Nephritic Factor Research Articles

Loss of Autoantibody Activity by Alteration in Autoantigen

C3 nephritic factor (C3NeF) is an autoantibody produced by patients with membranoproliferative glomerulonephritis (MPGN); it is thought to be responsible for the continued breakdown of C3 in these patients. We have studied three patients with MPGN for periods of 7 to 17 years who were noted to develop a normal C3 and factor B level in the face of persistent circulating C3NeF. In addition, C3NeF obtained from other sera were inactive when added to these patients’ sera. When C3NeF was isolated from these patients’ sera, however, it was completely active when added to normal human serum as a source of C3 and factor B. Removal of the C3 and factor B from these patients’ sera by passage over anti-C3 and anti-factor B columns followed by reconstitution with C3 and factor B isolated from normal serum allowed C3NeF to be active in these sera. Replacement of C3 alone did not restore activity to these sera but replacement with factor B alone restored full C3NeF activity. These data suggest some alteration in autoantigen (factor B) as a mechanism for reduction in autoantibody (C3NeF) activity.

Outcome of idiopathic membranoproliferative glomerulonephritis in children

The aim of this multicentre study was to analyse the long-term outcome of idiopathic membranoproliferative glomerulonephritis (MPGN) according to histological type and to the presence of C3 nephritic factor. Fifty patients aged 2-14 years at the onset of the study were followed over 2-20 years; 26 patients had MPGN type I, 17 had type II and 7 had type III. Treatment was variable. At the last observation, 30 patients had reached terminal and four pre-terminal renal failure. The median survival probability until renal death was 15.3, 8.7 and 15.9 years for disease types I, II and III respectively (difference between MPGN types I + III versus type II: p = 0.013). The presence of an initial nephrotic syndrome was associated with a more rapid progression (p = 0.018). C3 nephritic factor was of no prognostic value. We conclude that the outcome of MPGN mainly depends on the histological type observed.

Pathological and biochemical modifications of renal function in ibuprofen-induced interstitial nephritis.

Use of ibuprofen in patients with asymptomatic renal failure is known to produce acute renal toxicity. One of the manifestations is interstitial nephritis of which the pathogenic mechanism remains unclear. In the present study, this nephrotoxic syndrome was induced in rabbits by giving a single dose of uranyl nitrate, followed by consecutive doses of ibuprofen. This animal model thus allowed the assessment of renal functional and pathological changes associated with ibuprofen use in renal insufficiency. In these rabbits, the major abnormality appeared to be confined to the tubulointerstitial compartment. Microscopic examinations of the renal necropsy specimens showed tubular necrosis and interstitial lymphocytic infiltration. The histological finding of lymphocytic aggregation suggests that this nephrotoxic effect stems from a cytotoxic immune reaction in the interstitium. Moreover, levels of renal 2-arylpropionyl-CoA epimerase, a key enzyme involved in the metabolic inversion of ibuprofen, showed a significant reduction, which may result from the massive destruction of the tubular cells in these animals. These results support the premise that renal insufficiency is a prerequisite factor for ibuprofen-induced interstitial nephritis.

Paramesangial glomerular deposits in membranoproliferative glomerulonephritis type II correlate with hypocomplementemia

To gain support for a previously proposed hypothesis that nephritic factors predispose to chronic glomerulonephritis, the glomerular deposits of patients with membranoproliferative glomerulonephritis type II have been studied by electron microscopy and immunofluorescence and the results correlated with the C3 level at the time of biopsy. If, as hypothesized, circulating convertase predisposes to nephritis, finding that the glomeruli of patients hypocomplementemic at biopsy, presumably with nephritic factor-stabilized convertase in their circulation, differ from those of patients normocomplementemic at biopsy would suggest that circulating convertase in some way alters the glomerulus. Among 25 biopsy specimens from 12 patients, hypocomplementemia did not correlate with capillary loop deposits, but there was strong correlation with deposits in the paramesangial region as detected by electron microscopy. Of 11 patients who were normocomplementemic at biopsy, none had paramesangial deposits in their glomeruli. Of 14 patients who were hypocomplementemic at biopsy, deposits were present in the paramesangium in 12 patients ( P <0.001). The deposits were either on both sides of the paramesangial segment of the basement membrane (waist basement membrane related) or in apposition to the paramesangial basement membrane in a subepithelial position only. The detection of paramesangial deposits in the ultrastructure correlated with the detection of C3-containing mesangial granules by immunofluorescence; immunoglobulin G, C5, properdin, and factor B could not be demonstrated in these granules. The study identifies the mesangial deposits described by others in membranoproliferative glomerulonephritis type II as paramesangial deposits and, more importantly, demonstrates that their presence correlates closely with hypocomplementemia. It is likely that these deposits in some way result from the presence in the circulation of convertase stabilized by the nephritic factor of the amplification loop.

