Clinical journal of the American Society of Nephrology: CJASN | |
Circulating Antibodies against Thrombospondin Type-I Domain-Containing 7A in Chinese Patients with Idiopathic Membranous Nephropathy | |
Jia Wang1  | |
[1] *Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University;§Euroimmun Academy, Euroimmun Medical Diagnostics (China) Co., Ltd., Beijing, China;¶Department of Nephrology and Dialysis, Pierre and Marie Curie University, Paris Cedex 06, France;‖Institute of Experimental Immunology, Euroimmun Academy, Euroimmun Medical Diagnostics Co., Ltd Lubeck, Germany | |
关键词: glomerular disease; Immunology and pathology; membranous nephropathy; Antibodies; Antibodies, Anti-Idiotypic; Autoimmunity; Biopsy; Fluorescent Antibody Technique; Follow-Up Studies; GN, Membranous; Humans; immunohistochemistry; Kidney Glomerulus; Neoplasms; Prevalence; proteinuria; Receptors, Phospholipase A2; Recurrence; Thrombospondins; United States; PLA2R1 protein, human; | |
DOI : 10.2215/CJN.01460217 | |
学科分类:泌尿医学 | |
来源: American Society of Nephrology | |
【 摘 要 】
Background and objectives Thrombospondin type-I domain–containing 7A (THSD7A) was recently identified as the target antigen in about 10% of patients with M-type phospholipase A2 receptor (PLA2R)–negative membranous nephropathy in European and North American populations. The prevalence of THSD7A in other populations and their clinical associations deserve further clarification.Design, setting, participants, & measurements Immunofluorescence assay was performed to investigate anti-THSD7A antibodies in 578 consecutive patients with biopsy-proven idiopathic membranous nephropathy, 114 patients with secondary membranous nephropathy, 64 disease controls, and 20 healthy controls. Glomerular expression of THSD7A antigen was examined by immunohistochemistry. Anti-PLA2R antibodies and glomerular PLA2R expression were also screened.Results Among the 578 patients with idiopathic membranous nephropathy, 12 (2%) patients were identified as THSD7A-positive: ten patients were THSD7A-positive alone, which accounted for 16% (ten of 64) of PLA2R-negative patients; two patients were dual-positive for both anti-THSD7A and anti-PLA2R antibodies and showed enhanced expression of both antigens colocalized in glomeruli. Among the 114 patients with secondary membranous nephropathy, one among 44 (2%) patients with cancer had anti-THSD7A antibodies, whereas 18 of 44 (41%) had anti-PLA2R antibodies. No anti-THSD7A antibody was detected in other disease controls or healthy individuals. Clinical features were comparable between the patients with and without THSD7A. During follow-up, two patients who achieved remission had a clearance of circulating antibodies against THSD7A, whereas antibodies increased in parallel with proteinuria in a patient with a relapse.Conclusions THSD7A-associated membranous nephropathy has a low prevalence in Chinese patients. The double-positive patients suggest dual autoimmune responses.
【 授权许可】
CC BY
【 预 览 】
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