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Distribution and specificity of nucleotide-reactive autoantibodies in human SLE.

An enzyme-linked immunosorbent assay (ELISA) was utilized to characterize nucleotide-reactive antibodies present in the sera of 67 human subjects: 27 active SLE, 20 inactive SLE, and 20 asymptomatic controls. This assay consisted of measuring the quantity of antibodies retained by a panel of immobilized 5'-nucleotide-BSA conjugates (AMP-, GMP-, CMP-, UMP-, and TMP-BSA) together with ssDNA and dsDNA antigens. Although the relative distribution of antibodies binding to nucleotide-BSA antigens (i.e., anti-GMP greater than anti-AMP greater than or equal to anti-TMP greater than anti-UMP greater than or equal to anti-CMP antibodies) was independent of clinical status, the sera of active SLE patients possessed three- and five-fold higher concentrations of these antibodies relative to those present in inactive SLE and control subjects, respectively. Affinity purification of the most dominant of these antibody populations with DNA- and GMP-agarose adsorbents suggested that the majority of anti-GMP antibodies were monospecific with respect to the guanine base moiety. For example, antibodies retained by GMP-agarose reacted with GMP-BSA and ssDNA but not with other nucleotide-BSA or dsDNA antigens. However, ELISA competition-inhibition studies with affinity-purified anti-GMP antibodies indicated that although the guanine base represents an important determinant, guanine-enriched oligo- and polynucleotides were preferred substrates (i.e., guanine-dependent, oligonucleotide specificity). This was exemplified by the finding that a 500- and 50-fold molar excess of dGMP and d(G)4 were required to achieve the same degree of inhibition as that observed with d(G)8. Finally, and as evaluated by indirect immunofluorescence with fixed HEp-2 cells, affinity-purified anti-GMP antibodies reacted with antigens restricted to nucleolar organelles.

Antibody Specificity↗

Decrease in HLA-DR-positive monocytes in patients with systemic lupus erythematosus (SLE).

Monocyte populations expressing HLA-DR antigens were studied in SLE patients by flow cytofluorometry with indirect immunofluorescence. Both the number of HLA-DR-positive monocytes and the expression of HLA-DR antigens on monocytes were markedly decreased in active SLE patients and were recovered to the normal level in inactive SLE patients. Because Ia-positive monocytes play a regulatory role for several immune responses, the decrease in HLA-DR-positive monocytes will result in abnormal regulations of immune responses and will play some critical role in the pathogenesis and the process of SLE.

Adult↗

Family studies of erythrocyte complement receptor type 1 levels: reduced levels in patients with SLE are acquired, not inherited.

It has been claimed that patients with systemic lupus erythematosus (SLE) have an inherited deficiency of erythrocyte complement receptor type 1 (CR1, with ligand binding specificity for C3b, iC3b and C4b). CR1 functions as the only cofactor for factor I-mediated cleavage of iC3b to C3c and C3dg. The activity of this receptor on red cells may be an important mechanism for handling immune complexes which have bound C3b or iC3b. Radioligand binding studies were performed using a monoclonal antibody to CR1, E11, to enumerate these receptors accurately. The results confirmed that patients with SLE have a reduced number of CR1 molecules per red cell, but showed no reduction in CR1 levels amongst their consanguineous relatives. Study of 13 normal families suggested the presence of heritable factors controlling the numbers of erythrocyte CR1 molecules; in particular there was a correlation between mean parental CR1 numbers and CR1 numbers in their children. However, amongst 17 families of 19 patients with SLE, four families were identified in which genotypically 'high CR1' SLE patients had persistently low phenotypes. This is not compatible with the hypothesis that the reduction in erythrocyte CR1 numbers in these patients is inherited.

Antibodies, Monoclonal↗

Effects of long-term treatment with procaine amide. A prospective study with special regard to ANF and SLE in fast and slow acetylators.

During 1970-75 a total of 42 patients have been subjected to long-term treatment with procaine amide (PrA) because of different cardiac arrhythmias and have been observed up to over 5 years. Among these patients 35 (83%) developed a significantly increased titer of ANF and of these, 12 patients (29%) developed a "classical" drug-induced SLE syndrome. In the SLE group all but 2 improved rapidly after cessation of PrA, and the ANF titer decreased continuously but slowly in both groups. Acetylation test with sulphamidine and/or isoniazid in 11 patients among the SLE cases showed 8 slow and 3 fast acetylators. Among 12 patients who also had received PrA for a long time, but had not shown any signs of an SLE syndrome, there were 10 fast and 2 slow acetylators.

