The
X-linked Alport syndrome is associated with mutations and deletions in COL4A5 gene, one of six genes which constitute the alpha-chains of
type IV collagen in basement membranes. The autosomal recessive form of
Alport syndrome is characterized by mutations and deletions in the COL4A3 and COL4A4 genes. A fraction of Alport patients who undergo
renal transplantation develop anti-glomerular basement membrane (GBM)
nephritis, which results in loss of the renal allograft function. Recently, the target for
alloantibodies from an X-linked Alport patient with complete COL4A5 gene deletion was determined to be the alpha 3 chain of
type IV collagen. The present study characterized the post-transplant
alloantibodies from an autosomal recessive Alport patient with
anti-GBM glomerulonephritis and a COL4A3 gene mutation which predicted a loss of 85% of the alpha 3(IV) NC1 domain. The specificity of these new
antibodies were studied using glomerular basement membrane constituents and recombinant
type IV collagen domains. The results establish the target for the
alloantibodies from an autosomal recessive Alport patient with COL4A3 deletion as principally the alpha 3(IV)
collagen chain, similar to the post-transplant
alloantibodies from X-linked Alport patients with COL4A5 gene deletions. The absence of alpha 3(IV) chain in the GBM of patients with both these forms of
Alport syndrome, due either to a failure of synthesis or a failure of assembly, presumably leads to a loss of immunologic tolerance for the alpha 3(IV) NC1 domain in transplanted allografts.