Detection of 'antiphospholipid' antibodies: a single chromogenic assay of thrombin generation sensitively detects lupus anticoagulants, anticardiolipin antibodies, plus antibodies binding beta(2)-glycoprotein I and prothrombin.

The diagnosis of the antiphospholipid syndrome (APS) requires both a typical clinical event plus a persistently positive test in an assay for either anticardiolipin (aCL) antibodies or a lupus anticoagulant (LA). Enzyme linked immunosorbent assays (ELISA) specific for autoantibodies against beta(2)-glycoprotein I (beta(2)GPI) or prothrombin are also used, but none of the tests are adequately sensitive or specific. A chromogenic assay was developed that measures the effect of test antibody or plasma samples on in vitro thrombin formation. It is able to detect both LA and beta(2)GPI-dependent aCL antibodies and may have greater specificity for APS than currently available tests. Using this method various monoclonal antibodies (MoAbs) were examined, from mice immunized with beta(2)GPI, mice with a spontaneous animal model of APS, and from three humans with APS. Plasma and affinity purified antibodies from patients with APS and control groups were also examined. Thrombin inhibition was more sensitive to perturbation by MoAbs than a combination of tests for LA (P < 0.05) and at lower antibody concentrations (12.5 microg/ml versus 100 microg/ml). There was a significant correlation between inhibition of thrombin generation and the level of MoAb reactivity to beta(2)GPI (r = 0.90; P < 0.001) but not to CL (r = 0.06; P = 0.76). Plasma and affinity purified antibodies from patients with APS also inhibited thrombin generation, and significantly more so than patients with aPL from causes other than APS. APS patient samples showed thrombin inhibition in the presence of anti-beta(2)GPI or antiprothrombin antibodies. All MoAbs binding beta(2)GPI showed inhibition of thrombin generation, while MoAbs binding domain I of beta(2)GPI had more LA effect.

Mast cells/basophils in the peripheral blood of allergic individuals who are HIV-1 susceptible due to their surface expression of CD4 and the chemokine receptors CCR3, CCR5, and CXCR4.

A population of metachromatic cells with mast cell (MC) and basophil features was identified recently in the peripheral blood of patients with several allergic disorders. This study now shows that these metachromatic cells express on their surface the high-affinity IgE receptor (FcepsilonRI), CD4, and the chemokine receptors CCR3, CCR5, and CXCR4, but not the T-cell surface protein CD3 and the monocyte/macrophage surface protein CD68. This population of MCs/basophils can be maintained ex vivo for at least 2 weeks, and a comparable population of cells can be generated in vitro from nongranulated hematopoietic CD3(-)/CD4(+)/CD117(-) progenitors. Both populations of MCs/basophils are susceptible to an M-tropic strain of human immunodeficiency virus 1 (HIV-1). Finally, many patients with acquired immunodeficiency syndrome have HIV-1-infected MCs/basophils in their peripheral blood. Although it is well known that HIV-1 can infect CD4(+) T cells and monocytes, this finding is the first example of a human MC or basophil shown to be susceptible to the retrovirus. (Blood. 2001;97:3484-3490)

Monoclonal antibodies from NZW x BXSB F1 mice to beta2 glycoprotein I and cardiolipin. Species specificity and charge-dependent binding.

NZW x BXSB F1 mice develop a systemic autoimmune syndrome with various lupus-like manifestations. Male animals develop a degenerative coronary disease with myocardial infarction, resulting in death before 6 mo of age. The presence in these mice of anti-phospholipid Abs reacting with beta2-glycoprotein I may contribute to the pathogenesis of the cardiovascular lesions. beta2-glycoprotein I, a plasma protein implicated in various aspects of the coagulation pathway, is also the target of autoantibodies in humans with the anti-phospholipid syndrome. We obtained several mAbs from NZW x BXSB F1 mice that were selected for binding to cardiolipin. Two mAbs are specific for beta2-glycoprotein I and display a species-dependent pattern with preferential reactivity to mouse beta2-glycoprotein I. The other mAbs display charge-mediated interactions with anionic phospholipids in the absence of beta2-glycoprotein I. The analysis of the V region sequences of the mAbs suggests that cationic residues in the H chain complementarity-determining region 3 are important for their phospholipid reactivity. The structural features of the V(H)-D-J(H) junctions of these mAbs further support the view that an increased frequency of unusual V(D)J rearrangements directly contributes to the development of murine autoimmunity.

