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Dear Editor,A 62-year-old woman was admitted to our hospital because of edema of both lower limbs for more than 3 months and oliguria for 1 week. The patient’s laboratory test results were listed i...

We report the case of a French woman with acquired von Willebrand syndrome who presents recurrent subarachnoid and intra-cerebral hemorrhage since 2012. She had no family or personal bleeding history. In the biologic explorations, APTT was abnormally high with no anticoagulant drugs (it was normal, historically). Two monoclonal IgG and IgM kappa proteins were detected without any lymphoproliferative disorder. Intravenous infusion of immunoglobulin is very effective in AVWS with immunoglobulin G monoclonal gammapathie of undetermined significance. We had a satisfactory correction of coagulation factors for about 30 days. The exploration of APTT is surely essential for the diagnosis and treatment.

The aim of this study was to investigate neonatal Fc receptor (FcRn) concentration developmental pharmacology in adult and pediatric subjects using minimal physiologically-based pharmacokinetic (mPBPK) modelling. Three types of pharmacokinetic (PK) data for three agents (endogenous/exogenous native IgG, bevacizumab and palivizumab) were used. The adult group contained six subjects with weights from 50 to 100 kg. For pediatric subjects, seven age groups were assumed, with five subjects each having the weight of 95%, 75%, 50%, 25% and 5% percentile of the population. A first evidence-based rating system to evaluate the quality of the source data used to derive pediatric-specific mPBPK model parameter was proposed. A stepwise approach was used to examine the best combination of age/weight effect on the parameters of the mPBPK model in adult and pediatric subjects. IgG synthesis rate (K(syn)), extravasation rate (ER) and FcRn were fitted simultaneously to the PK of bevacizumab and native-IgG in both adult and pediatric. All fitting showed good fits based on the graphs and the coefficient of variation of the fitted parameters (

Glomerulopathy due to dysproteinemia can have a wide spectrum of pathologic and clinical features based on specific characteristics of the abnormal protein and the response induced within the parenchymal tissue. Monoclonal immunoglobulin G (IgG) deposition can manifest as a different glomerular disease. Proliferative glomerulonephritis (GN) with monoclonal IgG deposits (PGNMID) is a unique entity mimicking immune complex GN that does not conform to any of those subtypes. IgG monoclonal granular deposition in the glomeruli with a pattern similar to immune complex disease suggested by C3 and C1q deposition should prompt consideration of PGNMID. Literature is scarce in terms of recurrence of disease in renal allografts. In this article we present the clinical-pathologic features of three cases of PGNMID in the renal allograft showing the variable course and manifestation of the disease.

Proliferative glomerulonephritis with monoclonal immunoglobulin G deposits (PGNMID) is a newly identified and rare form of glomerulonephritis which is characterized by endocapillary proliferative or membranoproliferative with monoclonal deposit stain for IgG and a single light chain. We describe the case of a 63-year-old woman with type 2 diabetes who was considered to have PGNMID.

Proliferative glomerulonephritis occurring as a consequence of monoclonal glomerular deposits of IgG is uncommon. It is a form of renal involvement in monoclonal gammopathy that mimics immune complex glomerulonephritis. Here, we report the first series of proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) from the Indian subcontinent highlighting use of light chain immunofluorescence (IF) in routine renal biopsy interpretation. We retrieved 6 patients diagnosed as proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) out of 160 biopsies (3.7%) with membranoproliferative patterns over 5 1/2 years (2009–2014), one of whom had recurrence 6 months post-renal transplant. Four (67%) patients presented with rapidly progressive renal failure and two (33%) with nephrotic syndrome. None of these patients had overt multiple myeloma. The predominant histologic pattern was membranoproliferative with all the biopsies showing IgG3 Kappa deposits on IF. The deposits were primarily subendothelial on electron microscopy.