Hypocomplementaemia, C3 Nephritic Factor and Type III Mesangiocapillary Glomerulonephritis Progressing to Systemic Lupuis Erythematosus

Hypocomplementaemia, C3 Nephritic Factor and Type III Mesangiocapillary Glomerulonephritis Progressing to Systemic Lupuis Erythematosus Get access T.P. SHEERAN, T.P. SHEERAN *Dudley Road HospitalDudley Road, Birmingham T. P. Sheeran, Cannock Chase Hospital, Brunswick Road, Cannock WSll 2XY. Search for other works by this author on: Oxford Academic PubMed Google Scholar R.H.R. WHITE, R.H.R. WHITE †Children's HospitalLadywood, Birmingham Search for other works by this author on: Oxford Academic PubMed Google Scholar F. RAAFAT, F. RAAFAT †Children's HospitalLadywood, Birmingham Search for other works by this author on: Oxford Academic PubMed Google Scholar M.A. JACKSON, M.A. JACKSON †Children's HospitalLadywood, Birmingham Search for other works by this author on: Oxford Academic PubMed Google Scholar D.S. KUMARARATNE, D.S. KUMARARATNE *Dudley Road HospitalDudley Road, Birmingham Search for other works by this author on: Oxford Academic PubMed Google Scholar R.D. SITUNAYAKE R.D. SITUNAYAKE *Dudley Road HospitalDudley Road, Birmingham Search for other works by this author on: Oxford Academic PubMed Google Scholar Rheumatology, Volume 34, Issue 1, January 1995, Pages 90–92, https://doi.org/10.1093/rheumatology/34.1.90 Published: 01 January 1995 Article history Accepted: 22 September 1994 Published: 01 January 1995

Nephritic factors predispose to chronic glomerulonephritis.

Chronic glomerulonephritis has been reported in three rare conditions in which factor H of the complement system does not function normally. Factor H is essential for the inactivation of the C3b-dependent convertase, C3b,Bb, which is constantly being formed in vivo. With factor H dysfunction, this convertase accumulates and produces hypocomplementemia. Twenty-two individuals have been reported with the three forms of H dysfunction, and 12 have displayed evidence of chronic glomerulonephritis. In addition, matings of certain Yorkshire pigs result in offspring that are homozygous deficient in factor H and have a high incidence of a severe hypocomplementemic glomerulonephritis closely resembling membranoproliferative glomerulonephritis type II. The hypothesis proposed is that the nephritis that develops with these forms of H dysfunction is in some way the result of circulating convertase. The corollary is that nephritic factors, also producing H dysfunction and higher than normal circulating levels of the C3b-dependent convertase, are responsible for the glomerulonephritides with which they are associated, mainly membranoproliferative glomerulonephritis types II and III. Nephritic factors are autoantibodies that bind to the C3b-dependent convertase and render it resistant to dissociation by factor H. Although nephritic factors are currently considered epiphenomena, their role in the pathogenesis of membranoproliferative glomerulonephritis should be reconsidered based on the evidence that circulating convertase is nephritogenic.

Are Nephritic Factors Nephritogenic?

HE COMPLEMENT system is a complex cascade of proteins that plays a role in a number of aspects of immune function: host de­ fence against microbial infection, particularly with encapsulated bacteria; amplification of anti­ body-mediated inflammation; efficient transport and disposal of immune complexes; induction of immune responses and antigen presentation. I In health, complement activation is tightly regu­ lated; in certain pathologic states, complement components are consumed, resulting in hypo­ complementemia. Nephrologists have long rec­ ognized the association of hypocomplementemia with certain forms of chronic glomerulonephri­ tis/ particularly the histologic type known in the United States as membranoproliferative glo­ merulonephritis (MPGN) and in Europe by the synonym mesangiocapillary glomerulonephri­ tis, which has three subtypes based on the na­ ture and distribution of the glomerular immune deposits. It remains a matter of some contro­ versy, however, whether the complement activa­ tion is a cause or a consequence of the nephritis or, indeed, merely an epiphenomenon. Activation of the complement cascade can take place via two pathways, the classical and alterna­ tive pathways, and both may be activated in ne­ phritis. This activation is often associated with the presence in the circulation of fac­ tors, which interfere with the normal regulation of complement activation. Several such factors have been described,2 of which the best charac­ terized is C3 nephritic (usually referred to simply as factor [NeF]). Nephritic is an immunoglobulin G autoantibody to neoantigens formed during assembly of the alter

