PLA2R antibodies and PLA2R glomerular deposits in psoriasis patients with membranous nephropathy

Abstract

BackgroundThe association between psoriasis and membranous nephropathy (MN) remains largely unclear. We examined the prevalence of serum PLA2R antibody and characterized the expression of PLA2R and THSD7A in glomeruli in patients with MN and psoriasis.MethodsA total of 24 patients with MN without evidence of a secondary cause except psoriasis were enrolled. The clinical and pathological features were retrospectively analyzed. Serum anti-PLA2R antibody was measured using IFA Mosaic. Renal tissue samples stored in the laboratory bio-bank were used for PLA2R staining under immunofluorescence microscopy and THSD7A immunohistochemical analysis.ResultsTwenty-four patients (21 male and 3 female) with a mean age of 43.6 ± 15.7 years old were enrolled. Serum anti-PLA2R antibody was positive in 7 patients, which was significantly lower than the positivity observed in idiopathic MN (29.2% vs. 81.7%, P < 0.001). Glomerular PLA2R staining was positive in 7 patients with positive serum anti-PLA2R antibody. THSD7A staining was negative in all 24 patients. During the follow-up visits, 13 patients with negative serum PLA2R antibody achieved CR. In contrast, CR was only achieved in 1 patient with positive serum PLA2R antibody, PR was achieved in 2 patients.ConclusionsThe prevalence of serum anti-PLA2R antibody and glomerular expression of PLA2R was significantly lower in patients with psoriasis and MN than in those with idiopathic MN, and THSD7A staining was negative, suggesting that MN is associated with psoriasis in the majority of patients. However, idiopathic MN might also accompany psoriasis in a minority of psoriatic patients with positive serum anti-PLA2R antibody.

An update on clinical significance of use of THSD7A in diagnosing idiopathic membranous nephropathy: a systematic review and meta-analysis of THSD7A in IMN

“…In the European cohort, a 29-year-old female patient was diagnosed with systemic lupus erythematosus had positive serum THSD7A antibody, and in the Boston cohort, a 77 years old male SMN patient had active prostate cancer at the time of the diagnosis of MN. In another study [ 14 ], the authors analyzed 24 patients with psoriasis related MN and did not find positive THSD7A in the serum.…”

Phospholipase A2 receptor is associated with hypercoagulable status in membranous nephropathy: a narrative review

“…Other study ( 14 ) has shown that PLA2R can be continuously expressed in protocellular cells, and the expression of PLA2R can be detected in renal tissues of about 75% IMN patients. Multiple studies ( 15 , 16 ) have confirmed that the expression of PLA2R in renal tissue is expressed on protocellular surface through intracellular recycling, and is not affected by changes in patients’ conditions, so its diagnosis of IMN has a high stability. Studies ( 17 , 18 ) have shown that the risk of renal function progression increases with the increase of PLA2R antibody levels.…”

Idiopathic Membranous Nephropathy: Glomerular Pathological Pattern Caused by Extrarenal Immunity Activity

“…It was reported that 9 out of 32 patients with secondary MN presented with positive anti-PLA2R1, including 7 cancer patients, 1 Crohn's disease patient, and 1 patient with scleroderma ( 27 ). Furthermore, the result from another cohort showed that, among the 24 patients with psoria-associated MN, 7(29.2%) patients had positive anti-PLA2R1 ( 28 ). And, in 39 patients of hepatitis B virus-associated MN, 25(64.1%) patients with aPLA2R1ab positive were found ( 29 ).…”