Acetylation↗

Serum antibodies to human fetal antigens in patients with systemic lupus erythematosus (SLE).

Serum antibodies to human fetal antigens were measured by a radiolabeled anti-immunoglobulin binding assay by using human fetal fibroblasts (Flow cell line No. 1000) as target cells. High titers of IgG antibody to the fetal cells were found in sera of patients with systemic lupus erythematosus (SLE). The antibody reacted with surface membrane antigens shared by various fetal tissues of human and murine origin but not by adult tissues. The reaction of the SLE antibody to the fetal cells was inhibited by heterologous antiserum to the Flow 1000 cells and antiserum to murine embryonic fibroblasts, but not by antiserum to human alpha-fetoprotein or human fibronectin. Absorption of SLE serum with isolated nuclei did not abolish the reaction indicating that these were not anti-nuclear antibodies. The antibody activity was found to reside in the F(ab')2 fragment. The serum titer of the anti-fetal antibody was higher in SLE patients with active disease than those in clinical remission.

Animals↗

[The neuro-ophthalmological complications in SLE (author's transl)].

In a 44 years old woman, a flare up of polyarthritis becoming positive for sero-reaction at the time of hospitalization, is referred to an earlier unknown SLE. The bilateral optic neuritis which began 15 years earlier, while she was pregnant, simultaneously with a bilateral carpal tunnel syndrome is retrospectively related to the SLE. Such an optic neuritis is rare, its clinical features are specified among the neuro-ophthalmological complications in SLE. Very often optic neuritis is associated with myelopathy. Hypercytosis with moderate elevation of albumin C.S.F., a high level of cyclic GMP, and a low concentration of IgG in C.S.F., are found in central neurological complications in SLE. Other biological alterations are described but both their signification and their interest, as well for diagnostic as for therapeutic supervision, are unknown. Neuropathological findings show either vasculitis or demyelinizing lesions. This case shows the therapeutic problems of such medical situations.

Adolescent↗

Suppressor T cell dysfunction and depressed immunoglobulin production by B cells in vitro in patients with SLE.

Peripheral blood lymphocytes or T and B cells from systemic lupus erythematosus (SLE) patients and normal individuals were stimulated with pokeweed mitogen and the intracytoplasmic immunoglobulin positive cells were observed. From the results of coculture of normal and SLE cells, it was postulated that SLE patients had not only a loss of suppressor T cell activity but abnormal B cell function. Further experiments showed that these abnormalities in SLE lymphocytes remained in spite of corticosteroid treatment or inactive disease.

Antibody Formation↗

Isotypes of spontaneous and mitogen-induced autoantibodies in SLE-prone mice.

A common cellular abnormality of all murine strains prone to systemic lupus erythematosus (SLE) is an increased spontaneous polyclonal expansion of B cells. Our findings support the existence of this SLE-associated abnormality because the numbers of B lymphocytes secreting all the different IgG subclasses and IgM in spleens of all lupus-prone mice are elevated, compared to levels of normal splenic immunoglobulin-producing cells. We also report that 1) spontaneous polyclonal stimulation of immunoglobulin in autoimmune mice is preferential for subclass, and that the preferentially stimulated isotypes in each SLE strain consistently dominate both circulating and kidney-deposited immune complexes; 2) distinct patterns of isotype preference exist among the autoimmune strains determined by inherent B cell proliferative abnormalities or by B cell proliferation affected by thymus-derived lymphocytes; and 3) chronic administration of the TI B cell mitogen Lipid A in late-life SLE-prone mice induces an early-life glomerulonephritis with auto-antibodies of an isotype composition characteristic of those spontaneously produced by inherently abnormal B cells of early-life lupus mice.

Animals↗

Computer analysis of factors influencing the appearance of aseptic necrosis in patients with SLE.

A computer analysis of 234 patients with SLE followed for an average of 31 months revealed 22 patients with aseptic necrosis of bone (AN) (9%), with projected frequency approaching 30% at 10-15 years of follow-up. Most patients developed between four and seven years after diagnosis of SLE. When compared to all other patients with SLE and no AN or to three computer-selected groups matched by age of SLE diagnosis, duration of disease, or cumulative corticosteroid dose, AN did not correlate with any of the preliminary ARA criteria, total number of criteria fulfilled, renal disease, skin vasculitis, or disease activity. Although all patients received corticosteroid therapy prior to development of AN, no correlation was found with duration, peak dose, or cumulative dose of corticosteroid therapy.