The inhibitory effect of factor J on the alternative complement pathway

Factor J (FJ) is a cationic glycoprotein with inhibitory activity in C1, the first component of the classical complement pathway. This study demonstrates that FJ is able to regulate the activity of the alternative complement pathway. FJ inhibits the generation of fluid-phase and cell-bound alternative pathway C3 convertase, C3b,Bb (C3-cleaving enzyme). Thus, FJ interferes with the generation of alternative pathway C3 convertase when sheep erythrocytes bearing antibody and activated C3 and C4 (EAC4b,3b) are incubated with the individual complement components, factors B, D, and P. FJ accelerates the decay of C3 convertase with a time course similar to that of factor H, and when both regulators are present together, the decay of enzyme activity is faster than when they are added separately. Furthermore, FJ is able to inhibit the cleavage of C3 by factor B in a fluid-phase assay. FJ prevents the initiation of alternative pathway activation in "more stabilized systems" with well known activators of alternative pathway C3 convertase such as C3 nephritic factor (an autoantibody against alternative pathway C3 convertase), cobra venom factor, and rabbit erythrocytes. In these systems, FJ has no effect on C3 convertase stabilized by rabbit erythrocytes or cobra venom factor. In contrast, FJ promotes the dissociation of C3 convertase stabilized by C3 nephritic factor, but with much lower efficiency than in preventing initiation. Direct interaction of FJ with individual components of C3 convertase was shown by a solid-phase binding assay using plates coated with C3, C3b, B, Bb, or FJ. FJ inhibitory activity in the alternative pathway can be modulated by polyanions like heparin. FJ-mediated inhibition in the alternative complement pathway can be modified by surface interactions, as occurs during alternative pathway C3 convertase activation. Thus, when FJ is adsorbed by and eluted from hydroxylapatite and reverse-phase columns, its inhibitory effect on more stabilized systems is lost. This loss of inhibitory activity is fully reversed when FJ is rechromatographed on heparin-Sepharose or Sepharose columns. Taking into account these data, FJ may be included in the group of highly charged molecules that inhibit the activation of classical and alternative complement pathways (i.e. eosinophil major basic protein, protamine, and heparin).

C3 nephritic factor and SLE: report of four cases and review of the literature

We present four patients with C3 nephritic factor associated with partial lipodystrophy and/or mesangiocapillary glomerulonephritis type II. Each of these patients subsequently developed features of SLE, with an onset between 2 and 24 years after the development of the lipodystrophy or glomerulonephritis. All four patients had antinuclear antibodies and three of the four had anti-Ro antibodies. These patients bring to six the number of reported cases of this association. Possible explanations for the link between these two conditions are discussed.

Selective disappearance of C3NeF IgG autoantibody in the plasma of a patient with membranoproliferative glomerulonephritis following renal fransplantation

The serum of patients with membranoproliferative glomerulonephritis (MPGN) often exhibits C3 nephritic factor activity (C3NeF) associated with autoantibodies directed against the C3bBb alternative complement pathway C3 convertase. In the present study, we have sequentially assessed C3NeF activity in the purified IgG fraction of the serum of a patient with MPGN type II and end-stage renal disease every month for 1 year following renal transplantation and bilateral nephrectomy. C3NeF activity in the patient's purified serum IgG decreased with time from the first month after transplantation and became undetectable after forty-five weeks. At that time, plasma levels of C3 and factor B had returned to normal values. The disappearance of C3NeF activity in patient's IgG was selective in that no change in activity of two other autoantibodies and of one antibody against a non-self antigen was observed with time, indicating that the decrease in C3NeF activity was not related to a non-specific effect of immunosuppressive therapy. Loss of C3NeF activity was not related to the generation of anti-idiotypic antibodies against C3NeF. This study documents for the first time the selective disappearance of C3NeF activity following renal transplantation and bilateral nephrectomy. The results suggest that the autoantibody represents an antigen-driven expansion of self reactive B cell clones in response to a specific disease process in the kidney of patients with MPGN.

