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Anti-phospholipase A2 receptor antibody in membranous nephropathy
Weisong Qin1, Laurence H Beck, Caihong Zeng
1Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China.
Abstract:
The M-type phospholipase A2 receptor (PLA2R) is a target autoantigen in adult idiopathic membranous nephropathy (MN), but the prevalence of autoantibodies against PLA2R is unknown among Chinese patients with MN. Here, we measured anti-PLA2R antibody in the serum of 60 patients with idiopathic MN, 20 with lupus-associated MN, 16 with hepatitis B (HBV)-associated MN, and 10 with tumor-associated MN. Among patients with idiopathic MN, 49 (82%) had detectable anti-PLA2R autoantibodies using a Western blot assay; an assay with greater sensitivity detected very low titers of anti-PLA2R in 10 of the remaining 11 patients. Using the standard assay, we detected anti-PLA2R antibody in only 1 patient with lupus, 1 with HBV, and 3 with cancer, producing an overall specificity of 89% in this cohort limited to patients with secondary MN. The enhanced assay detected low titers of anti-PLA2R in only 2 additional samples of HBV-associated MN. In summary, these results suggest that PLA2R is a major target antigen in Chinese idiopathic MN and that detection of anti-PLA2R is a sensitive test for idiopathic MN.
Insights
Phospholipase A2 receptor (PLA2R) autoantibodies are prevalent in Chinese patients with idiopathic membranous nephropathy (MN). Detecting these anti-PLA2R antibodies is a sensitive diagnostic marker for idiopathic MN in this population.
Area of Science:
- Nephrology
- Immunology
- Autoimmunity
Background:
- Idiopathic membranous nephropathy (MN) is a leading cause of nephrotic syndrome in adults.
- The M-type phospholipase A2 receptor (PLA2R) is a key autoantigen in MN.
- Prevalence of anti-PLA2R antibodies in Chinese MN patients was previously unknown.
Purpose of the Study:
- To determine the prevalence of anti-PLA2R autoantibodies in Chinese patients with various forms of MN.
- To assess the diagnostic utility of anti-PLA2R antibody detection for idiopathic MN.
Main Methods:
- Serum samples from 60 idiopathic MN, 20 lupus-associated MN, 16 HBV-associated MN, and 10 tumor-associated MN patients were analyzed.
- Western blot assay was used for anti-PLA2R antibody detection.
- A highly sensitive assay was employed to detect low-titer antibodies.
Main Results:
- 82% of idiopathic MN patients had detectable anti-PLA2R antibodies by standard assay.
- An enhanced sensitivity assay identified anti-PLA2R antibodies in 91% of idiopathic MN patients.
- Low specificity was observed for secondary MN (lupus, HBV, cancer-associated).
Conclusions:
- PLA2R is a major target antigen in Chinese patients with idiopathic MN.
- Anti-PLA2R antibody detection is a sensitive diagnostic marker for idiopathic MN.
- Further research may explore the role of PLA2R in secondary MN.
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