International audience; Le STUDIUM conference was held November 24-25, 2016 in Tours, France as a satellite workshop of the 5(th) meeting of the French GDR 3545 on "G Protein-Coupled Receptors (GPCRs) - From Physiology to Drugs", which was held in Tours during November 22-24, 2016. The conference gathered speakers from academia and industry considered to be world leaders in the molecular pharmacology and signaling of GPCRs, with a particular interest in the development of therapeutic GPCR antibodies (Abs). The main topics were new advances and challenges in the development of antibodies targeting GPCRs and their potential applications to the study of the structure and function of GPCRs, as well as their implication in physiology and pathophysiology. The conference included two sessions, with the first dedicated to the recent advances in methodological strategies used for GPCR immunization using thermo-stabilized and purified GPCRs, and the development of various formats of Abs such as monoclonal IgG, single-chain variable fragments and nanobodies (Nbs) by in vitro and in silico approaches. The second session focused on GPCR Nbs as a "hot" field of research on GPCRs. This session started with discussion of the pioneering Nbs developed against GPCRs and their application to structural studies, then transitioned to talks on original ex vivo and in vivo studies on GPCR-selective Nbs showing promising therapeutic applications of Nbs in important physiological systems, such as the central nervous and the immune systems, as well as in cancer. The conference ended with the consensus that Abs and especially Nbs are opening a new era of research on GPCR structure, pharmacology and pathophysiology.

Proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) is a recently described entity. It is featured by glomerular nonorganized monoclonal immunoglobulin G deposits. Monoclonal IgG deposits are associated with glomerular proliferative lesions, mimicking different types of immune-complex glomerulonephritis. We report two classic cases of PGNMID which fulfilled all criteria of this disease. We conclude that recognition of proliferative glomerulonephritis with monoclonal IgG deposits requires routine immunostaining for light chain and IgG isotype.

A male patient is presented with long-lasting paraproteinemia of monoclonal IgG λ, who suffered from recurrent, and until the last one, mostly reversible episodes of dermatoneuro syndrome, described exclusively in scleromyxedema. The skin biopsy revealed λ-light chain amyloid deposition instead of changes typical for scleromyxedema. Systemic AL amyloidosis was diagnosed post mortem since the patient had no clinical signs of any other organ impairment except skin and brain. Neuropathology is described and possible etiopathogenesis of brain involvement is considered.

In the diagnosis of atherosclerosis, detailed evaluation of biomarkers related to its lesion formation is desired for estimation of its progression rate. In our previous proteomic studies of atherosclerosis mice, the protein level of thrombospondin-4 (TSP4) in the aorta, but not in plasma, elevated relatively with atherosclerotic plaque formation. Therefore, we supposed that TSP4 would be a potential biomarker for diagnostic imaging of atherosclerotic progression. Immunoglobulin G (IgG) has been widely used as a basic molecule of imaging probes providing images specific to their target biomolecules, owing to the antigen-antibody reaction. Therefore, we first developed anti-TSP4 monoclonal IgG radiolabeled with 99mTc (99mTc-TSP4-mAb). 99mTc-TSP4-mAb showed higher accumulation in atherosclerotic aortas of apoE−/− mice (atherosclerotic model mice); however, we found that the non-targeted monoclonal IgG radiolabeled with 99mTc also showed similar distribution in atherosclerotic aortas of apoE−/− mice. IgG has also known to accumulate nonspecifically in the immunological disease such as inflammatory arthritis. However, the accumulation mechanism of IgG has still been unclear in detail. In this chapter, we would like to introduce recent topics on atherosclerotic imaging, focused on our work exploring the accumulation mechanisms of IgG in atherosclerotic lesions, and elucidating the usefulness of radiolabeled IgG images in the diagnosis of atherosclerosis.

Proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) is a rare and recently identified disease with a poor prognosis irrespective of the treatment. Recently, the possibility of recurrent or de novo PGNMID after kidney transplantation has been reported, which is associated with a better prognosis compared to PGNMID on native kidneys. Nevertheless, at present, due to the very few cases of recurrent PGNMID diagnosed, there is no proven effective treatment. Here, we report a case of recurrent PGNMID successfully treated with plasmapheresis, steroids and mycophenolate mofetil. Our report suggests that plasmapheresis might be a valid therapeutic option to treat recurrent PGNMID.

In this paper, we describe guided-mode resonance biochemical sensor technology. We briefly discuss sensor fabrication and show measured binding dynamics for example biomaterials in use in our laboratories. We then turn our attention to a particularly powerful attribute of this technology not possessed by competing methods. This attribute is the facile generation of multiple resonance peaks at an identical physical location on the sensor surface. These peaks respond uniquely to the biomolecular event, thereby enriching the data set available for event quantification. The peaks result from individual, polarization-dependent resonant leaky modes that are the foundation of this technology. Thus, by modeling the binding event and fitting to a rigorous electromagnetic formalism, we can determine individual attributes of the biolayer and its surroundings and avoid a separate reference site for background monitoring. Examples provide dual-polarization quantification of biotin binding to a silane-coated sensor as well as binding of the cancer biomarker protein calreticulin to its monoclonal IgG capture antibody. Finally, we present dual-polarization resonance response for poly (allylamine hydrochloride) binding to the sensor with corresponding results of backfitting to a simple model; this differentiates the contributions from biolayer adhesion and background changes.