Adult↗

Identification of components of IC purified from human sera. I. Immune complexes purified from sera of patients with SLE.

Immune complexes (IC) were purified by affinity chromatography on conglutinin columns from human sera (five SLE, one AML and one leishmaniasis) and compared with IC formed in vitro in the presence of normal serum (NHS). First, analysis by SDS-polyacrylamide gel electrophoresis (SDS-PAGE) demonstrated a common qualitative pattern, but with marked quantitative differences, in IC obtained from five patients' sera (four SLE, one leishmaniasis) and for in vitro formed IC. In two other patients (one SLE, one AML), the pattern of IC components was very different, with a major band in the 26 kD region. Secondly, after electrophoretic transfer of the SDS-PAGE bands to nitrocellulose membranes, the nature of IC components was studied by defining the reactivity of the bands with antisera against human serum antigens. Several serum proteins were identified in the purified IC:IgG, IgA, IgM, C1q, C1r, C1s, C3bi and Bb. A few bands did not correspond with any normal serum protein. One of them, at 26 kD was shown to react with anti-C reactive protein (CRP) antiserum. From all the constituents observed in the SDS-PAGE analysis of purified IC, only two bands in one SLE patient might be corresponding to unidentified antigens.

Antigen-Antibody Complex↗

Effect of pregnancy in patients with SLE.

The effect of pregnancy on the activity of SLE and that of SLE on the product of conception was analyzed from data reported in nine series of 20 or more pregnancies published between 1956 and 1981. Although pregnancy has an adverse effect on SLE activity, an established diagnosis of SLE does not preclude an outlook for a successful pregnancy even in patients with previous signs of severe multisystem involvement and lupus nephropathy. Complete clinical remission for 6 mo or more prior to conception indicates a favorable prognosis for an uncomplicated course during pregnancy and a live birth. Continued signs of disease activity or renal disease reduce, however, the likelihood for an uncomplicated course and decreases the live birth rate by 25% - 30%. Since there is no evidence that glycocorticoids or cytotoxic agents affect fetal development or induce congenital abnormalities treatment during pregnancy should be directed towards suppression of disease activity and controlling hypertension.

Antineoplastic Agents↗

[Drug-induced systemic lupus erythematosus (SLE)].

Oral administration of anticonvulsive drugs like hydantoin can induce a syndrome similar to systemic lupus erythematosus (SLE). This syndrome is characterized by development of typical symptoms or signs of SLE following the drug administration, occurrence of a significant elevation of ANA titer (above 1:40), and clinical remission after dropping the anticonvulsive treatment. A patient is reported and the typical clinical features and laboratory (mainly serological) findings of hydantoin-induced SLE are discussed. The potentially SLE-inducing drugs are reviewed.

Child↗

Restriction fragment length polymorphism (RFLP) analysis in the TNF genes of patients with systemic lupus erythematosus (SLE).

Although systemic lupus erythematosus (SLE) is known to be positively associated with certain major histocompatibility complex (MHC) class I and/or class II antigens, it is not clear whether the MHC genes are the predisposing genes of the disease rather than markers for other closely linked gene(s). Because of the involvement of tumor necrosis factor (TNF) in the inflammation process and localization of the TNF genes in the proximity of the HLA-B locus, we studied the restriction fragment length polymorphism (RFLP) of the TNF-alpha and -beta genes in 20 SLE patients and 23 normal individuals using restriction endonuclease NcoI. The frequency of a 5.5 kb NcoI fragment from SLE patients was significantly higher than that from normal controls. This result suggests that the polymorphic TNF genes may be involved in the pathogenesis of SLE.

Alleles↗

[Effects of combined administration of prednisolone and mizoribine in the course of remission for SLE children with nephritis].

