Spontaneous Reversal of Acquired Autoimmune Dysfibrinogenemia Probably Due to an Antiidiotypic Antibody Directed to an Interspec

Total Page:16

File Type:pdf, Size:1020Kb

Spontaneous Reversal of Acquired Autoimmune Dysfibrinogenemia Probably Due to an Antiidiotypic Antibody Directed to an Interspec Spontaneous reversal of acquired autoimmune dysfibrinogenemia probably due to an antiidiotypic antibody directed to an interspecies cross-reactive idiotype expressed on antifibrinogen antibodies. A Ruiz-Arguelles J Clin Invest. 1988;82(3):958-963. https://doi.org/10.1172/JCI113704. Research Article A young man with a long history of abnormal bleeding was seen in January 1985. Coagulation tests showed dysfibrinogenemia and an antifibrinogen autoantibody was demonstrable in his serum. This antibody, when purified, was capable of inhibiting the polymerization of normal fibrin monomers, apparently through binding to the alpha fibrinogen chain. 6 mo later the patient was asymptomatic, coagulation tests were normal, and the antifibrinogen autoantibody was barely detectable. At this time, affinity-purified autologous and rabbit antifibrinogen antibodies were capable of absorbing an IgG kappa antibody from the patient's serum, which reacted indistinctly with both autologous and xenogeneic antifibrinogen antibodies in enzyme immunoassays. It has been concluded that the patient's dysfibrinogenemia was the result of an antifibrinogen autoantibody, and that later on an anti-idiotype antibody, which binds an interspecies cross- reactive idiotype expressed on anti-human fibrinogen antibodies, inhibited the production of the antifibrinogen autoantibody which led to the remission of the disorder. Find the latest version: https://jci.me/113704/pdf Spontaneous Reversal of Acquired Autoimmune Dysfibrinogenemia Probably Due to an Antildiotypic Antibody Directed to an Interspecies Cross-reactive Idiotype Expressed on Antifibrinogen Antibodies Alejandro Ruiz-Arguelles Department ofImmunology, Laboratorios Clinicos de Puebla, Puebla, Puebla 72530, Mexico Abstract disorder. This anti-Id antibody was shown to react with xeno- geneic antifibrinogen antibodies, hence, its specificity is an A young man with a long history of abnormal bleeding was interspecies cross-reactive Id (IdX)' most likely encoded by seen in January 1985. Coagulation tests showed dysfibrinogen- germline V-region genes. emia and an antifibrinogen autoantibody was demonstrable in his serum. This antibody, when purified, was capable of inhib- Methods iting the polymerization of normal fibrin monomers, appar- ently through binding to the a fibrinogen chain. 6 mo later the Case report. A 22-yr-old male patient with a long history of abnormal patient was asymptomatic, coagulation tests were normal, and bleeding was referred to Laboratorios Clinicos de Puebla in January the antifibrinogen autoantibody was barely detectable. At this 1985. For 10 yr he had presented a moderate to severe bleeding ten- time, affinity-purified autologous and rabbit antifibrinogen an- dency characterized by recurrent bleeding for several days from lacera- tibodies were capable of absorbing an IgG kappa antibody tions or dental procedures, soft tissue hematoma formation after mild from the patient's serum, which reacted indistinctly with both trauma, and one episode of intraarticular bleeding. He had no family autologous and antibodies in enzyme history ofbleeding disorders or autoimmune diseases. Although he was xenogeneic antifibrinogen seen by several physicians, a definite diagnosis of his hemostatic abnor- immunoassays. It has been concluded that the patient's dysfi- mality was never established. When first studied in our clinic he had brinogenemia was the result of an antifibrinogen autoantibody, abnormally prolonged thrombin and reptilase times (16, 17), while the and that later on an antiidiotype antibody, which binds an in- clottable fibrinogen was < 10% of the total fibrinogen mass as detected terspecies cross-reactive idiotype expressed on anti-human fi- by immunological and thermoprecipitation methods (18). Reptilase- brinogen antibodies, inhibited the production of the antifibrin- induced fibrin polymerization (17) was null. Complete hemostatic test ogen autoantibody which led to the remission of the disorder. results are summarized in Table I. The physical examination revealed retinal vasculitis, and cryoglobulins were demonstrated in his serum. The diagnosis of dysfibrinogenemia of possible autoimmune origin Introduction was established. Other