Ability of monoclonal antibodies to the thyrotropin receptor to increase collagen synthesis in human fibroblasts: an assay which appears to measure exophthalmogenic immunoglobulins in Graves' sera.

Immunoglobulin G (IgG) preparations from 17 of 20 hyperthyroid patients with Graves' ophthalmopathy stimulated collagen biosynthesis in human fibroblasts, as measured by [3H]proline incorporation. This activity was not associated with thyroid-stimulating antibody (TSAb) activity in a thyroid cell cAMP assay in 50% of the IgG preparations, and it was not found in IgGs from 12 normal subjects, 7 of 8 patients with Graves' hyperthyroidism but no ophthalmopathy, 4 patients with Hashimoto's disease, 7 patients with nontoxic goiter, or 4 hypothyroid patients. In the same assay, 11E8, 22A6, and 13D11, 3 mouse monoclonal antibodies to the bovine TSH receptor, and 307H6, a human monoclonal antibody to the TSH receptor of the thyroid from a Graves' patient with ophthalmopathy, also stimulated [3H]proline incorporation into collagen and were active at more than 1,000- to 10,000-fold lower IgG concentrations (0.1-0.5 microgram/ml as opposed to greater than 1 mg/ml). 11E8 and 13D11 are TSH binding inhibitory antibodies (TBIAbs); 22A6 and 307H6 are TSAbs in cAMP assays. Two other mouse anti-TSH receptor monoclonal antibodies, both TBIAbs, as well as 8 human monoclonal antibodies to the TSH receptor from Graves' patients with or without ophthalmopathy (2 TBIAbs and 6 TSAbs) were negative or significantly less potent (greater than 50 fold) in the assay. The fibroblast activity of the monoclonal antibodies was lost if the antibodies were preincubated with thyroid membranes, was significantly decreased when fibroblasts were exposed to mild trypsin treatment before the assay, was not inhibited by human asialoagalacto-thyroglobulin, and required more than a TSH receptor determinant, since TSH alone neither duplicated nor inhibited the antibody activity. In summary, an assay for measuring the activity of autoantibodies active in causing ophthalmopathy is described, and some but not all TSH receptor monoclonal antibodies have been found to duplicate the action of the autoimmune IgGs from the ophthalmopathy patients.