SUMMARY ANCA are found in various systemic vasculitis and are supposed to play a role in the pathogenesis of the disease, in cooperation with other factors such as cytokines. A total of 36 ANCA-positive and 10 ANCA-negative serum samples were analysed for the presence of TNF soluble receptors (TNF-sR), which are shed from the surface of activated cells and may act as TNF inhibitors. Of the ANCA-positive samples, 67% had elevated TNF-sR75 and 72% had elevated TNF-sR55 compared to ANCA-negative specimens (mean [S.E.] ANTINEUTROPHIL cytoplasmic antibodies, specific for constituents of neutrophil granules and monocyte lysosomes, are present in patients with various systemic vasculitis. Two main types of staining patterns were distinguished on ethanol-fixed neutrophils used as substrate for indirect immunofluorescence microscopy: the cytoplasmic (cANCA) and the perinuclear (pANCA) pattern. Most cANCA are raised against a serine protease, termed proteinase 3 (PR3) or myeloblastine, and are associated with Wegener's granulomatosis, whereas pANCA have specificity for myeloperoxidase or elastase and tend to be associated with idiopathic crescentic glomerulonephritis or necrotizing vasculitis other than Wegener's [1,2]. ANCA levels correlate closely with disease activity, and relapses of Wegener's granulomatosis are preceded by a rise of cANCA levels [3,4]. It thus follows that ANCA may play a role in the pathogenesis of systemic vasculitis. Indeed, it has been shown in vitro that both cANCA and pANCA are able to activate neutrophil respiratory burst and degranulation and to enhance their chemotactic response to fMLP [5,6]. The resulting release of neutrophil proteases and reactive oxygen species may damage endothelial cells, leading to vascular necrosis. This neutrophil activation was most effective after priming neutrophils with TNF-a, known to enhance the expression of adhesion molecules on neutrophils and vascular endothelial cells [5]. TNF binds to two distinct receptors of 55 kDa (TNF-R55) and 75 kDa (TNF-R75) [7], which are expressed in nearly identical amounts at the neutrophil surface [8]. Upon exposure to chemotactic factors, neutrophils shed their surface TNF-R and then release TNF soluble receptors (TNF-sR) which may act as TNF inhibitors [8,9]. We therefore tested sera for a possible
MATERIALS AND METHODS
Serum specimensA total of 46 serum samples sent to the laboratory for ANCA analysis (19 cANCA-positive, 17 pANCApositive and 10 ANCA-negative) and 21 serum samples obtained from normal blood donors were analysed.
ANCA determinationANCA concentrations were determined by flow cytometry using fixed neutrophils as targets [10]. ANCA-positive specimens were further characterized by indirect immunofluorescence to distinguish pANCA staining from cANCA staining [5,11].
TNF-sR measurementTNF-sR55 and TNF-sR75 were assayed by enzymelinked immunological biological assay (ELIBA; F Hoffmann-La Roche, Basel, Switzerland) as previously described [12]. Briefly, 96-well microtitre plates were coated with either monoclonal...