laboratory tests for autoimmunity, such as The presence of auto anti-Id directed towards Ids lupus erythematosus clot, antinuclear antibodies, antiplatelet antibod- antibodies, ies, direct antiglobulin test, Ig levels, and rheumatoid factor, were all expressed on antibodies against exogenous (1-3) as well as normal or negative. A 10-d course oflow-dose methylprednisolone was endogenous (4-8) antigens, has been widely documented in given and withdrawn gradually in 2 wk. 6 mo later, he was absolutely humans. In fact, it is presumable that the expression of au- asymptomatic and all the laboratory tests had returned to normal. He toimmune humoral immune responses might be modulated, has been in complete remission for 30 mo. ita, est, augmented, or depressed, by anti-Id antibodies (6, Demonstration, isolation, and characterization of the autoantifi- 9-1 1). The production of autoantibodies directed to fibrino- brinogen antibody. Detection of antifibrinogen antibodies was per- gen as a cause of dysfibrinogenemia has been observed in the formed by means of an enzyme-linked immunosorbent assay (19). past (12-15). In some instances, these antibodies interfere with Briefly, purified human fibrinogen (lot S4F-9545, Sigma Chemical fibrinogen clotting by inhibiting the cleavage of fibrinopep- Co., St. Louis, MO) was adsorbed to microtiter dishes (Nunc, Ros- tides A and B while in other instances kilde, Denmark) by overnight incubation in carbonate buffer. Serum by thrombin, they samples and controls were placed in triplicate wells and incubated for 2 block the polymerization of fibrin monomers after thrombin h. After washing the wells repeatedly, an alkaline phosphatase-labeled cleavage. goat anti-human Ig antibody (lot 123F-8860; Sigma) was added and its This report refers to a case of autoimmune dysfibrinogen- binding was demonstrated by the addition ofp-nitrophenyl-phosphate. emia that was due to an antibody that inhibited fibrin poly- Antifibrinogen antibodies were purified by affinity chromatography on merization, in which a spontaneously produced anti-Id au- columns containing purified human fibrinogen coupled to cyanogen toantibody caused the inhibition of the antifibrinogen autoan- bromide (CNBr)-activated Sepharose 4B beads (20). The chain speci- tibody and led to the clinical remission of the hemorrhagic ficity of the antifibrinogen antibody was analyzed by immunoblotting (21); native purified fibrinogen, as well as samples that were either reduced by 2-mercaptoethanol (2ME) (22) or cleaved by CNBr (23) Address all correspondence to Dr. Alejandro Ruiz-Arguelles, Labora- were electrophoresed onto 7.5% polyacrylamide gels and transferred to torios Clinicos de Puebla, Diaz Ordaz 808, Puebla, Pue. 72530, nitrocellulose sheets. Duplicate strips, each of which contained the Mexico. three different fibrinogen preparations, were reacted with the patient's Received for publication 25 August 1987 and in revised form 18 antifibrinogen antibody, and its binding was developed by using a April 1988. biotinylated anti-human IgG antibody (lot 60407; Vector Laborato- J. Clin. Invest. © The American Society for Clinical Investigation, Inc. 1. Abbreviations used in this paper: CNBr, cyanogen bromide; EIA, 0021-9738/88/09/0958/06 $2.00 enzyme immunoassay; IdX, cross-reactive Id; 2ME, 2-mercaptoeth- Volume 82, September 1988, 958-963 anol. 958 A. Ruiz-Arguelles Table L Coagulation Studies in the Patient When Symptomatic described above. To further confirm preliminary results, normal fi- and during Clinical Remission brinogen was treated with thrombin in the presence of either patient's or control serum samples according to Kehl et al. (27). After heat Result precipitation of fibrin (ogen), the supernatant was analyzed by hydro- phobic interaction HPLC using a TSK phenyl 5 PW column (2133- Normal or 510; LKB, Bromma Sweden) along with a sodium sulfate gradient as Test Symptomatic Remission control descibed by Regnier and Fausnaugh (28). Additionally, total fibrino- peptide release was measured through quantitating the guanidino Fibrinogen (immunodiffusion) group of arginine according to Crum et al. (29). (mg/dl) 206 270 200-500 Demonstration and isolation ofanti-Id antibodies. The affinity-pu- Fibrinogen (clottable) (mg/dl) 18 240 200-400 rified anti-human fibrinogen antibody isolated from the patient's Thrombin time (s) serum was coupled to CnBr-activated Sepharose and packed into col- umns. Domestically raised rabbit anti-human fibrinogen antibodies 25 NIH U 278 79 82 were also affinity-purified and