Clinical correlates of human leucocyte antigen (HLA)-G in systemic sclerosis.

Human leucocyte antigen (HLA)-G has a tolerogenic function and could play a role in the pathogenesis of immune-mediated diseases, including systemic sclerosis (SSc). The aim of this study was to evaluate HLA-G serum expression (sHLA-G) and the HLA-G gene 14 base pairs (bp) insertion/deletion (del(-)/del(+)) polymorphism in patients with Ssc, to search for possible associations with clinical and laboratory variables. sHLA-G was measured by enzyme-linked immunosorbent assay (ELISA) in sera from 77 patients with SSc and 32 healthy donors (HD); the 14 bp del(-)/del(+) polymorphism was evaluated by polymerase chain reaction (PCR) amplification of peripheral blood mononuclear cells (PBMC) genomic DNA. Receiver operating characteristics (ROC) analysis identified the HLA-G cut-off that best discriminated dichotomized clinical and serological variables, that was subsequently employed to subdivide SSc patients into HLA-G high (HLA-G(+)) and low (HLA-G(-)) profile groups. sHLA-G were not statistically different between SSc patients and HD, nor between distinct SSc autoantibody subsets. Subdividing SSc patients by HLA-G positivity or negativity yielded significant differences for the modified Rodnan skin score (mRss) (P = 0.032), 'general' (P = 0.031) and 'kidney' (P = 0.028) Medsger severity scores (MSS) and disease activity index, and especially Δ heart/lung (P = 0.005). A worse 'general' MSS (P = 0.002) and Δ heart/lung (P = 0.011) were more frequent in the low sHLA-G group. These two variables and mRss were associated with sHLA-G levels at logistic regression analysis. Treatment had no influence on sHLA-G. Moreover, a higher frequency of scleredema was detected in the del(+)/del(+) than the del(-)/del(+) group (P = 0.04). These data suggest modulatory effects of sHLA-G on SSc. Prospective studies are needed to investigate a role in predicting the disease course.

Effects of adjuvants for human use in systemic lupus erythematosus (SLE)-prone (New Zealand black/New Zealand white) F1 mice.

The safety of four different adjuvants was assessed in lupus-prone New Zealand black/New Zealand white (BW)F1 mice. Four groups of mice were injected intraperitoneally with incomplete Freund's adjuvant (IFA), complete Freund's adjuvant (CFA), squalene (SQU) or aluminium hydroxide (ALU). An additional group received plain phosphate-buffered saline (PBS) (UNT group). Mice were primed at week 9 and boosted every other week up to week 15. Proteinuria became detectable at weeks 17 (IFA group), 24 (CFA group), 28 (SQU and ALU groups) and 32 (UNT group). Different mean values were obtained among the groups from weeks 17 to 21 [week 17: one-way analysis of variance (anova) P = 0·016; weeks 18 and 19: P = 0·048; weeks 20 and 21: P = 0·013] being higher in the IFA group than the others [Tukey's honestly significant difference (HSD) post-test P < 0·05]. No differences in anti-DNA antibody levels were observed among groups. Anti-RNP/Sm antibody developed at week 19 in only one CFA-treated mouse. Mean mouse weight at week 18 was lower in the ALU group than the IFA (Tukey's HSD post-test P = 0·04), CFA (P = 0·01) and SQU (P < 0·0001) groups, while the mean weight in the SQU group was higher than in the IFA (P = 0·009), CFA (P = 0·013) and UNT (P = 0·005) groups. The ALU group weight decreased by almost half between weeks 29 and 31, indicating some toxic effect of ALU in the late post-immunization period. Thus, SQU was the least toxic adjuvant as it did not (i) accelerate proteinuria onset compared to IFA; (ii) induce toxicity compared to ALU or (iii) elicit anti-RNP/Sm autoantibody, as occurred in the CFA group.

Severe pulmonary hypertension as the initial manifestation of systemic lupus erythematosus: a case report and review of the literature.

