Werwitzke Sonja, Trick David, Kamino Kenji, Matthias Torsten, Kniesch Katja, Schlegelberger Brigitte, Schmidt Reinhold E, Witte Torsten
Department of Clinical Immunology (6830), Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany.
Arthritis Rheum. 2005 Nov;52(11):3629-38. doi: 10.1002/art.21379.
In systemic lupus erythematosus (SLE), immune complexes (ICs) containing pathogenic IgG anti-double-stranded DNA (anti-dsDNA) autoantibodies are deposited in renal capillaries and initiate glomerulonephritis (GN) by the activation of complement and effector cells. In contrast, it has been demonstrated that the presence of IgM anti-dsDNA antibodies correlates negatively with the development of GN in SLE. The aim of this study was to determine whether anti-dsDNA antibodies of the IgM isotype protect against IC-mediated organ damage in SLE.
Lupus-prone (NZB x NZW)F(1) mice (females) were treated with murine monoclonal IgM anti-dsDNA antibodies. Treatment was delivered by subcutaneous injection at a dosage of 100 mug/week starting at 16 weeks of age (prophylactic) or at 24 weeks of age (therapeutic).
Mice treated with IgM anti-dsDNA exhibited a delayed onset of proteinuria and a reduced degree of renal pathology, which resulted in significantly improved survival as compared with control mice. Serum concentrations of IgG anti-dsDNA antibodies were not significantly modified. However, glomerular deposition of ICs was markedly reduced in both treatment protocol groups. In contrast, higher amounts of IgG and IgM and increased expression of Fcgamma receptor were demonstrated in liver sections from the treated mice compared with the untreated mice, suggesting an enhanced clearance of soluble ICs from phagocytic cells of the reticuloendothelial system.
These data demonstrate the efficacy of IgM anti-dsDNA treatment in inhibiting the pathologic changes of lupus in (NZB x NZW)F(1) mice. Lower glomerular IC deposition is associated with a reduced inflammatory response and impaired organ damage. The reduced frequency of GN in SLE patients who have IgM anti-dsDNA antibodies may therefore reflect a disease-modifying effect of this class of autoantibodies that has potential therapeutic implications. Our findings should encourage the development of new therapeutic modalities using IgM anti-dsDNA antibodies in humans with SLE.
在系统性红斑狼疮(SLE)中,含有致病性IgG抗双链DNA(抗dsDNA)自身抗体的免疫复合物(ICs)沉积于肾毛细血管,并通过补体和效应细胞的激活引发肾小球肾炎(GN)。相比之下,已有研究表明IgM抗dsDNA抗体的存在与SLE中GN的发生呈负相关。本研究的目的是确定IgM同种型的抗dsDNA抗体是否能预防SLE中IC介导的器官损伤。
将狼疮易感(NZB×NZW)F1小鼠(雌性)用鼠单克隆IgM抗dsDNA抗体进行治疗。治疗通过皮下注射给药,剂量为100μg/周,从16周龄(预防性)或24周龄(治疗性)开始。
用IgM抗dsDNA治疗的小鼠蛋白尿发作延迟,肾脏病理程度减轻,与对照小鼠相比,生存率显著提高。IgG抗dsDNA抗体的血清浓度没有明显改变。然而,在两个治疗方案组中,ICs的肾小球沉积均显著减少。相比之下,与未治疗的小鼠相比,治疗小鼠肝脏切片中显示出更高水平的IgG和IgM以及Fcγ受体表达增加,提示从网状内皮系统的吞噬细胞中可溶性ICs的清除增强。
这些数据证明了IgM抗dsDNA治疗在抑制(NZB×NZW)F1小鼠狼疮病理变化方面的有效性。较低的肾小球IC沉积与炎症反应减轻和器官损伤受损有关。因此SLE患者中具有IgM抗dsDNA抗体时GN频率降低可能反映了这类自身抗体的疾病修饰作用,具有潜在的治疗意义。我们的发现应鼓励在人类SLE中开发使用IgM抗dsDNA抗体的新治疗方法。