Labarrere C A, Pitts D, Halbrook H, Faulk W P
Center for Reproduction and Transplantation Immunology, Methodist Hospital of Indiana, Indianapolis 46202.
J Heart Lung Transplant. 1993 May-Jun;12(3):394-402.
We have studied 56 human hearts before and after transplantation for the presence of immunoglobulin M. None of the 56 time-zero biopsy specimens studied contained immunocytochemically detectable immunoglobulin M, but they all had immunoglobulin M deposits on vascular endothelial cells after transplantation. The vascular location of immunoglobulin M was confirmed in double-antibody experiments with antibodies to von Willebrand factor and immunoglobulin M. None of the immunoglobulin M antibody reactivity was shown to colocalize with complement. Biopsy specimens from 29 of the 56 patients contained abundant deposits of immunoglobulin M. These patients were clinically stable, and only one of them has died. Biopsy specimens from 27 of the 56 patients had scant deposits of immunoglobulin M. These patients were clinically unstable; eight of them have died, and one has undergone retransplantation. In addition, biopsy specimens from stable allografts contained fewer fibrin deposits than biopsy specimens from unstable grafts, suggesting a protective role for non-complement fixing immunoglobulin M. The observation that immunoglobulin deposits were found soon after transplantation prompts us to consider them to be natural antibodies. Efforts to identify the antigen for immunoglobulin M natural antibodies in heart transplant recipients are currently under study.
我们研究了56例心脏移植前后的人体心脏，以检测免疫球蛋白M的存在情况。在研究的56份零时活检标本中，均未通过免疫细胞化学检测到免疫球蛋白M，但移植后所有标本的血管内皮细胞上均有免疫球蛋白M沉积。在使用抗血管性血友病因子抗体和免疫球蛋白M的双抗体实验中，证实了免疫球蛋白M的血管定位。未发现免疫球蛋白M抗体反应性与补体共定位。56例患者中的29例活检标本含有丰富的免疫球蛋白M沉积。这些患者临床稳定，其中仅1例死亡。56例患者中的27例活检标本中免疫球蛋白M沉积较少。这些患者临床不稳定；其中8例死亡，1例接受了再次移植。此外，稳定同种异体移植物的活检标本中纤维蛋白沉积少于不稳定移植物的活检标本，提示非补体结合免疫球蛋白M具有保护作用。移植后不久就发现免疫球蛋白沉积这一观察结果促使我们认为它们是天然抗体。目前正在研究确定心脏移植受者中免疫球蛋白M天然抗体的抗原。