coupled to Sepharose beads for chroma- 50NIHU 68 33 36 tography. Serum samples from the patient when in clinical remission Reptilase time (s) >300 20 20 and from healthy controls were loaded into the aforementioned col- One-stage prothrombin time (s) 47 32 34 umns and allowed to react for 1 h at neutral pH. After complete elution Factor V activity Normal Normal Normal of the unbound material, the pH of the eluent was gradually lowered Factor VIII activity Normal Normal Normal until all bound antibodies were obtained (20). The Ig heavy and light Factor VIII related antigen (%) 96 102 65-130 chain classes present in this material were analyzed by immunofixa- Platelet aggregation (%) tion as previously described, and their antibody specificity was assessed Adenosine diphosphate by
Recommended publications
  • Guidelines for Writing Examination Items (Questions)
    Guidelines for Writing Examination Items (Questions) Enclosed are the content outlines for the Immunology certification examinations. The content outline specifies the breakdown of content and overall structure of the examination and indicates how many test questions are assigned to each topic area from a total of 70 questions. The content outline will guide you in creating new items to match certain topic areas. We would appreciate at least two (2) new items for each major roman numeral on the content outline(s). This means we are asking you to write two items for Roman numeral I, two items for Roman numeral II, and so on for each of the Roman numeral sections of the Content Outline. We would appreciate items submitted in advance, preferably no later than Tuesday, February 25, 2020. • Please use the “Item Writing Template” to create your new items. This is the proper format to be used for all items you submit. Font: Times New Roma. Font Size: 11 • Please identify the Content Outline position for each item (e.g., Chemistry Content Outline, Roman numeral I. “Proteins”, A. “Total Proteins” should be noted as “I.A.”). • New items must be multiple choice with four (4) possible answers. Remember to avoid "double negatives," "not" questions (e.g., "Which of the following is NOT true?"), and those allowing "all (or none) of the above," or "a and b" as a possible answer. • Each new item that you create must be accompanied with a reference [Author, Publication Year, Title, Edition, Page Number(s)] containing the correct answer. IMPORTANT: references must be from an AAB Review Manual, Governmental Regulations, Association or World Health Organization (WHO) Guidelines, or a text or manual published within the last six (6) years.
    [Show full text]
  • El Paso Community College Syllabus Part II Official Course Description
    MLAB 1235; Revised Fall 2019/Spring 2020 El Paso Community College Syllabus Part II Official Course Description SUBJECT AREA Medical Laboratory Technology COURSE RUBRIC AND NUMBER MLAB 1235 COURSE TITLE Immunology/Serology COURSE CREDIT HOURS 2 1 : 3 Credits Lec Lab I. Catalog Description Provides an introduction to the theory and application of basic immunology, including the immune response, principles of antigen-antibody reactions, and the principles of serological procedures as well as quality control, quality assurance, and lab safety. A grade of “C” or better is required in this course to take the next course. Corequisite: MLAB 1260. (1:3). Lab fee. II. Course Objectives A. Unit I. Laboratory Operations Upon satisfactory completion of this unit, the student will be able to: 1. Demonstrate adherence to Standard Precautions and the organizations’ SOP (Standard Operating Procedures) at all times. 2. Discuss legal and ethical concerns pertaining to Patient Informed Consent, Standard of Care, and HIPAA regulations. 3. Compliance with government, state, and organizational safety regulations involving Biological, Chemical, Radioactive, Fire, Physical, and Electrical hazards. 4. Explain the importance of actively participating in Quality Assurance, Quality Control and Proficiency Testing protocols incorporating precision, accuracy, Levi Jennings Charts and Westgard Rules. 5. Locate and make use of MSDS (Material Safety Data Sheets) 6. Discuss how OSHA affects safety, health, and compliance policies in the workplace. 7. Discuss nosocomial infections and identify the basic programs for infection control. 8. Identify the potential routes of infection and methods for preventing transmission of microorganisms through these routes. 9. Explain the proper techniques for hand washing, gowning, gloving, and masking.