Severe pulmonary arterial hypertension (PAH) is rarely observed as the initial manifestation of systemic lupus erythematosus (SLE), and the diagnosis is often delayed. Here we present the case of a 32-year-old woman with severe PAH as the initial manifestation of SLE, who was successfully treated with mycophenolate mofetil and cyclosporine. This case offered the opportunity to critically review the epidemiology data, predictive markers, and pathogenic pathways of SLE-associated PAH (SLE-PAH) in relation to the currently available therapeutic options and to the main clinical trials of the last 10 years focused on the treatment of SLE-PAH. Mycophenolate mofetil and cyclosporine - currently used in the maintenance phase of the disease in certain clinical settings - should be considered, as an alternative to cyclophosphamide, in future clinical trials aimed at evaluating the most effective treatment of SLE-PAH at presentation.

CD20-depleting therapy in autoimmune diseases: from basic research to the clinic.

The B lymphocyte-associated antigen CD20 is becoming an important immunotherapy target for autoimmune diseases, although its biological function has not been defined. Besides rheumatoid arthritis, growing experience with B cell-depleting therapy indicates that it may be effective in Sjögren's syndrome, dermatomyositis-polymyositis, systemic lupus erythematosus and some types of vasculitides. However, controlled clinical trials are still lacking for some of these indications. Infection has not been seen as a major limitation to this therapy, but reports of progressive multifocal leukoencephalopathy in an extremely small number of patients are of concern. Here, we review the therapeutic actions of anti-CD20 antibodies, and the recent and ongoing clinical trials with CD20-depleting therapy in autoimmune diseases.

Evaluation of the influence of social, demographic, environmental, work-related factors and/or lifestyle habits on Raynaud's phenomenon: a case-control study.

Raynaud's phenomenon (RP) is a clinical disorder characterized by recurrent, reversible episodes of digital vasospasm. RP can be classified as primary (pRP) or secondary, depending on whether it occurs as a benign condition (not disease-associated) or is associated with other diseases, mainly of the connective tissues. In both cases, it can be triggered by environmental factors, as indicated by the increased incidence of pRP episodes following exposure to cold, vibration injury or chemicals. The purpose of this prospective case-control study was to assess, in an Italian cohort of 132 pRP patients, the association of the phenomenon with demographic, lifestyle habits, environmental and work-related factors. Compared to healthy controls, pRP was found to be inversely associated with the use of contact lenses (OR = 0.4; p = 0.004) and of chlorous-based disinfectants (OR = 0.3; p < 0.001) and directly associated with the presence of prosthesis implants (OR = 5.3; p = 0.001) and the use of hydrogen peroxide-based compounds (OR = 2.6; p = 0.002), suggesting that the latter should be avoided in RP affected patients. Multivariate and multivariable analysis confirmed the associations. Further investigations are needed to understand the mechanism(s) underlying these findings.

Murine antiidiotypic monoclonal antibodies that bear the internal image of HLA-DR allospecificities.

Hybridization of murine myeloma cells P3-X63-Ag8.653 with splenocytes from a BALB/c mouse immunized with the syngeneic anti HLA-DR1,4,w6,w8,w9 MAb AC1.59 resulted in the development of 108 hybridomas secreting antiidiotypic antibodies. 100 of them inhibited the binding of MAb AC1.59 to target cells. Detailed analysis of the antiidiotypic MAb F5-444, F5-830, F5-963, F5-1126, F5-1336, and F5-1419 showed that all of them recognize idiotopes within or spatially close to the antigen combining site of MAb AC1.59. In cross-blocking experiments, the six antiidiotypic MAbs cross-blocked each other. It is likely that the six MAbs recognize spatially close, but not identical idiotopes because they elicited antiantiidiotypic antibodies of different or similar, but not identical specificity and differ in their ability to elicit anti-HLA class II antibodies. The latter, which were found only in sera from BALB/c mice immunized with antiidiotypic MAb F5-444 and F5-830, mimic the specificity of MAb AC1.59 and express the idiotope defined by the immunizing antiidiotypic MAb. These results indicate that the MAb F5-444 and F5-830 are antiidiotypes beta and the remaining four are antiidiotypes gamma.