Since oral steroid therapy was introduced for SLE, the long-term prognosis of the patients has been significantly improved. Adverse effects of the drug, however, are inevitable for these patients. The characteristic of the adverse effects especially for the child case is the suppression of linear growth. In order to prevent these undesirable effects and to improve their quality of life (QOL), we had introduced the methylprednisolone pulse therapy for SLE in children as both an initial and a relapse therapy. Although this therapy improved QOL of the patients significantly, there was little benefit for the growth disturbance. Then, we have introduced Mizoribine in addition to prednisolone (PSL) therapy for more than 18 months in three SLE children with lupus nephritis. In this trial, the combination therapy was effective for the decrease of urinary protein in one case, and for the reduction of a dosage of oral PSL in one case. In other case, MZR showed only partial immunosuppression. Thus, we concluded that there was a limitation with this combination therapy, however, it is one of the worthy therapy to be tried in SLE children with nephritis.

Adolescent↗

[ELISA for detection of SC5b-9 levels in plasma and its clinical significance in SLE disease].

Using IgG from rabbit antiserum to human MAC neoantigens and SC5b-9, we established a sandwich ELISA for detecting SC5b-9 levels in human plasma. SC5b-9 was measured in 51 normal plasma samples and 40 plasma samples from patients with SLE. We found that SC5b-9 levels in 96.1% of the controls and in 78.9% of the patients with inactive SLE were below 450 ng/ml, while SC5b-9 levels in 81.0% of the patients with active SLE were above 450 ng/ml. This shows that SC5b-9 levels may be useful for diagnosing patients with clinically active SLE.

Animals↗

Inhibition of platelet aggregation by an SLE-derived human hybridoma autoantibody against an activation-dependent antigen.

Anti-platelet autoantibodies may be responsible for hematological complications in patients with systemic lupus erythematosus (SLE), but the mechanisms by which these antibodies cause abnormal hemostasis remain unknown. In the present study, using fluorescence activated cell sorter (FACS) analysis, we demonstrate that an SLE-derived human hybridoma autoantibody, 9604, recognizes a surface antigen expressed on platelets activated by ADP, calcium ionophore A23187, or phorbol myristate acetate (PMA), showing saturation with approximately 2,000 antibody molecules bound per platelet and a Kd of 41 nM. The binding of 9604 to activated platelets was significantly inhibited by EDTA, indicating partial dependence on divalent cations. It did not appear to be dependent on platelet secretion, nor did it directly affect alpha-granule or dense granule secretion. The protein antigen responsible for the binding of 9604 to activated platelets was characterized by Western blot and immunoprecipitation and shown to have a native molecular weight (M. W.) of greater than 400,000, with a 32,000 M. W. subunit (p 32). Antibody 9604 had little or no effect on the shape change and the initial rate of primary aggregation of normal platelets. In contrast, 9604 inhibited secondary aggregation of stirred platelet suspensions (IC50 < or = 1 nM) following activation by ADP, thromboxane A2 mimetic U46619, or calcium ionophore A23187, but not PMA or thrombin. The inhibition of large platelet aggregate formation (secondary aggregation), with a major shift to smaller microaggregates and singlets, was confirmed by direct particle count and sizing studies. The functional inhibition of platelet aggregation by an SLE-derived human hybridoma autoantibody in vitro suggests one potential mechanism that may play a role in the hemostatic disorders found in SLE.

Adenosine Diphosphate↗

[Hemolytic anemias observed in SLE].

Hemolytic anemia observed in patients with SLE include autoimmune hemolytic anemia (AIHA) and thrombotic microangiopathic hemolytic anemia (TMHA). AIHA is caused by anti-erythrocyte antibody, which can be detected by direct Coombs' test. Recently, anti-phospholipid antibody draw attention as a cause of AIHA in SLE. TMHA include thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS). Patients with TTP show CNS symptoms and renal damage, while those with HUS develop renal insufficiency, but show minimal CNS symptoms. Clinical findings of TMHA are fever, hemolytic anemia, thrombocytopenia, CNS symptoms, and renal insufficiency, which are quite same as the findings of SLE itself. TMHA should be considered for differential diagnosis in acute exacerbation of SLE.

Anemia, Hemolytic↗

SLE nephropathy in a patient with HIV infection: case report and review of the literature.

We describe a 39-year-old bisexual man with clinical category B2 human immunodeficiency virus (HIV) infection who subsequently developed systemic lupus erythematosus (SLE). SLE was diagnosed on the basis of a clinical presentation of malar rash, polyarthritis, membranous glomerulonephritis, and characteristic serology. To our knowledge, this is the fourth reported case of a patient with HIV infection to develop SLE and the second adult patient with HIV and coexistent SLE nephropathy.

Adult↗