Immunization of a rabbit with beta 2-glycoprotein I induces charge-dependent crossreactive antibodies that bind anionic phospholipids and have similar reactivity as autoimmune anti-phospholipid antibodies.

A rabbit immunized with beta 2-glycoprotein I (beta 2-GPI) produced Abs that bind to negatively charged phospholipids and to beta 2-GPI. After affinity purification of the Abs to beta 2-GPI, the dual reactivity could still be detected. Adsorption studies with a phosphatidylserine affinity column depleted phospholipid-reactive Abs, but beta 2-GPI reactivity was retained. The same pattern of reactivity was found with culture supernatants from rabbit anti-beta 2-GPI splenocytes fused with an immortalized rabbit cell line. The reactivity to negatively charged phospholipids is likely to involve ionic interactions, as high ionic strength buffers eliminated binding to anionic phospholipids, but not to beta 2-GPI. Affinity-purified anti-phospholipid (aPL) Abs from four of seven autoimmune patients bound anionic phospholipids in the absence of beta 2-GPI. However, in high ionic strength buffer, this binding was abolished in three patients and significantly reduced in the fourth. In contrast, affinity-purified aPL Abs from seven autoimmune patients bound to beta 2-GPI-coated plates, and binding in high ionic strength buffer was reduced only moderately in three patients. Therefore, autoimmune-type aPL Abs display anti-beta 2-GPI reactivity and charge-dependent binding to anionic phospholipids similar to affinity-purified rabbit anti-beta 2-GPI Abs.

Expression of human recombinant beta 2-glycoprotein I with anticardiolipin antibody cofactor activity.

To enable the synthesis of beta 2-glycoprotein I mutants we have established a stable Chinese hamster ovary cell line that expresses human beta 2-glycoprotein I up to 2.9 micrograms/10(6) cells/day. Recombinant beta 2-glycoprotein I is identical to the purified native protein with respect to cofactor activity revealed in a modified anti-cardiolipin ELISA. Autoimmune type anti-cardiolipin antibody requires recombinant beta 2-glycoprotein I in a dose-dependent manner to bind cardiolipin whilst binding of infectious type antibody is inhibited. The purified recombinant beta 2-glycoprotein I in serum free medium exists as two oligosaccharide species which upon deglycosylation have identical apparent molecular weight to the deglycosylated native protein.

The distribution of intracellular acetylcholine receptors and nuclei in avian slow muscle fibres during establishment of distributed synapses.

The distribution of intracellular acetylcholine receptor was studied by 125I-alpha-bungarotoxin autoradiography as a measure of the local acetylcholine receptor synthesis at junctional and extrajunctional sites in single fibres of the developing anterior latissimus dorsi muscle of the chicken. Large (longer than 2 microns) acetylcholine receptor clusters characteristic of synaptic contacts were localized by immunofluorescence with anti-acetylcholine receptor antibodies. The distance between acetylcholine receptor clusters at embryonic day 11 was 166 +/- 10.5 microns and this distance did not increase despite growth until after 4 days posthatch. The distance between acetylcholine receptor clusters subsequently increased proportionately with the increase in the length of fibres. Intracellular acetylcholine receptors were labelled with 125I-alpha-BGT after first blocking cell-surface acetylcholine receptor with unlabelled alpha-BGT, and treatment with saponin. Intracellular acetylcholine receptor represented about 5-15% of total cellular acetylcholine receptor. Cycloheximide experiments indicated that 80-90% of intracellular acetylcholine receptor examined represented newly synthesized acetylcholine receptor. The spatial distribution of this pool, studied by autoradiography, was determined in relation to the acetylcholine receptor clusters labelled with anti-acetylcholine receptor antibody. Between embryonic day 11 and posthatch day 14 there was a continual increase in intracellular acetylcholine receptor at both junctional and extrajunctional parts of the fibres, but with the greater increases occurring at the junctional regions. Peaks of intracellular acetylcholine receptor became associated with an increasing number of acetylcholine receptor clusters so that by posthatch day 14 there was an 80% correspondence. The accumulation of newly synthesized intracellular acetylcholine receptor under acetylcholine receptor clusters was not the result of the aggregation of nuclei at these sites, suggesting that a higher rate of acetylcholine receptor synthesis per nucleus develops at distributed synaptic sites on anterior latissimus dorsi fibres.