    [Show full text]
  • A Challenging Case of Igd Kappa Multiple Myeloma Associated with Primary Amyloidosis: Importance of Serum Free Light Chains in M
    L al of euk rn em u i o a J Journal of Leukemia García de Veas Silva JL et al, J Leuk 2014, 2:5 ISSN: 2329-6917 DOI: 10.4172/2329-6917.1000164 Case Report Open Access A Challenging Case of IgD Kappa Multiple Myeloma Associated With Primary Amyloidosis: Importance of Serum Free Light Chains in Monitoring Treatment Response and Disease Relapse José Luis García de Veas Silva1*, Carmen Bermudo Guitarte1, Paloma Menéndez Valladares1, Rafael Duro Millán2 and Johanna Carolina Rojas Noboa2 1Department of Clinical Biochemistry, Hospital Universitario Virgen Macarena, Sevilla, Spain 2Department of Hematology, Hospital Universitario Virgen Macarena, Sevilla, Spain *Corresponding author: José Luis García de Veas Silva, Laboratory of Proteins, Department of Clinical Biochemistry, Hospital Universitario Virgen Macarena, Sevilla, Spain, Tel: +034955008108; E-mail: [email protected] Rec date: Oct 10, 2014, Acc date: Oct 16, 2014; Pub date: Oct 24, 2014 Copyright: © 2014 García de Veas Silva JL, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Multiple Myeloma (MM) is a malignancy of B cells characterized by an atypical proliferation of plasma cells. IgD MM has a very low incidence (2% of total MM cases) and it´s characterized by an aggressive course and a worse prognosis than other subtypes. The serum free light chains (sFLC) are very important markers for monitoring patients with MM and other monoclonal gammopathies. When the sFLC are present in low concentrations, it is often difficult to detect them by conventional methods such as serum protein electrophoresis and serum immunofixation.
    [Show full text]
  • Monitoring Multiple Myeloma Patients Treated with Daratumumab: Teasing out Monoclonal Antibody Interference
    Clin Chem Lab Med 2016; 54(6): 1095–1104 Open Access Christopher McCuddena, Amy E. Axela, Dominique Slaets, Thomas Dejoie, Pamela L. Clemens, Sandy Frans, Jaime Bald, Torben Plesner, Joannes F.M. Jacobs, Niels W.C.J. van de Donk, Philippe Moreau, Jordan M. Schecter, Tahamtan Ahmadi and A. Kate Sasser* Monitoring multiple myeloma patients treated with daratumumab: teasing out monoclonal antibody interference DOI 10.1515/cclm-2015-1031 developed using a mouse anti-daratumumab antibody. To Received October 21, 2015; accepted February 10, 2016; previously evaluate whether anti-daratumumab bound to and shifted published online March 30, 2016 the migration pattern of daratumumab, it was spiked into Abstract daratumumab-containing serum and resolved by IFE/SPE. The presence (DIRA positive) or absence (DIRA negative) Background: Monoclonal antibodies are promising anti- of residual M-protein in daratumumab-treated patient myeloma treatments. As immunoglobulins, monoclonal samples was evaluated using predetermined assessment antibodies have the potential to be identified by serum criteria. DIRA was evaluated for specificity, limit of sensi- protein electrophoresis (SPE) and immunofixation elec- tivity, and reproducibility. trophoresis (IFE). Therapeutic antibody interference with Results: In all of the tested samples, DIRA distinguished standard clinical SPE and IFE can confound the use of between daratumumab and residual M-protein in com- these tests for response assessment in clinical trials and mercial serum samples spiked with daratumumab and disease monitoring. in daratumumab-treated patient samples. The DIRA Methods: To discriminate between endogenous myeloma limit of sensitivity was 0.2 g/L daratumumab, using protein and daratumumab, a daratumumab-specific spiking experiments. Results from DIRA were repro- immunofixation electrophoresis reflex assay (DIRA) was ducible over multiple days, operators, and assays.