New therapies in multiple myeloma.

The melphalan-prednisone regimen has been considered as standard therapy for patients with multiple myeloma (MM) for many years. Recently, high-dose chemotherapy with stem-cell support has extended progression-free survival and increased overall survival, and it is now considered conventional therapy in younger patients. However, most patients relapse and the salvage treatment is not very effective. New active drugs, including immunomodulatory agents, thalidomide (Thal) and lenalidomide, and the proteasome inhibitor bortezomib, have shown promising anti-myeloma activity. These novel treatments are aimed at overcoming resistance of tumour cells to conventional chemotherapy, acting both directly on myeloma cells and indirectly by blocking the interactions of myeloma cells with their local microenvironment and suppressing growth and survival signals induced by autocrine and paracrine loops in the bone marrow. Thal has been widely studied, mostly in combination regimens in patients with relapsed MM and, more recently, in front-line therapy, showing efficacy in terms of response rate and event-free survival. Bortezomib has been found to possess remarkable activity, especially in combination with other chemotherapeutic agents, in relapsed/refractory and newly diagnosed MM, as well as in patients presenting adverse prognostic factors. Lenalidomide, in combination with dexamethasone, is showing high overall response rates in relapsed and refractory MM and promising results also in first-line therapy. In this paper, the results of the most significant trials with Thal, bortezomib and lenalidomide are reported. Several ongoing clinical studies will hopefully allow the identification of the most active combinations capable of improving survival in patients with MM.

Syngeneic antiidiotypic antisera to murine antihuman high-molecular-weight melanoma-associated antigen monoclonal antibodies.

BALB/c mice were immunized with the murine antihuman high-molecular-weight melanoma-associated antigen monoclonal antibodies (MoAbs) 149.53, 225.28, 653.25, and 763.74. Antiidiotypic antibodies could be detected in bleedings obtained 3 days following the first booster, increased in titer in bleedings obtained following the second booster, and persisted at high level in bleedings obtained 38 days following the second booster. Cross-blocking studies with a panel of anti-melanoma-associated antigen, anti-HLA Class I, and anti-HLA Class II monoclonal antibodies showed that the antisera recognize private idiotypes. The latter are located within the antigen combining site, since antiidiotypic antisera specifically inhibited the binding of the corresponding immunizing anti-human high-molecular-weight melanoma-associated antigen monoclonal antibody to cultured human melanoma cells Colo 38 in a dose-dependent fashion. The spectrotype of the anti-MoAb 149.53 antiserum comprises eight major components in the range of pH 6.2 to 7.0; those of the anti-MoAb 225.28 antiserum and of the anti-MoAb 653.25 antiserum, two major components in the ranges of pH 6.4 to 6.6 and 6.5 to 6.7, respectively; and that of the anti-MoAb 763.74 antiserum, three major components in the range of pH 6.2 to 6.4.

Biological therapy with monoclonal antibodies: a novel treatment approach to autoimmune disease.

Most autoimmune diseases (ADs) are still associated with high morbidity and mortality despite the use of a wide range of drugs that can delay their progression, control their symptoms, but never bring about a complete cure. This failure has aroused interest in new forms of monoclonal antibody-based experimental immunotherapy (IT), aiming at targeting cellular antigens or cytokines involved in the pathogenesis of ADs. The first part of this review offers a general overview of the molecular mechanisms that mediate the immune response and the molecule regarded as potential IT targets. A critical evaluation will then be made of some forms of IT, with particular emphasis on TNF-alpha and CD20-blocking reagents. Lastly an account will be given of active IT whereby an endogenous response against antigens regarded as the target of passive IT can be induced by anti-idiotype or peptides.

Cloning and chromosomal localization of a cDNA encoding a mitochondrial porin from Drosophila melanogaster.

