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Increased IgG4 responses to multiple food and animal antigens indicate a
polyclonal expansion and differentiation of pre-existing B cells in IgG4-related
disease
#MMPMID25646372
Culver EL
; Vermeulen E
; Makuch M
; van Leeuwen A
; Sadler R
; Cargill T
; Klenerman P
; Aalberse RC
; van Ham SM
; Barnes E
; Rispens T
Ann Rheum Dis
2015[May]; 74
(5
): 944-7
PMID25646372
show ga
BACKGROUND: IgG4-related disease (IgG4-RD) is a systemic fibroinflammatory
condition, characterised by an elevated serum IgG4 concentration and abundant
IgG4-positive plasma cells in the involved organs. An important question is
whether the elevated IgG4 response is causal or a reflection of immune-regulatory
mechanisms of the disease. OBJECTIVES: To investigate if the IgG4 response in
IgG4-RD represents a generalised polyclonal amplification by examining the
response to common environmental antigens. METHODS: Serum from 24 patients with
IgG4-RD (14 treatment-naive, 10 treatment-experienced), 9 patients with primary
sclerosing cholangitis and an elevated serum IgG4 (PSC-high IgG4), and 18 healthy
controls were tested against egg white and yolk, milk, banana, cat, peanut, rice
and wheat antigens by radioimmunoassay. RESULTS: We demonstrated an elevated
polyclonal IgG4 response to multiple antigens in patients with IgG4-RD and in
PSC-high IgG4, compared with healthy controls. There was a strong correlation
between serum IgG4 and antigen-specific responses. Responses to antigens were
higher in treatment-naive compared with treatment-experienced patients with
IgG4-RD. Serum electrophoresis and immunofixation demonstrated polyclonality.
CONCLUSIONS: This is the first study to show enhanced levels of polyclonal IgG4
to multiple antigens in IgG4-RD. This supports that elevated IgG4 levels reflect
an aberrant immunological regulation of the overall IgG4 response, but does not
exclude that causality of disease could be antigen-driven.
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