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IgG4-IgE complex in a patient with IgG4-related disease
Keiichi Nakano1, Junichi Sugita2, Naoki Mafune2
1Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan; Department of Medical Technology and Sciences, School of Health Sciences at Narita, International University of Health and Welfare, Chiba, Japan.
Insights
Elevated IgE in IgG4-related disease (IgG4-RD) can be misleading due to reagent discrepancies. This study identifies an IgG4-IgE complex causing these measurement differences, highlighting the importance of understanding IgE in IgG4-RD.
Area of Science:
- Immunology
- Rheumatology
- Clinical Chemistry
Background:
- Elevated immunoglobulin E (IgE) levels are sometimes observed in patients with immunoglobulin G4-related disease (IgG4-RD).
- A novel case of IgG4-related disease presented with discordant IgE measurements between different assay reagents.
Background:
IgE concentrations are occasionally elevated in patients with IgG4-related disease (IgG4-RD). In this report, we describe a novel case of IgG4-RD in which IgE concentrations were discordant between measuring reagents.
Case:
An 81-year-old man was diagnosed with IgG4-RD and histological autoimmune pancreatitis, which ensued without treatment. The IgE concentrations measured using Elecsys IgE II Immunoassay and Iatroace IgE were 1287.0 IU/mL and 60.9 IU/mL, respectively. IgG4 concentration was 675 mg/dL.
Methods:
To identify IgG and IgG4 directly bound to IgE, purification using protein G and anti-IgG4 antibody-conjugated matrixes and size-exclusion high-performance liquid chromatography (HPLC) were performed.
Results:
In purification analysis, the IgE concentration of the flow-through and bound fractions were 6.8 IU/mL (10.8%) and 56.2 IU/mL (89.2%) for IgG purification and 6.8 IU/mL (12.2%) and 49.0 IU/mL (87.8%) for IgG4 purification. IgE was eluted as a single peak (640 kDa) using size-exclusion HPLC. In the elution pattern of IgG4, a minor peak (640 kDa) and a major peak (170 kDa) were observed. These results indicate that IgG4 binds to IgE and forms a complex, resulting in a discrepancy between reagents.
Conclusions:
In this report, we present an IgG4-IgE complex in a patient with IgG4-RD, which affected the discrepancy in IgE concentrations between IgE reagents. This report points to the significance of increased IgE production in IgG4-RD.
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