Anti-Phospholipase A2 Receptor (PLA2R) Antibody and Glomerular PLA2R Expression in Japanese Patients with Membranous Nephropathy.
Anti-Phospholipase A2 Receptor (PLA2R) Antibody and Glomerular PLA2R Expression in Japanese Patients with Membranous Nephropathy.
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DOI：
10.1371/journal.pone.0158154
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Shibata T
中科院分区：
文献类型：
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作者：
Hihara K;Iyoda M;Tachibana S;Iseri K;Saito T;Yamamoto Y;Suzuki T;Wada Y;Matsumoto K;Shibata T
磷脂酶A2受体(PLA2R)是特发性膜性肾病(IMN)的主要靶抗原。近年来，已有多种类型的抗PLA2R抗体免疫分析系统问世。然而，在日本患者中，血清抗PLA2R抗体与肾小球PLA2R抗原表达的相关性及其与临床病理特征的相关性尚未得到证实。我们用ELISA法和细胞间接免疫荧光法(CIIFA)检测了59例MN患者血清中的抗PLA2R抗体，并用免疫荧光法(IF)检测了肾小球PLA2R的表达。在本研究中，抗PLA2R抗体在50%的IMN患者中存在，但在SMN患者中缺失。ELISA法与CIIFA法符合率为100%。抗PLA2R抗体阳性患者血清免疫球蛋白水平显著降低。血清白蛋白水平与血清抗PLA2R抗体效价呈负相关。在抗PLA2R抗体阳性患者中，IF对肾小球IgG4染色的发生率和强度明显高于抗PLA2R抗体阴性患者。IF法检测52.6%的IMN患者肾小球PLA2抗原表达阳性，而SMN患者肾小球PLA2抗原表达缺失。肾小球PLA2R抗原表达与抗PLA2R抗体的符合率为84.2%。用ELISA/CIIFA测定的抗PLA2R抗体的流行率与以前用Western blotting评估的日本研究结果相当。这些分析对IMN的诊断有很好的特异性，抗PLA2R阳性与某些临床病理特征，特别是肾小球以IgG4为主的沉积有关。
The phospholipase A2 receptor (PLA2R) is the major target antigen (Ag) in idiopathic membranous nephropathy (IMN). Recently, several types of immunoassay systems for anti-PLA2R antibody (Ab) have been developed. However, the correlation of serum anti-PLA2R Abs and glomerular expression of PLA2R Ag, and their association with clinicopathological characteristics have yet to be proven in Japanese patients. We examined serum anti-PLA2R Abs by both ELISA and cell-based indirect immunofluorescence assay (CIIFA), and glomerular PLA2R expression by immunofluorescence (IF) in 59 biopsy-proven MN patients including IMN (n = 38) and secondary MN (SMN) (n = 21). In this study, anti-PLA2R Abs were present in 50% of IMN patients, but was absent in SMN patients. The concordance rate between ELISA and CIIFA was 100%. Serum IgG levels were significantly lower in anti-PLA2R Ab-positive patients. Serum albumin levels correlated inversely with serum anti-PLA2R Ab titers. The prevalence and intensity of glomerular staining for IgG4 by IF were significantly higher in anti-PLA2R Ab-positive patients than in -negative patients. Glomerular PLA2 Ag expression evaluated by IF was positive in 52.6% of IMN patients, but was absent in SMN patients. The concordance rate between the prevalence of glomerular PLA2R Ag expression and anti-PLA2R Ab was 84.2%. The prevalence of anti-PLA2R Abs measured by ELISA/CIIFA was equivalent to previous Japanese studies evaluated using Western blotting. These analyses showed an excellent specificity for the diagnosis of IMN, and anti-PLA2R positivity was associated with some clinicopathological features, especially glomerular IgG4-dominant deposition.