Nephrology Dialysis Transplantation, Vol 12, Issue 11 2269-2276, Copyright © 1997 by Oxford University Press
R Coppo, P Cirina, A Amore, R Sinico, A Radice, C Rollino, f the Italian Group of Renal Immunopathology Collaborative Study on Henoch-Schonlein purpura in adults and i children
Background: The presence and the pathogenetic role of
circulating IgA reacting with neutrophil cytoplasmic antigens (IgA-ANCA) in
patients with Henoch-Schonlein purpura (HSP) is still debated. This study
was aimed to investigate some characteristics of serum IgA and
macromolecular IgA in HSP patients, focusing on IgA-ANCA.
Methods: Eighty-seven HSP patients with biopsy proved
renal involvement (51 adults and 36 children) enrolled in a multicentre
study of the Italian Group of Immunopathology were investigated.
Results: Significantly high levels of IgA immune
complexes were found in both adults (P <0.05) and children (P
<0.01), while the binding of IgA to jacalin, was significantly low
in children with HSP (P <0.01) only. Two series of ELISA were done
for IgA-ANCA, in two different laboratories. Increased binding to PMN crude
extracts (P <0.01) without any modification in IgA binding to
proteinase 3 was found by either specific ELISA. Conversely, the binding of
IgA to myeloperoxidase (MPO) was found to be significantly (P <0.05)
increased with positive values in 25% of patients by one assay only. Three
of four sera with positive IgA-MPO ANCA exhibited binding in Western-blot
studies with the MPO preparation used in ELISA to a 28-kDa species.
D-galactose and N-acetyl-glucosamine decreased the binding of serum IgA to
MPO more in HSP than in controls (P <0.05).
Conclusions: The conflicting reports on IgA-ANCA may
reflect some atypical characteristics of the reaction which can be detected
only by some ELISAs. We suggest that not an antigen-antibody reaction but a
lectinic interaction due to abnormal composition of IgA carbohydrate side
chains may account for the IgA-ANCA reaction in patients with HSP
nephritis. Key words: ANCA; IgA-ANCA; Henoch-Schonlein
purpura; IgA glycosylation; lectins
ORIGINAL ARTICLES
Properties of circulating IgA molecules in Henoch-Schonlein purpura nephritis with focus on neutrophil cytoplasmic antigen IgA binding (IgA-ANCA): new insight into a debated issue
Nephrology and Dialysis Department, Regina Margherita Children's Hospital, Piazza Polonia 94, I-10126 Torino, Italy; Nephrology and Dialysis Department, S Carlo Hospital, Milano, Italy; Nephrology and Dialysis Department, Giovanni Bosco Hospital, Torino, Italy; Corresponding author
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