    [Show full text]
  • Immunoglobulin D-Lambda Multiple Myeloma, and a Review of the Literature Aissam EL MAATAOUI*, Salma FARES and Aadil TAOUFIK
    ISSN: 2378-3656 MAATAOUI et al. Clin Med Rev Case Rep 2021, 8:341 DOI: 10.23937/2378-3656/1410341 Volume 8 | Issue 3 Clinical Medical Reviews Open Access and Case Reports CASE REPORT Immunoglobulin D-Lambda Multiple Myeloma, and a Review of the Literature Aissam EL MAATAOUI*, Salma FARES and Aadil TAOUFIK Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco Check for updates *Corresponding author: Aissam EL MAATAOUI, Faculty of medicine and pharmacy, Ibn Zohr University, Agadir, Morocco MM. It is characterized by the high preponderance of Abstract lambda light chains over kappa light chains [3]. IgD multiple myeloma (MM) is a rare plasma cell neoplasm, considered to have a poor prognosis compared to the other Patients with IgD myeloma presented more often isotypes. Many studies reported an advanced stage at the with features of high-risk disease, that is, with advanced presentation. In contrast to these studies, we report a case ISS (International staging system), high LDH (lactate de- of rare IgD-Lambda MM at the early stage. The laboratory data showed no hypercalcemia, without any renal impair- hydrogenase), significant renal dysfunction, and large ment, or monoclonal spike (M-spike or paraprotein) at the amounts of Bence jones proteinuria [1,3]. Response to Serum protein electrophoresis (SEP) but only a hypogam- primary therapy was similar to other patients, although maglobulinemia. IF is performed with antisera to IgG, IgA, there was a trend for better quality of responses in pa- IgM, total kappa and total lambda(anti-γ, anti-α and an- ti-µ heavy chains, and anti-κ and anti-λ total light chains) tients with IgD myeloma [3].
    [Show full text]
  • IMMUNOCHEMICAL TECHNIQUES Antigens Antibodies
    Imunochemical Techniques IMMUNOCHEMICAL TECHNIQUES (by Lenka Fialová, translated by Jan Pláteník a Martin Vejražka) Antigens Antigens are macromolecules of natural or synthetic origin; chemically they consist of various polymers – proteins, polypeptides, polysaccharides or nucleoproteins. Antigens display two essential properties: first, they are able to evoke a specific immune response , either cellular or humoral type; and, second, they specifically interact with products of this immune response , i.e. antibodies or immunocompetent cells. A complete antigen – immunogen – consists of a macromolecule that bears antigenic determinants (epitopes) on its surface (Fig. 1). The antigenic determinant (epitope) is a certain group of atoms on the antigen surface that actually interacts with the binding site on the antibody or lymphocyte receptor for the antigen. Number of epitopes on the antigen surface determines its valency. Low-molecular-weight compound that cannot as such elicit production of antibodies, but is able to react specifically with the products of immune response, is called hapten (incomplete antigen) . antigen epitopes Fig. 1. Antigen and epitopes Antibodies Antibodies are produced by plasma cells that result from differentiation of B lymphocytes following stimulation with antigen. Antibodies are heterogeneous group of animal glycoproteins with electrophoretic mobility β - γ, and are also called immunoglobulins (Ig) . Every immunoglobulin molecule contains at least two light (L) and two heavy (H) chains connected with disulphidic bridges (Fig. 2). One antibody molecule contains only one type of light as well as heavy chain. There are two types of light chains - κ and λ - that determine type of immunoglobulin molecule; while heavy chains exist in 5 isotypes - γ, µ, α, δ, ε; and determine class of immunoglobulins - IgG, IgM, IgA, IgD and IgE .
