alpha-chymotrypsin and Anemia--Hemolytic--Autoimmune

Rh proteins and the Wr(b) antigen, which results from an interaction between Band 3 and glycophorin A, are the most common targets for warm immunoglobulin (Ig)G autoantibodies. Apart from autoanti-Di(b) , a scarce specificity, IgG warm autoantibodies specific for Band 3 have never been characterized by serologic methods.. Blood samples from 120 patients with autoimmune hemolytic anemia (AIHA) and IgG-coated red blood cells (RBCs) were studied by serologic methods. Some autoantibodies were investigated by immunochemical methods.. Autoantibodies against the third external loop of Band 3 have a distinctive pattern of reactivity in that they fail to react after RBC treatment with α-chymotrypsin and pronase, whereas papain, ficin, and trypsin have no effect. Eleven (9%) patients had pure anti-Band 3 autoantibodies. Autoanti-Band 3 antibodies were associated with other specificities in 66 (55%) patients. Immunoprecipitation and rare RBCs from a Wu+ homozygote, known to have an unusual pattern of reactivity after protease treatment, were used to confirm the Band 3 specificity. Treatment with sodium hypochlorite, believed to oxidize the Met residue at Position 559 in the third loop, showed that these autoantibodies were heterogeneous. Most antibodies reacted optimally at 37 °C, but two patients had incomplete cold IgG autoantibodies. Unlike autoantibodies to Rh proteins, warm autoanti-Band 3 activate complement and are almost totally bound to autologous RBCs.. We describe the first cases of warm IgG autoantibodies specific for the third loop of Band 3. This external loop also appears as a major target in patients with warm antibody AIHA.

Topics: Anemia, Hemolytic, Autoimmune; Autoantibodies; Chymotrypsin; Female; Ficain; Humans; Immunoglobulin G; Immunoprecipitation; Male; Pronase

Red blood cell (RBC) autoantibodies from patients with IgG warm-type autoimmune hemolytic anemia were labeled with iodine 125 and their RBC binding behavior characterized. Epitope-bearing RBC membrane polypeptides were identified after autoantibody immunoprecipitation of labeled membranes and immunoblotting. Immunoaffinity isolation of labeled membrane proteins with 12 different IgG hemolytic autoantibodies with protein A-agarose revealed a major polypeptide at Mr 95 to 110 kd, which coelectrophoresed on sodium dodecylsulfate-polyacrylamide gel electrophoresis with a membrane component isolated with sheep IgG anti-band 3. Immunoprecipitation studies with chymotrypsinized RBCs resulted in the recovery of two labeled membrane polypeptides with molecular weights characteristically resulting from the chymotryptic fragmentation of band 3. Immunoblotting with sheep IgG anti-band 3 of the immunoprecipitated polypeptides confirmed that hemolytic autoantibody binding led to recovery of band 3 or its fragments. Two 125I-labeled IgG hemolytic autoantibodies showed binding behavior consistent with epitope localization on band 3. The labeled RBC autoantibodies bound immunospecifically to all types of human RBC tested, including those of rare Rh type (Rh-null, D--) at a site density of approximately 10(6) per RBC. The 125I-IgG in two labeled autoantibodies was 84% and 92% adsorbable by human and higher nonhuman primate RBCs. Antigen-negative animal RBC bound less than 10% (dog, 2.6%; rhesus monkey, 7.4%), consistent with immunospecific RBC binding. IgG-1 was the major subclass in five autoantibodies tested; one of six fixed complement; and autoantibody IgG appeared polyclonal by isoelectric focusing. We conclude that IgG eluted from RBCs of patients with autoimmune hemolytic anemia consists predominantly of a single totally RBC-adsorbable antibody population that binds to antigenic determinants on band 3. Unlike RBC autoantibodies from antiglobulin-positive normal blood donors, autoantibodies from patients with autoimmune hemolytic anemia did not show Rh-dependent properties as judged by antigen site density, absence of differential binding to RBC of different Rh phenotypes, failure to immunoprecipitate 30 kd Rh-epitope bearing membrane polypeptides, absence of multiple antibody populations, and the lack of a significant nonadsorbable IgG population that has been associated with the presence of antiidiotypic IgG. The absence of antiidiotypic IgG in hemolytic autoantibo

Topics: Aged; Anemia, Hemolytic, Autoimmune; Anion Exchange Protein 1, Erythrocyte; Autoantibodies; Chymotrypsin; Epitopes; Erythrocytes; Female; Humans; Immunoblotting; Immunoglobulin G; Immunohistochemistry; Iodine Radioisotopes; Isoelectric Focusing; Male; Middle Aged; Phenotype; Precipitin Tests; Rh-Hr Blood-Group System

Topics: Anemia, Hemolytic, Autoimmune; Antigens; Autoantibodies; Blood Group Antigens; Bromelains; Child; Chromatography, DEAE-Cellulose; Chymotrypsin; Clostridium perfringens; Cold Temperature; Coombs Test; Hemagglutination Tests; Humans; Immunochemistry; Immunodiffusion; Immunoelectrophoresis; Immunoglobulin G; Infant; Mercaptoethanol; Neuraminic Acids; Neuraminidase; Papain; Peptide Hydrolases; Trypsin; Vibrio