性IgA₁结合蛋白。②IgAN患者血清IgA₁与HMC结合力高于正常人IgA₁。     

The juxtaglomerular apparatus in IgA nephropathy: An analysis of the transport and fate of IgA deposits at the glomerular hilus

Summary This study on 27 cases of IgA nephropathy has shown that IgA deposits are rare in the juxtaglomerular apparatus (JGA) despite large amounts of IgA deposits in the mesangium. Phagocytes are absent in JGA. A small number of ill-defined, IgA-positive substances are seen in the matrix of lacis cells, and their electron-density is decreased. These findings indicate dissolution of IgA deposits in the intercellular matrix. In addition, it is suggested that the transport of IgA deposits through the glomerular stalk toward JGA is prevented at the border area between the mesangium of glomerular hilus and the lacis cell region. The block is not complete, because small, IgA-positive substances are seen sparsely in the matrix of lacis cells. The structure of the lacis cell region is thought to restrict the passage of macromolecules such as IgA deposits. Frequently positive staining for C3 in the mesangium and lacis cell region and within the wall of afferent and efferent arterioles indicates that C3 is easily accessible to the arteriolar wall adjacent to JGA, by the route through the glomerular stalk and JGA. This may be concerned in the pathogenesis of arteriolar hyalinosis at the glomerular hilus.     

Significance of broad distribution of electron-dense deposits in patients with IgA nephropathy

Immunoglobulin A nephropathy (IgAN) is characterized by mesangial cell proliferation and mesangial expansion with mesangial depositions of IgA. We have found that electron-dense deposits (EDD) are often observed in areas other than paramesangial areas in glomeruli. To compare electron microscopic findings with light microscopic findings and clinical data, we examined the biopsies from 178 patients with IgAN. Patients were divided into two groups: group A had only paramesangial deposits and group B had deposits not only in paramesangial areas but also in other areas. All patients examined in this study had EDD in glomerular paramesangial areas. Thirty-six patients were included in group B. Cellular crescent formation in glomeruli and urinary protein in group B were significantly higher than those in group A (P < 0.01). Serum albumin and estimated glomerular filtration rate (eGFR) in group B were significantly lower than those in group A (P < 0.05). Group B showed a significant positive correlation with histological severity, which is defined in the Japanese Clinical Guidelines on IgAN. In patients with broad distribution of EDD, urinary protein was significantly increased (P < 0.05). Detailed observation of EDD distribution has an impact on evaluation of the disease activity of IgAN.     

Intensified IgA mesangial deposits after administration of sheep anti-type IV collagen serum in mice

Sheep anti-type IV collagen serum was intravenously administered to male mice of the BALB/c, C3H and ddY strains, and their kidneys were morphologically studied monthly for 10 months thereafter. By immunofluorescence, the sheep IgG was seen to have immediately become conjugated to the glomeruli, mainly in a mesangial pattern. Successively, autologous mouse C3 and IgG appeared with the same type of distribution. Within 3 to 4 months after the start of the experiment, mouse IgA also appeared in the mesangium, especially in ddY mice. The intensity and frequency of mesangial IgA deposition and the serum IgA level increased with time in this strain. BALB/c and C3H mice also showed the same tendency of mesangial IgA deposition, although to a lesser degree. In summary, it was concluded that mesangial IgA deposition was due to non-immunological local trapping, on the basis of the results obtained by ELISA analysis of the sera and renal eluate. Although the ddY mouse is known to show spontaneous mesangial IgA deposition associated with a high serum IgA level with aging, these characteristics were much accelerated and intensified by this antiserum treatment. The relation of this observation to the pathogenesis of human IgA nephritis is discussed.     

Cross-reactivity of IgA antibodies between renal mesangial areas and nuclei of tonsillar cells in patients with IgA nephropathy.

A study on autoradiographical analysis of antigenic sites in patients with IgA nephropathy is described. Renal biopsy specimens were obtained from patients with IgA nephropathy. These specimens were treated with citrate buffer (pH 3.2) and the 'eluate' was neutralized by sodium hydroxide. The 'eluate' was labelled with 125iodine by the chloramine-T method. 125I-labelled eluate was then applied to the tonsillar cells obtained from the same and other patients with IgA nephropathy as well as to those with other glomerular diseases. The tonsillar cells were dipped into the emulsion (NBT-2) and then examined with a light microscope. It was demonstrated that the antibodies eluted from renal tissues of patients with IgA nephropathy specificially bound with the nuclear regions of tonsillar cells. The binding of eluted antibodies and tonsillar cells was completely inhibited by the addition of anti-human IgA antisera, but not inhibited by human IgA myeloma proteins. The eluted antibodies bound with tonsillar cells from the same patients, but only 10% of them bound with the tonsillar cells obtained from other patients with IgA nephropathy. It is concluded that IgA antibodies deposited in glomeruli specifically bind with tonsillar cells obtained from patients with IgA nephropathy and these antibodies show some heterogeneity among those patients.     

Immunofluorescence characterization of light chains in human nephropathies

Summary Renal tissue from 185 patients with various nephropathies were studied by immunofluorescence, in order to look for the frequency and potential predominance of kappa or lambda light chain glomerular deposits. Four normal renal biopsies were used as controls. An overall study shows that light chains were present in glomeruli in 136 out of 185 cases; kappa light chain deposits were more frequent than lambda light chain deposits (73,5% and 64,3% respectively). An analytical study shows that this was not observed in all nephropathies studied. In mesangial IgA nephropathy, lambda light chain deposits were seen in 81% of cases (29 out of 37) and kappa light chain deposits were observed in 78% (30 out of 37 cases). In lupus nephritis, lambda light chain deposits were present in 13 out of 14 cases (92,8%) whereas kappa light chain deposits were demonstrated in 12 cases (85,7%). In other nephropathies such as membranous, endocapillary proliferative and amyloid nephritis, kappa was the predominant light chain observed in glomeruli or was present in the same number of cases as lambda light chain (mesangiocapillary glomerulonephritis). These findings show that in certain nephritides, for example IgA nephropathy and lupus nephritis, IgA and IgG deposits are mainly composed of lambda light chain in contrast with the normal kappa:lambda ratio in human serum of 2:1.     