Hypocomplementaemia of poststreptococcal acute glomerulonephritis is associated with C3 nephritic factor (C3NeF) IgG autoantibody activity

We have observed that decreased plasma levels of C3 in the serum of three children with poststreptococcal acute glomerulonephritis (PSAGN) at the time of presentation were associated with the presence of C3NeF activity in purified serum IgG from the patients. C3NeF activity was determined using a sensitive assay measuring the ability of patients' IgG to stabilize a preformed cell-bound alternative pathway convertase complex. C3NeF activity of patients' IgG decreased within weeks as plasma levels of C3 progressively returned to normal values. C3NeF activity became undetectable within 1-4 months following normalization of plasma C3 levels. Our observations suggest that early alternative pathway-dependent hypocomplementaemia, a cardinal feature of PSAGN, is mediated by the transient expression of C3NeF autoantibody activity by patients' IgG.

Molecular analysis of C3 allotypes in patients with systemic vasculitis

The third component of complement (C3) exists in two main allotypic forms, C3S and C3F, distinguished at the DNA level by a single base change. An increased frequency of the rarer C3F allele has been reported in patients with the autoantibody nephritic factor and in several other autoimmune conditions such as rheumatoid arthritis and IgA nephropathy. Studies of the immunogenetic factors predisposing to the development of systemic vasculitis have produced conflicting results and no major genetic predisposing factors have been identified. We have studied the C3S/F polymorphism in 63 patients with systemic vasculitis using DNA allotyping by the amplification refractory mutation system, a modification of the polymerase chain reaction. The allele frequency in these patients was C3S 0.71, C3F 0.29 (expected C3S 0.8, C3F 0.19; chi-squared = 5.1, P < 0.025), with the average relative risk for the development of systemic vasculitis associated with the presence of a C3F allele being 2.6. Moreover, there was a marked excess of C3FF homozygotes (11/63, [17.5%], versus 4% expected: chi-squared = 9.5, p < 0.01). The average relative risk for the development of systemic vasculitis in C3F homozygotes was 5.1, indicating a gene dosage effect. These data indicate that the C3F allele is associated with a predisposition to the development of systemic vasculitis and that C3F homozygotes are at particularly high risk. This association is the strongest genetic factor reported so far for this group of diseases.

Occurrence of C3 nephritic factor and C4 nephritic factor in membranoproliferative glomerulon eephritis

Occurrence of C3 nephritic factor and C4 nephritic factor in membranoproliferative glomerulon eephritis

Complement-mediated adipocyte lysis by nephritic factor sera.

Recent data indicate a previously unsuspected link between the complement system and adipocyte biology. Murine adipocytes produce key components of the alternative pathway of complement and are able to activate this pathway. This suggested to us an explanation for adipose tissue loss in partial lipodystrophy, a rare human condition usually associated with the immunoglobulin G(IgG) autoantibody nephritic factor (NeF) which leads to enhanced alternative pathway activation in vivo. We hypothesized that in the presence of NeF, there is dysregulated complement activation at the membrane of the adipocyte, leading to adipocyte lysis. Here we show that adipocytes explanted from rat epididymal fat pads are lysed by NeF-containing sera but not by control sera. A similar pattern is seen with IgG fractions of these sera. Adipocyte lysis in the presence of NeF is associated with the generation of fluid-phase terminal complement complexes, the level of which correlates closely with the level of lactate dehydrogenase, a marker of cell lysis. Lysis is abolished by ethylenediaminetetraacetic acid, which chelates divalent cations and prevents complement activation, and reduced by an antibody to factor D, a key component of the alternative pathway. These data provide an explanation for the previously obscure link between NeF and fat cell damage.

Nucleotide sequence of a human autoantibody to the alternative pathway C3/C5 convertase (C3NeF).

The production of autoantibodies to the alternative pathway C3/C5 convertase or C3 Nephritic Factor (C3NeF) is one characteristic of membranoproliferative glomerulonephritis. The complete nucleotide sequences of the heavy and light chain variable regions of an IgG C3NeF produced by an EBV transformed B cell line derived from a patient with membranoproliferative glomerulonephritis were determined. The VH and VL gene segments used by this C3NeF are extensively mutated suggesting that antigenic selection and affinity maturation may occur during the generation of these autoantibodies.

