B. Baslund et al., MEASUREMENTS OF PROTEINASE-3 AND ITS COMPLEXES WITH ALPHA(1)-PROTEINASE INHIBITOR AND ANTINEUTROPHIL CYTOPLASM ANTIBODIES (ANCA) IN PLASMA, Journal of immunological methods, 175(2), 1994, pp. 215-225
Wegener's granulomatosis (WG) is a systemic vasculitis which is diagno
sed on clinicopathological findings. The diagnosis may be aided by the
presence of anti-neutrophil cytoplasm antibodies (ANCA). In WG, ANCA
are primarily directed to proteinase 3 (PR3), a serine protease of the
azurophilic granules of the neutrophilic granulocyte. The main plasma
inhibitor of PR3 is alpha(1)-proteinase inhibitor (PI). To study if f
ree PR3 or complexes between the enzyme and PI or PR3 and ANCA could b
e found in the plasma from patients with WG we have developed three EL
ISA systems for the detection of these complexes and free PR3. In all
three assays monoclonal antibodies against PR3 were used as capture an
tibodies. After incubation with plasma, free PR3 was detected by affin
ity purified rabbit anti-PR3 followed by alkaline phosphatase-labelled
swine anti-rabbit IgG. Serial dilutions of purified PR3 was used as s
tandard. The detection limit was 3 ng/ml. PR3 complexed with PI was me
asured by rabbit anti-PI antibodies and alkaline phosphatase-labelled
swine anti-rabbit IgG. Pre-formed in vitro complexes of PR3/PI in seri
al dilutions were used as standard. The detection limit of this assay
was 1 ng/ml. PR3/IgG-ANCA complexes were detected by alkaline phosphat
ase labelled goat anti-human IgG. A positive plasma sample in serial d
ilutions was used as standard. Plasma samples from nine patients with
WG, eight patients with fever of infectious origin without evidence of
vasculitis and ten healthy donors were examined by these methods. Fre
e PR3 could not be found in any of the plasma samples. PR3/PI complexe
s were detected in healthy donors at levels between 41-85 ng/ml. All W
G patients, both active and inactive, had PR3/PI concentrations above
this level, and so had all patients with fever. PR3/IgG-ANCA was found
in three of the patients with WG, two being ANCA negative with inacti
ve disease andone was ANCA positive with active disease. Thus, the dev
eloped methods can be useful for future studies of the clinical releva
nce of these complexes in patients with WG and possibly other vasculit
ides.