Binding capacity and pathophysiological effects of IgA1 from patients with IgA nephropathy on human glomerular mesangial cells

IgA deposition in glomerular mesangium and the interaction with mesangial cells may well be the final common pathway to IgA nephropathy (IgAN). Altered hinge-region O-glycosylation of IgA1 from patients with IgAN may predispose to mesangial deposition and activation of the mesangial cell (MC) by IgA1, via a novel IgA1 receptor, and may be a key event in the pathogensis of IgAN. The aim of this study was to investigate the binding capacity and biological effects of IgA1, from both patients with IgAN and healthy controls, on human mesangial cells (HMC). Serum IgA1 was isolated with jacalin affinity chromatography, heated to aggregated form (aIgA1) and labelled with (125)I. Binding capacity of aIgA1 in vitro to cultured primary HMC was evaluated by a radioligand binding assay and the specificity of binding was determined by a competitive inhibition assay. Intracellular calcium release was studied by confocal analysis and phosphorylation of extracellular signal-regulated kinase (ERK) was determined by Western blot analysis. Change of cell cycles was demonstrated by flow cytometry and HMC proliferation was evaluated by direct cell count. Expression of TGF-beta mRNA and production of supernatant fibronectin were tested by RT-PCR and indirect competitive ELISA, respectively. aIgA1 from both the patients with IgAN and normal controls bound to HMC in a dose-dependent, saturable manner, and was saturated at approximately 500 pmoles per 0.5 ml of aIgA1. aIgA1 from patients with IgAN, however, bound to HMC at a higher speed and Scatchard analysis revealed a Kd of (8.89 +/- 2.1) x 10(-8)m versus (4.3 +/- 1.2) x 10(-7)m for aIgA1 from healthy controls (P = 0.026).The binding was specific because it was only inhibited by unlabelled Mono-IgA1 (mIgA1) and not by serum albumin or IgG. aIgA1 from patients with IgAN could induce release of intracellular calcium, phosphorylation of ERK, DNA synthesis, proliferation of HMC, expression of TGF-betamRNA and secretion of fibronectin in HMC in a similar time-dependent manner as aIgA1 from healthy controls, but the effects were much stronger and the durations were much longer (P < 0.05, respectively). We conclude that aIgA1 from patients with IgAN has a higher binding capacity to HMC and stronger biological effects than aIgA1 from healthy controls. This suggests that direct interaction between IgA1 and HMC and subsequential pathophysiological responses may play an important role in the pathogenesis for IgAN.     

Immunoelectron microscopic studies of immune complex deposits and basement membrane components in IgA nephropathy

The relationship between the immune complex deposits of mesangial IgA nephropathy and the basement membrane components, type IV collagen and fibronectin, has been investigated by an indirect immunogold technique in four cases of mesangial IgA disease. Using paraformaldehyde-fixed, Lowicryl K4M resin-embedded kidney, IgA, IgM and C3 were localized in the mesangial electron-dense deposits with 10 and 20 nm gold-labelled secondary antibodies. In the same glomeruli, type IV collagen and fibronectin were rarely present within the electron-dense deposits, although both were distributed throughout the remainder of the mesangial matrix with the exception of the subepithelial regions. These two components were also present within the glomerular basement membrane and localized mainly on the endothelial aspect. A similar distribution of the basement membrane components was seen in a control kidney processed in the same way. This technique gives reproducible results and has demonstrated for the first time the relationship between the mesangial immune complex deposits of mesangial IgA nephropathy and the basement membrane components of the matrix in which they are found.     

Immunogold quantitation of immunoglobulin light chains in renal amyloidosis and kappa light chain nephropathy.

By quantitative immunoelectron microscopy using protein A-gold, the authors compared the content and distribution of immunoglobulin light chain (LC) antigens in glomeruli from 11 cases of renal amyloidosis with that in two cases of kappa LC glomerulopathy and two cases of diabetic glomerulosclerosis. In a supplementary study and using a similar immunogold technique, the authors identified amyloid A in deparaffinized renal tissue from three of the 11 cases of renal amyloidosis. Each patient had similar clinical manifestations (chronic renal failure with proteinuria) and similar glomerular morphology (thickened glomerular basement membranes and nodular expansion of the mesangium). In 12 cases (10 amyloid, 2 kappa LC), immunoelectron microscopy localized LC antigens over the glomerular deposits and allowed indirect tissue quantitation of each LC antigen to the various cellular and interstitial compartments. In 6 of the 11 cases of renal amyloidosis, the amyloid labeled only for lambda, and in one, only for kappa. In one patient with Waldenström''s macroglobulinemia, who had a biclonal gammopathy, both LC were identified in the amyloid. In two cases, both of whom had a history of chronic suppurative lung disease, both LC antigens as well as amyloid A were localized to the amyloid fibrils. In only one case, in which glomerular amyloid labeled for amyloid A, the amyloid did not label for either LC. Whereas lambda LC-derived fibrils often appeared as spicules in the glomerular subepithelial space, other amyloid deposits usually accumulated in the subendothelial zone and did not form spicules. The epimembranous location of spicules suggested that the amyloid precursor protein transformed into amyloid fibrils after filtration into the urinary space. Presence of epimembranous spicules may explain the more severe proteinuric renal failure and the more rapid progression to glomerulosclerosis described in primary amyloidosis.