Rapid decrease of anti-beta-glucan antibody as an indicator for early diagnosis of carinii pneumonitis and deep mycotic infections following immunosuppressive therapy in antineutrophil cytoplasmic antibody-associated vasculitis.

Abstract

Deep mycosis (aspergillus pneumonia (AsP)) and carinii pneumonitis (PCP) are complications of immunosuppressive treatment for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). The objective was to clarify the clinical significance of plasma titer of antibody against beta-glucans (anti-BG antibody) as a predictor of complications such as AsP or PCP and the prognosis of patients. Enzyme-linked immunosorbent assay was used to measure the plasma titer of antibodies against beta-glucans (BG) from Candida albicans in 22 healthy subjects and 52 patients with various stages of AAV. The mean plasma titer of the anti-BG antibody was 2,677 +/- 1,686 U in healthy subjects, 691 +/- 522 U in patients with untreated active vasculitis (n = 14), and 547 +/- 416 U in patients soon after immunosuppressive treatment (n = 24). Healthy subjects had significantly higher antibody titers than the other two groups (P < 0.05). Repeated measurements over the clinical course of AAV revealed an increase during remission to 1,180 +/- 130 U (n = 11), while there was a significant rapid decrease to 369 +/- 441 U (P < 0.01) concomitantly with elevation in plasma C-reactive protein and BG levels in patients with AAV that had AsP or PCP infection. Antifungal therapy resulted in a rapid rise of anti-BG antibody titer. Experiments in mice suggested that the anti-BG antibody neutralizes BG. Rapid decrease of the anti-BG antibody titer may be a useful indicator for diagnosis of the presence of AsP or PCP and for estimating the prognosis of patients with these opportunistic infections during immunosuppressive treatment of AAV.

• Authors: Masaharu Yoshida, Ken-ichi Ishibashi, Shunsuke Hida, Noriko Yoshikawa, Iwao Nakabayashi, Masakazu Akashi, Taeko Watanabe, Tomohiro Tomiyasu, Naohito Ohno
• Journal: Clinical rheumatology (Clin Rheumatol) Vol. 28 Issue 5 Pg. 565-71 (May 2009) ISSN: 1434-9949 [Electronic] Germany
• PMID: 19190977 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Antineutrophil Cytoplasmic
• Antifungal Agents
• Immunosuppressive Agents
• beta-Glucans

Topics

• Aged, 80 and over
• Antibodies, Antineutrophil Cytoplasmic (chemistry)
• Antifungal Agents (pharmacology)
• Aspergillus (metabolism)
• Candida albicans (metabolism)
• Enzyme-Linked Immunosorbent Assay
• Female
• Humans
• Immunosuppressive Agents (pharmacology, therapeutic use)
• Male
• Middle Aged
• Mycoses (immunology)
• Pneumonia (diagnosis)
• Remission Induction
• Reproducibility of Results
• Vasculitis (immunology)
• beta-Glucans (chemistry, metabolism)