We have raised polyclonal antibodies against purified the Drosphila melanogaster mitochondrial porin. They showed high titre and specificity and were thus used as a tool for screening an expression library. The isolated clone 1T1 showed 74% sequence identity in the last 19 residues at the C-terminus of human porin. A subclone of 1T1, containing the porin-like sequence, was thus used as a probe for re-screening a cDNA library and several positive clones were plaque-purified. We present here the sequence of a 1363 bp cDNA encoding a protein of 279 amino acids. Its identity with porin was also confirmed by N-terminal Edman degradation of the purified protein. The D. melanogaster porin shows an overall 51.8% identity with human porin isoform 1 (porin 31HL or HVDAC1) and an overall 55.7% identity with human porin isoform 2 (HVDAC2). Hydrophobicity plots and secondary structure predictions showed a very high similarity with data obtained from known porin sequences. The D. melanogaster porin cDNA was used as a probe for in situ hybridization to polytenic salivar gland chromosomes. It hybridizes with different intensities in two sites, in chromosome 2L, at region 31E and in chromosome 3L at region 79D. Thus, also in Drosophila melanogaster porin polypeptide(s) belong(s) to a multigene family.

The Fab region of IgG2 human myeloma proteins does not bear the streptococcal protein G-specific determinant.

Seven out of ten Fab (F(ab')2/Fab') preparations derived from purified human myeloma IgG showed a substantial binding to protein G-Sepharose. Subclass analysis revealed that the 7 protein G-reactive Fabs included 3 IgG1, 2 IgG3 and 2 IgG4 Fabs, whereas the remaining 3 which were not adsorbed were IgG2 Fab. Incubation of protein G-Sepharose with non-saturating amounts of 4 Fab preparations, representative of all IgG subclasses, showed that gamma 1, gamma 3 and gamma 4 Fabs adsorbed from 26 to 28.3%, whereas 80% of gamma 2 Fab was left in the supernatant after adsorption. These results indicate that human IgG2 lack PG-specific Fab-associated reactive site(s).

Purification of human immunoglobulins by sequential precipitation with caprylic acid and ammonium sulphate.

We have tested the usefulness of sequential precipitation with caprylic acid and ammonium sulfate to purify human monoclonal and polyclonal immunoglobulins from sera of 11 patients with monoclonal gammapathy (4 IgG kappa, 2 IgG lambda, 2 IgM kappa, 1 IgA kappa, 2 IgA lambda), four patients with autoimmune diseases and four healthy donors. In terms of purity and activity of Ig as well as execution time and cost, this two-step non-chromatographic procedure is highly efficient for the purification of IgG, IgA and IgM, thus offering several advantages over other methods of purification. Therefore, this procedure may have useful application in the preparation of human Ig for structural studies and therapeutic purposes.

A sandwich assay to detect and characterize syngeneic anti-idiotypic antibodies to murine anti-HLA and tumor associated antigen monoclonal antibodies.

The parameters of a sandwich assay to analyze syngeneic polyclonal and monoclonal anti-idiotypic antibodies to murine anti-HLA and anti-human melanoma associated antigen monoclonal antibodies have been characterized. Furthermore, the sensitivity of the sandwich assay has been compared with that of assays widely used to characterize anti-idiotypic antibodies, i.e., the binding assay to F(ab')2 fragments of monoclonal antibodies and the radioimmunoassay. The latter is more sensitive than the sandwich assay when monoclonal anti-idiotypic antibodies are tested, but less sensitive when anti-idiotypic antisera are analyzed. Both assays are less sensitive than the binding assay to F(ab')2 fragments of monoclonal antibodies.

Fine specificity and idiotype diversity of the murine anti-HLA-A2, A28 monoclonal antibodies CR11-351 and KS1.

