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2018 ; 9
(ä): 612
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Overactivity of Alternative Pathway Convertases in Patients With
Complement-Mediated Renal Diseases
#MMPMID29670616
Michels MAHM
; van de Kar NCAJ
; Okrój M
; Blom AM
; van Kraaij SAW
; Volokhina EB
; van den Heuvel LPWJ
Front Immunol
2018[]; 9
(ä): 612
PMID29670616
show ga
Overactivation of the alternative pathway of the complement system is associated
with the renal diseases atypical hemolytic uremic syndrome (aHUS) and C3
glomerulopathy (C3G). C3 nephritic factors (C3NeF) play an important role in C3G
pathogenesis by stabilizing the key enzymatic complex of complement, the C3
convertase. However, the reliability of assays detecting these autoantibodies is
limited. Therefore, in this study, we validated and optimized a prototype
hemolytic method for robust detection and characterization of factors causing
convertase overactivity in large patient cohorts. The assay assesses convertase
activity directly in the physiological milieu of serum and therefore is not
restricted to detection of stabilizing autoantibodies such as C3NeF but may also
reveal genetic variants resulting in prolonged convertase activity. We first
defined clear cutoff values based on convertase activity in healthy controls.
Next, we evaluated 27 C3G patient samples and found 16 positive for prolonged
convertase activity, indicating the presence of factors influencing convertase
stability. In three patients, the overactive convertase profile was persistent
over disease course while in another patient the increased stability normalized
in remission. In all these four patients, the convertase-stabilizing activity
resided in the purified immunoglobulin (Ig) fraction, demonstrating the
autoantibody nature. By contrast, the Igs of a familial aHUS patient carrying the
complement factor B mutation p.Lys323Glu did not reveal convertase stabilization.
However, in serum prolonged convertase activity was observed and segregated with
the mutation in both affected and unaffected family members. In conclusion, we
present a robust and reliable method for the detection, characterization, and
evaluation over time of factors prolonging convertase activity (C3NeF or certain
mutations) in patient cohorts. This assay may provide new insights in disease
pathogenesis and may contribute to the development of more personalized treatment
strategies.