A novel ELISA assay for the detection of C3 nephritic factoro

We have developed an ELISA procedure for the detection of C3 nephritic factor (C3NeF), in which wells are coated with a fixed concentration of 2 μg C3b per well, and subsequently reacted with B and D. The presence of increasing concentrations of NiCl 2 showed a NiCl 2 concentration-dependent generation of C3bBb and very little solid-phase bound C3bBb was generated with MgCl 2. The formation of solid-phase C3bBb in the presence of an optimal concentration of 1 mM NiCl 2, was time-dependent and plateau values were reached after 30 min at 37°C. IgG purified from the serum of a patient with membranoproliferative glomerulonephritis (MPGN) type II containing C3NeF stabilizing activity was bound to the C3bBb generated on microwells in a dose-dependent manner whereas normal IgG exhibited only minor reactivity. C3NeF activity was measured using the ELISA method in patients with MPGN type II ( n = 15) and other diseases ( n = 17) and in normal controls ( n = 15). Most of the patients with MPGN type II exhibited positive C3NeF at various levels, while two of the disease controls showed only slight reactivities. C3NeF titers measured by this new ELISA procedure correlated well with previously described hemolytic assays ( r = 0.617, p < 0.01).

Changes in nephritic factor in hypocomplementemia.

Changes in nephritic factor in hypocomplementemia.

On the origin of C3 nephritic factor (antibody to the alternative pathway C3 convertase): Evidence for the Adam and Eve concept of autoantibody production

The antibody to the alternative pathway C3 convertase, designated C3 nephritic factor or C3NeF, is an autoantibody that is produced in everyone from the time of birth. The elaboration of C3NeF utilizes germline V-region genes which undergo antigen-driven affinity maturation, resulting in an autoantibody that is produced in large amounts with high affinity and narrow specificity. Our data also suggest that under normal conditions, the idiotypic network may play an important part in the control of this autoantibody. Further, a defect in the network with loss of control or inappropriate stimulation may be an underlying mechanism in the unrestricted production of C3NeF in patients with membranoproliferative glomerulonephritis.

Mesangiocapillary glomerulonephritis.

The clinical and histological features of idiopathic mesangiocapillary glomerulonephritis (MCGN) have been reviewed, with a survey of the most recent literature, including the retrospective analysis of the data of the Italian Study Group of Renal Immunopathology on 368 patients. In both major types of MCGN, six morphological variants have been characterized (classical MCGN, nodular MCGN, exudative MCGN, focal segmental MCGN, MCGN with massive deposits, and crescentic MCGN) that have different etiologic, pathogenetic, or clinical outcome correlates. Actuarial renal survival 10 yr after renal biopsy has been calculated with life-table analysis to be 60 to 65% in type I MCGN, without significant differences between treated and untreated patients; none of the therapeutic regimens tested up to now for this disease have been independently demonstrated to be efficacious. As for the pathogenesis, the interrelationships between the three mechanisms that contribute to the development of the morphological features of the disease (accumulation of electron-dense deposits on the subendothelial side of the glomerular basement membrane or within the glomerular basement membrane; mesangial proliferation and peripheral interposition; and inflow of inflammatory cells, mainly monocytes) have been discussed, and the role of hypocomplementemia and circulating nephritic factors (NFa and NFt) has been analyzed. Available evidence suggests that MCGN is an immunocomplex-mediated disease, the deposition of immune deposits being the initiating phenomenon, whereas the morphologic changes and complement system activation are secondary events.

Accelerated decay of the cell bound C4b2a complex by serum of patients with membranoproliferative glomerulonephritis and acute poststreptococcal glomerulonephritis

Serum from patients with membranoproliferative glomerulonephritis (MPGN) and acute poststreptococcal glomerulonephritis (APSGN) accelerated the decay of the cell bound C4b2a (C42) and C4b hemolytic activity relative to pooled normal human serum (pNHS) after 5 min incubation at 30°C in EDTA-GVB. The accelerated decay of the C42 hemolytic activity was heat stable (56°C 30 min) and was inhibited by monoclonal antibody against human C4 binding protein (MoAb:C4BP) or C4 binding protein (C4BP) depleted serum. C4 nephritic factor (C4NeF) was employed to stabilize the labile classical pathway C3 convertase C42 complex. Serum from patients with MPGN and APSGN reduced the C4NeF stabilizing activity. Sera from 32 of 46 patients with MPGN and all of 7 patients with APSGN reduced the C42 hemolytic activity relative to 50 normal human serum (NHS) after 5 min incubation at 30°C in EDTA-GVB, and there was no relationship with the serum concentration of C4BP. In vivo, accelerated decay of C42 convertase might interfere with the clearing and processing mechanism of circulating immune complexes (IC) by reducing deposition of C3b on the IC latice.