Surface-reactive antibodies to human adrenal cells in Addison's disease

Organ-specific surface-reactive antibodies to viable human adrenal cell suspensions from adult or fetal glands were detected by indirect immunofluorescence (IFL) in 24 out of 28 idiopathic Addison's disease sera with adrenal cytoplasmic antibodies. Cell-surface reactions were also present in nine out of 10 cases of polyendocrine autoimmune disorders without overt adrenal failure but possessing adrenal cytoplasmic antibodies. None of 18 Addisonian patients, 25 cases with other autoimmune disorders and 10 normal individuals, all negative for adrenal cytoplasmic antibodies, showed positive surface reactions on viable cells. When the surface IFL was done on established monolayers, the positive sera gave variable staining suggesting that more than one antigen may be expressed under different conditions. These results suggest that adrenal-specific 'microsomal' antigens are also represented on the plasma membrane, and support the hypothesis that organ-specific autoantibodies reacting with the surface of living target cells may have a pathogenic role in the development of autoimmune adrenalitis.