    [Show full text]
  • Renal Manifestations of Common Variable Immunodeficiency Tiffany
    Kidney360 Publish Ahead of Print, published on April 21, 2020 as doi:10.34067/KID.0000432020 Renal Manifestations of Common Variable Immunodeficiency Tiffany N. Caza1, Samar I. Hassen1, Christopher Larsen1 1 Arkana Laboratories, Bryant, Arkansas Correspondence Dr. Tiffany N. Caza Arkana Laboratories 10810 Executive Center Drive Bryant, Arkansas 72022 United States [email protected] Copyright 2020 by American Society of Nephrology. ABSTRACT Background: Common variable immunodeficiency (CVID) is one of the most common primary immunodeficiency syndromes, affecting 1/25,000-50,000. Renal insufficiency occurs in approximately 2 percent of CVID patients. To date, there are no case series of renal biopsies from CVID patients, making it difficult to determine whether individual cases of renal disease in CVID represent sporadic events or are related to the underlying pathophysiology. We performed a retrospective analysis of renal biopsies in our database from patients with a clinical history of CVID (n=22 patients, 27 biopsies). Methods: Light, immunofluorescence, and electron microscopy were reviewed. IgG subclasses, PLA2R immunohistochemistry, and THSD7A, EXT1, and NELL1 immunofluorescence were performed on all membranous glomerulopathy cases. Results: Acute kidney injury and proteinuria were the leading indications for renal biopsy in CVID patients. Immune complex glomerulopathy was present in 12 of 22 (54.5%) cases including 9 with membranous glomerulopathy, one case with a C3 glomerulopathy, and one case with membranoproliferative glomerulonephritis with IgG3 kappa deposits. All membranous glomerulopathy cases were PLA2R, THSD7A, EXT1, and NELL1 negative. The second most common renal biopsy diagnosis was chronic tubulointerstitial nephritis, affecting 33% cases. All tubulointerstitial nephritis cases showed tubulitis and a lymphocytic infiltrate with >90% CD3+ T cells.
    [Show full text]
  • High Resolution Gel Electrophoresis Vs. Combined Light Chain Immunofixation (CLIF) for the Detection of Monoclonal Gammopathies
    High Resolution Gel Electrophoresis vs. Combined Light Chain Immunofixation (CLIF) for the detection of Monoclonal Gammopathies Joel Smith,1 Geoffrey Raines,1 Hans G Schneider1 1Clinical Biochemistry, Alfred Pathology Service, Melbourne, Australia. INTRODUCTION RESULTS (Continued) Monoclonal gammopathies are characterised by the production of a monoclonal HR SPEP was abnormal in 62 of 64 (97%) of patients with a known paraprotein, immunoglobulin or free light chains by an abnormal plasma cell or B-cell clone and whereas CLIF was abnormal in 57 of 64 (89%) cases. There was good inter- adjudicator agreement for both HR SPEP (κFleiss = 0.78) and CLIF (κFleiss = 0.82) may indicate malignancy or a precursor (MGUS). There is currently no consensus interpretations. HR SPEP was deemed abnormal in 76 cases (49%) and CLIF was on the initial test or combination of tests to be performed in suspected monoclonal deemed abnormal in 60 cases (38%). gammopathies. In our laboratory, serum protein electrophoresis (SPEP) and urine protein electrophoresis (UPEP) are commonly performed as initial investigations. If Sensitivity and specificity for the detection of paraprotein by HR SPEP was 97% abnormal, immunofixation electrophoresis (IFE) is then performed to confirm the and 85%, respectively. For CLIF, sensitivity and specificity was 89% and 97%, presence of paraprotein and to determine its heavy and light chain type. Recently respectively. (Table 2). some groups have developed simplified “screening” IFE methods for use in parallel to SPEP for the detection monoclonal gammopathies. Table 2: Detection of Paraprotein by both HR SPEP and CLIF in 156 patients (64 with known paraprotein) Jenner et al., found that the systematic implementation of a screening IFE known as combined κ and λ light chain immunofixation (CLIF) led to an increase in True False True False Sensitivity Specificity monoclonal bands missed by SPEP alone and improved turn-around times and Positives positives Negatives Negatives reduced the utilisation of laboratory consumables (1).
