A case of rheumatoid arthritis with various enzyme-immunoglobulin complexes

Several complexes of enzymes and immunoglobulins were detected at the same time in the serum of a patient with seropositive rheumatoid arthritis. The enzymes which were found to complex with immunoglobulins were lactate dehydrogenase, alkaline phosphatase (liver, bone, placental, and intestinal isoenzymes), amylase, cytosol leucine aminopeptidase, and microsomal leucine aminopeptidase. Reconstitution studies after papain or pepsin digestion showed that the association site of the enzymes was in the Fab portion of the immunoglobulin component. We found these complexes to be the result of an antibody-antigen reaction. The binding capacity of each enzyme was variable over the entire time course. The patient's immunoglobulins, complexed with lactate dehydrogenase or amylase, could not be reconstituted using alkaline phosphatase, cytosol leucine aminopeptidase, or microsomal leucine aminopeptidase in vitro. Therefore, this suggests that the immunoglobulins which bind to each enzyme are independent of each other.