The monoclonal antibodies (MoAb) CR11-351 and KS1 are secreted by hybridomas generated with splenocytes from BALB/c mice immunized with the cultured human B lymphoid cells LG-2 (HLA-A2,A2,B27,B27). The 2 monoclonal antibodies immunoprecipitated components with a superimposable 2-dimensional gel electrophoretic profile from the cultured B lymphoid cells LG-2 and inhibited the cytotoxicity of the anti-HLA-A2,A28 T cell clone MI#3 to a similar extent. In crossinhibition experiments, the MoAb CR11-351 and KS1 completely inhibited the binding of each other to lymphoid cells with the appropriate HLA phenotype. Testing with a panel of HLA-typed lymphoid cells showed that the MoAb CR11-351 and KS1 display the same serologic specificity, since both of them react with HLA-A2 and/or A28 antigens bearing cells. The 2 monoclonal antibodies recognize distinct, although spatially close, determinants, since only the MoAb CR11-351 displays differential reactivity with HLA-A2 variant cell lines and reacts with HLA-A9 bearing B lymphoid cells. Analysis of MoAb CR11-351 and KS1 with syngeneic polyclonal and monoclonal antiidiotypic antibodies detected no sharing of idiotopes between the 2 monoclonal antibodies. In view of their reactivity with distinct determinants, these results are in agreement with the concept that the antigenic specificity of an antibody controls at least in part the expression of its idiotypes.

Syngeneic antiidiotypic monoclonal antibodies to the murine anti-HLA-DR,DP monoclonal antibody CR11-462.

Two out of 625 hybridomas constructed with splenocytes from a Balb/c mouse immunized with the murine anti-HLA-DR, DP monoclonal antibody CR11-462 secrete antiidiotypic antibodies. Binding assays with a panel of 12 anti-HLA class I, 14 anti-HLA class II, and 9 anti-human melanoma-associated antigen MoAbs showed that the idiotopes recognized by MoAb F3-C25 and F3-B6 are not expressed by any of the tested antibodies, even those which inhibit the binding of MoAb CR11-462 to cultured B lymphoid cells. Crossblocking experiments showed that the two idiotopes are distinct and spatially distant. Both idiotopes require the association of heavy and light chain of MoAb CR11-462 for their expression. The idiotope recognized by MoAb F3-B6 is an alpha idiotope, since it is located outside the antigen combining site of MoAb CR11-462. The idiotope recognized by MoAb F3-C25 is a gamma idiotope, since it is antigen inhibitable but does not possess an internal image of the antigen. Interestingly the MoAb F3-C25 displays a differential inhibitory effect on the binding of MoAb CR11-462 to lymphoid cells that express different HLA phenotypes or share the HLA-DRw6 allospecificity. These results suggest that antiidiotypic antibodies may sharpen our ability to dissect the heterogeneity of HLA class II antigens.

Serum levels of beta-2-microglobulin-free heavy chain of HLA class I antigen in healthy individuals: relationship to their class I allotype.

An ELISA-based double determinant immunoassay has been established to measure the soluble beta2-microglobulin (beta2m)-free heavy chain (FHC) of the HLA-B, -C (and HLA-A3, -A28 and -A30) class I molecular complex in sera from 212 HLA-typed healthy unrelated individuals. FHC was calculated by means of a standard curve constructed using serial concentrations of beta2m-associated HLA-class I heavy chain (HLA-I)/FHC purified from cultured human lymphoid cell C1R-sB7-supernatant. The mean FHC concentration (+/-SD) was 0.25 mg/l (+/-0.2). Its median concentration did not statistically differ between males and females, though the male/female ratio was greater in the high secretor (FHC >0.45 mg/l; mean + 1SD) than in the low secretor group (FHC < 0.05 mg/l; mean - 1SD). FHC < 0.05 mg/l was statistically (Fisher's exact test) associated with HLA-B17 (p = 0.003); FHC > 0.45 mg/l was statistically associated with HLA-B35 (p = 0.003) and -Cw4 (p = 0.002). None of these allele-positive groups showed a mean FHC concentration 1.5 times higher than that of the corresponding allele-negative ones. This allotype-dependent HLA-B and C FHC enhancement was less marked than that previously reported for HLA-I in individuals carrying HLA-A9 (and its splits). These results indicate that FHC could be a more valuable marker when its levels are compared among individuals carrying different allotypes. Moreover the lack of correlation between FHC and HLA-I levels measured in 52 HLA-A3, -A28 or -A30 positive individuals suggests that the two molecules may be regulated by different metabolic pathways and their serum expression may have a different biological significance.

