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MR Vol.13 No.4 indexに戻る
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MODERN RHEUMATOLOGY
Vol.13 No.4 |
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Antineutrophil cytoplasmic antibodies in patients
with Graves disease: association of antimyeloperoxidase autoantibodies
with propylthiouracil therapy |
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| Hirokazu Honda1, Takanori Shibata1 , Hideo Hara2,
Yoshio Ban2 and Tetsuzo Sugisaki1 |
(1) Department of Nephrology, Showa University
School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666,
Japan
(2) Third Department of Internal Medicine, Showa University School of Medicine,
Tokyo, Japan |
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| Received: 04 December 2001 Accepted: 08 April
2003 |
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| Abstract |
| Antineutrophil cytoplasmic antibody (ANCA)-associated
vasculitic disorders have been reported in patients with Graves disease
during propylthiouracil (PTU) therapy. To investigate whether ANCA
are found in serum samples from patients with Graves disease, and
whether PTU therapy is associated with ANCA positivity, levels of
serum ANCA were examined in Graves-disease patients receiving either
PTU (n = 49) or 1-methyl-2-mercaptoimidazole (methimazole, MMI) (n
= 50), and in untreated Graves-disease patients (n = 32) by enzyme-linked
immunosorbent assay (ELISA). Serum samples from patients with Hashimotos
thyroiditis (n = 46) were also analyzed. Antimyeloperoxidase (MPO)
autoantibodies (MPO-ANCA) were present in 10 (20.4%) of 49 Graves-disease
patients receiving PTU therapy, whereas MPO-ANCA were not detected
in Graves-disease patients receiving MMI, in untreated Graves-disease
patients, or in Hashimotos thyroiditis patients. The MPO-ANCA-positive
sera showed a perinuclear staining pattern which was detected by
indirect immunofluorescence microscopy using a human polymorphonuclear
leukocyte?cytospin preparation. Furthermore, Western blot analysis
revealed that MPO-ANCA in the Graves-disease patients, as well as
MPO-ANCA in patients with idiopathic pauci-immune necrotizing and
crescentic glomerulonephritis, recognize the 105-kD protein of native
MPO. These results indicate that MPO-ANCA in Graves-disease patients
are strongly associated with PTU therapy, and not simply related
to the autoimmune thyroid disease. This study also suggests that
the presence of MPO-ANCA alone may not be sufficient for the development
of vasculitic disorders. |
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| Key words |
| Antimyeloperoxidase autoantibodies (MPO-ANCA)
- Graves disease - Propylthiouracil (PTU) |
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