Nahm Dong-Ho, Lee Kwang-Hoon, Shin Jee-Young, Ye Young-Min, Kang Yup, Park Hae-Sim
Department of Allergy and Rheumatology, Ajou University Hospital, Suwon 443-721, Korea.
J Allergy Clin Immunol. 2006 Aug;118(2):376-81. doi: 10.1016/j.jaci.2006.04.002. Epub 2006 Jun 9.
Approximately 5% to 10% of patients with asthma have severe disease that is not effectively controlled by typical therapies. The existence of an autoantigen associated with severe asthma has been previously reported.
We attempted to identify the autoantigen.
Severe asthma was defined as patients having at least 1 severe asthmatic exacerbation requiring an emergency department visit or admission in the last year despite continuous typical therapies. Autoantibodies to airway epithelial cells (A549) were examined in sera from patients with severe asthma by immunoblot analysis.
IgG autoantibodies to the 52-kd airway epithelial cell antigen were detected in sera from 32 of 78 patients with severe asthma (41%), 9 of 83 patients with mild-to-moderate asthma (11%), and 2 of 58 healthy controls (3%; P < .001). The 52-kd autoantigen was identified as alpha-enolase by mass spectrometry analysis and confirmed by using recombinant human alpha-enolase protein. The detection of IgG autoantibodies to alpha-enolase was the most significant indicator for distinguishing severe asthma from mild-to-moderate asthma, even after adjusting for the effects of other clinical variables, including age, sex, atopy, and FEV(1) (adjusted odds ratio, 5.2; 95% CI, 2.1-12.9; P < .001).
The alpha-enolase was identified as an autoantigen associated with severe asthma. Further studies are needed to determine the significance of this autoantigen in severe asthma.
IgG autoantibodies to alpha-enolase could be a biological marker for severe asthma.
约5%至10%的哮喘患者患有严重疾病，无法通过传统疗法有效控制。此前已有报道称存在与严重哮喘相关的自身抗原。
我们试图鉴定该自身抗原。
严重哮喘定义为尽管持续接受传统治疗，但在过去一年中至少有1次严重哮喘发作需要急诊就诊或住院治疗的患者。通过免疫印迹分析检测重度哮喘患者血清中针对气道上皮细胞（A549）的自身抗体。
78例重度哮喘患者中有32例（41%）血清中检测到针对52-kd气道上皮细胞抗原的IgG自身抗体，83例轻至中度哮喘患者中有9例（11%），58例健康对照中有2例（3%）（P <.001）。通过质谱分析将52-kd自身抗原鉴定为α-烯醇化酶，并使用重组人α-烯醇化酶蛋白进行了确认。即使在调整了包括年龄、性别、特应性和FEV(1)等其他临床变量的影响后，检测到针对α-烯醇化酶的IgG自身抗体仍是区分重度哮喘与轻至中度哮喘的最显著指标（调整后的优势比为5.2；95% CI为2.1-12.9；P <.001）。
α-烯醇化酶被鉴定为与严重哮喘相关的自身抗原。需要进一步研究以确定该自身抗原在严重哮喘中的意义。
针对α-烯醇化酶的IgG自身抗体可能是严重哮喘的生物学标志物。