Anti-CD4 monoclonal antibody (mAb) and anti-idiotypic mAb to anti-CD4 in the therapy of autoimmune diseases.

The present report critically reviews the rationale, experimental and clinical effectiveness and limits of anti-CD4 monoclonal antibody (mAb) therapy. References are also made to a novel approach involving active immunotherapy and an anti-idiotypic mAb bearing the internal image of human CD4 antigen. Preliminary observations concerning the effects of this treatment in one patient with rheumatoid arthritis and in one patient with systemic lupus erythematosus are reported.

Human CD4 internal antigen anti-idiotypic monoclonal antibody. immunochemical and sequence analysis.

The mouse mAb2 16D7 recognizes the paratope of the syngeneic anti-human CD4 mAb HP2/6 (mAb1 of our idiotypic cascade) and mimics CD4 in xenogeneic settings in humans. Immunochemical and sequence analyses were performed to define the minimum structural requirement for this mimicry. Binding assay of mAb1 with isolated naive 16D7 H and L chains showed that only the second reacted with mAb1. Specificity was indicated by the lack of reactivity of mAb1 with the L chain of mAb2 14D6, which also recognizes mAb1-paratope. It is likely that the 16D7-L mAb1-specific epitope is "sequence-dependent", since fully denatured 16D7-L still reacted with mAb1. Sequence analysis of 16D7 and mAb1 showed a high degree of homology of their VH. as both were coded by the same gene family (V/II), whereas CDR3 showed the greatest diversity. Alignment of 16D7-H CDR3 with CD4, however, produced no similarity. In contrast, analyses of the 16D7 VL sequence (XX/V) defined a CDR3 6-mer peptide with a 50% identity (83% of similarity) to the CD4 stretch 218-223. This peptide seems a suitable replacement for 16D7 in active immunotherapy as it did not match any protein fragment retrieved from the n-r database (NCBI) and both the peptide and the corresponding CD4 amino acid stretch are surface accessible. Based on their immunochemical profiles and similarity to CD4, four additional 16D7-derived peptides were designed for synthesis. The data indicate that CD4 mimicry by mAb2 can be obtained at the level of primary structure and provide useful information for the synthesis of peptide(s) with bioactive potential.

Purification of murine IgG monoclonal antibodies by precipitation with caprylic acid: comparison with other methods of purification.

Purification of murine IgG monoclonal antibodies from ascitic fluid by precipitation with caprylic acid was compared to that: 1) by sequential precipitation with caprylic acid and (NH4)2SO4; 2) by affinity chromatography on either antiidiotypic monoclonal antibodies or antimouse IgG xenoantibodies; and 3) by sequential (NH4)2SO4 precipitation, ion exchange chromatography and high pressure liquid chromatography (referred to as HPLC). In terms of yield of antibodies, precipitation with caprylic acid is comparable to sequential precipitation with caprylic acid and (NH4)2SO4, but superior to affinity chromatography on antibodies and to HPLC. In terms of purity of antibodies, precipitation with caprylic acid is less efficient than the other three methods. It should also be noted that precipitation with caprylic acid is associated with a reduction in the affinity of some antibodies and is not suitable to purify murine IgA and IgG3.

Monoclonal antibodies in the immunotherapy of autoimmune diseases.

The present report critically reviews the rationale, clinical effectiveness and limits of monoclonal antibody-based immunotherapy in the treatment of autoimmune diseases, with particular emphasis on tumor necrosis factor-alpha blocking reagents. Reference will also be made to active immunotherapy whereby an endogenous response induced by anti-idiotypic monoclonal antibodies or peptides toward molecules regarded as passive immunotherapy targets, is expected to mediate the therapeutic effects.