    [Show full text]
  • Titan Gel Immunofix-Plus Procedure
    TITAN GEL IMMUNOFIX-PLUS PROCEDURE Cat. No. 3067, 3068, 3069 Helena Laboratories TITAN GEL ImmunoFix-Plus is intended for the identification of materials completely dissolved. monoclonal gammopathies using protein electrophoresis and Storage and Stability: The packaged buffer should be stored at 15 to immunofixation. 30°C and is stable until the expiration date indicated on the package. Diluted buffer is stable two months stored at 15 to 30°C. SUMMARY Signs of Deterioration: Discard packaged buffer if the material shows Immunofixation electrophoresis (IFE) is a two stage procedure using signs of dampness or discoloration. Discard diluted buffer if it becomes agarose gel high resolution protein electrophoresis in the first stage and turbid. immunoprecipitation in the second. The specimen may be serum, urine or 3. Acid Blue Stain cerebrospinal fluid. There are numerous applications for IFE in research, Ingredients: The stain is comprised of acid blue stain. forensic medicine, genetic studies and clinical laboratory procedures. The WARNING: FOR IN-VITRO DIAGNOSTIC USE ONLY. DO NOT greatest demand for IFE is in the clinical laboratory where it is primarily INGEST. used for the detection and identification of monoclonal gammopathies. A Preparation for Use: Dissolve the dry stain in 1000 mL 5% acetic acid. monoclonal gammopathy is a primary disease state in which a single Storage and Stability: The dry stain should be stored at 15 to 30°C and clone of plasma cells produces elevated levels of an immunoglobulin of a is stable until the expiration date indicated on the package. The stain single class and type. Such immunoglobulins are referred to as solution is stable for six months when stored at 15 to 30°C in a closed monoclonal proteins, M-proteins, or paraproteins.
    [Show full text]
  • Antibodies As Diagnostic Targets and As Reagents for Diagnostics
    antibodies Editorial Antibodies as Diagnostic Targets and as Reagents for Diagnostics Nicole H. Trier and Gunnar Houen * Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens vej 13, 2600 Glostrup, Denmark; [email protected] * Correspondence: [email protected]; Tel.: +45-3863-3863 Received: 19 April 2020; Accepted: 22 April 2020; Published: 18 May 2020 Antibodies (Abs) were discovered around the turn of the 19th century and characterized in the following decades as an essential part of the human adaptive immune system [1,2]. Abs are produced in response to infections with pathogenic organisms and therefore have diagnostic potential. The levels of specific Abs reflect the burden of infection and the type of Abs produced may reflect the duration of infection and the site of infection, since Abs undergo class switching and affinity maturation in the course of infections [1,2]. Initially IgM is produced, but switching to IgG, IgA or IgE occurs during infections, depending on the type of pathogen and the site of infection. The use of Abs as targets of diagnostics can roughly be divided in five areas: 1. Infections The specificity, type and concentration of Abs have diagnostic value. The specificity giving information on the type of pathogen, the type and concentration giving information on the state of infection (IgM as an indication of early infection, IgG and IgA as indications of prolonged or chronic infections (IgA further indicating mucosal/epithelial infection)) [2]. 2. Autoimmune Diseases The specificity, type and concentration of auto-Abs have diagnostic value. The specificity and the type giving information on the tissue/organ involved (IgA indicating mucosal/epithelial affection, IgM being relevant in a few conditions), the concentration giving some information on the degree of affection [3].
    [Show full text]
  • Synergistic Activation of Src, ERK and STAT Pathways in Pbmcs for Staphylococcal Enterotoxin a Induced Production of Cytokines and Chemokines
    ORIGINAL ARTICLE Asian Pacific Journal of Allergy and Immunology Synergistic activation of Src, ERK and STAT pathways in PBMCs for Staphylococcal enterotoxin A induced production of cytokines and chemokines Xueting Liu,1 Yuhuan Wen,1 De Wang, 1 Zhongqiu Zhao,2,3 Joseph Jeffry,2 Liping Zeng,1 Zehong Zou,1 Huifang Chen,1 Ailin Tao1 Abstract Background: Staphylococcal enterotoxin A (SEA) is a well-known superantigen and stimulates human peripheral blood mononuclear cells (PBMCs) involving in the pathogenesis of inflammatory disorders and cancer. Objective: To better understand the biological activities of SEA and the possible intracellular mechanisms by which SEA plays its roles in conditions like staphylococcal inflammatory and/or autoimmune disorders and immunotherapy. Methods: Recombinant SEA (rSEA) was expressed in a prokaryotic expression system and its effects on the cytokine and chemokine production was examined by Enzyme-linked Immunospot (ELISpot) Assay and ELISA analysis. Results: In vitro experiments showed rSEA could significantly enhance secretion of a broad spectrum of cytokines and chemokines from PBMCs dose-dependently. Increased secretion of cytokines and chemokines from rSEA stimulated PB- MCs was barely affected by C-C motif chemokine receptor 2 (CCR2) antagonist INCB3344. However, Src, ERK and STAT pathway inhibitors were able to successfully block the enhanced secretion of most of cytokines and chemokines produced by rSEA stimulated PBMCs. Conclusions: Our work suggested that rSEA serves as a potent stimulant of PBMCs, and induces the release of cytokines and chemokines through Src, ERK and STAT pathways upon a relatively independent network. Our work also strongly sup- ported that Src, ERK and STAT signaling inhibitors could be effective therapeutic agents against diseases like toxic shock syndrome or infection by microbes resistant to antibiotics.
    [Show full text]
  • Belantamab Mafodotin Detection by Protein Electrophoresis: Assessing Interference for Defining Clinical Response
    Belantamab Mafodotin detection by protein electrophoresis: Assessing interference for defining clinical response Poster No. 407 Fiona McClure Comparative and Translational Sciences, IVIVT, UK Background ● The SAS-1 plus (Helena Detection of Belantamab Mafodotin in normal patients’ sera by IFE Channels 1, Conclusions Biosciences) is a microprocessor- 5 and 9 show 1.5 g/L and Channels 4, 8 and 12 show 0.5 g/L ● Multiple Myeloma (MM) is a life threatening, incurable cancer of the bone controlled instrument designed to ● Therapeutic monoclonal antibodies have the potential to be identified by SPE marrow resulting in plasma cell expansion and over-production of plasma automatically apply clinical samples and IFE, and as such can confound the International Myeloma Working Group proteins (‘M’ proteins). Belantamab Mafodotin (GSK2857916) is an antibody and controls on Helena Biosciences consensus criteria for response and minimal residual disease assessment in drug conjugate (ADC) consisting of an ADCC-enhanced humanised anti-B- agarose gel products and perform patients with multiple myeloma (Kumar S, et al. (2016): cell maturation antigen monoclonal antibody that is conjugated to the gel-electrophoresis, including serum – Criteria for partial response includes at least 50% reduction in serum microtubule inhibitor monomethylauristatin F (MMAF) for the treatment of protein electrophoresis (SPE) and M-component multiple myeloma. The antibody component is an afucosylated IgG1 directed immunofixation electrophoresis (IFE). against B-cell maturation antigen, a protein expressed on normal – Very good partial response of 90% or greater reduction in serum IFE is a two-stage process that uses high resolution agarose electrophoresis B lymphocytes and multiple myeloma cells.
    [Show full text]