Membranous-like glomerulopathy with masked IgG-κ deposits (MGMID) is a novel entity requiring antigen retrieval on formalin-fixed paraffin-embedded tissue to detect the immunoglobulin by immunofluorescence. MGMID is clinically distinct from other glomerulopathies with non-organized monoclonal IgG deposits, although the source of the kappa-restricted IgG is uncertain. Careful examination including ultrastructural analysis is essential for identifying diseases such as MGMID that may be misclassified by routine methods and ultimately require alternative techniques for accurate diagnosis.

First description of a case of early myeloma with monoclonal IgG, type kappa, anomaly plus Bence-Jones proteinuria and Fanconi's syndrome in a 67-year-old woman. Characteristic crystalline inclusion bodies were found in plasma cells of bone marrow and renal tissue.

A panel of four natural human monoclonal IgG antibodies derived from B lymphocytes isolated from regional draining lymph nodes of cancer patients has been developed and characterized. The four human antibodies are termed, RM1, RM2, RM3, and RM4. The immunoreactivity of this panel of four human antibodies is restricted to tumor cells. Individually, these human MAbs show tumor targeting and are effective in inhibiting tumor growth in nude mouse xenograft models. When used in combination the antibodies show an additive effect in slowing down the progression of tumors in xenograft models suggesting that cocktails of antibodies may be useful in the clinic.

Summary The features of GPs with Congo red-negative, non-cryoglobulinaemic deposits have been surveyed. Thesedisorders are rare and clinically heterogeneous andtheir pathogenesis is unclear. There is controversyconcerning the nomenclature of Congo-red negativeglomerular fibrilloses. A practical and reproducibleapproach is to classify these GPs on the basis of thesubstructure and arrangement of the deposits assessedat conventional electron microscopic magnifications.Accordingly, FGN and ITG can be identified. FGN ischaracterized by randomly arranged microfibrils (dia-meter: 12–30nm) composed of subclass-restrictedpolyclonal IgG and a low incidence of underlyingsystemic disease. In contrast, ITG is characterized byparallel bundles of microtubules (diameter: 10–90nm)composed mainly of monoclonal IgG and a highincidence of associated lymphoproliferative disease ormonoclonal gammopathy. The finding of Congo red-negative organized deposits on renal biopsy shouldprompt a careful search and follow-up for mono-clonal gammopathy, cryoglobulins and haemopoieticmalignancy.

Vibratory angio-oedema is a rare form of physical urticaria characterized by pruriginous weals and angio-oedema at the site of exposure to vibration. Severe treatment-resistant disease can occur, and is associated with significant disability. Therapy with omalizumab, a monoclonal IgG anti-IgE antibody, has been shown to be successful in several types of physical urticaria. We report a patient with vibratory angio-oedema for whom all standard treatments for urticaria, including omalizumab, failed to show a clinical benefit. Finally, ketotifen was tried, and unexpectedly reduced symptoms significantly. Ketotifen may thus represent a therapeutic option in patients with treatment-resistant vibratory angio-oedema.

Clostridium difficile infection has emerged as a growing worldwide health problem. The colitis of Clostridium difficile infection results from the synergistic action of C. difficile secreted toxins A and B upon the colon mucosa. A human monoclonal IgG anti-toxin has demonstrated the ability in combination therapy to reduce mortality in C. difficile challenged hamsters. This antibody is currently in a clinical trial for the treatment of human Clostridium difficile infection. More than one group of investigators has considered using polyclonal bovine colostral antibodies to toxins A and B as an oral passive immunization. A significant proportion of the healthy human population possesses polyclonal antibodies to the Clostridium difficile toxins. We have demonstrated that polyclonal IgA derived from the pooled plasma of healthy donors possesses specificity to toxins A and B and can neutralize these toxins in a cell-based assay. This suggests that secretory IgA prepared from such pooled plasma IgA may be able to be used as an oral treatment for Clostridium difficile infection.

A 69-year-old man presented with severe pain in hands and feet related to necrosis. Extensive explorations revealed type I cyroglobulinemia associated to monoclonal IgG kappa. Unfortunately he died a few months after.

A 78-year-old woman developed acute-onset nephrotic syndrome. A renal biopsy showed mild mesangial proliferative glomerulonephritis. Immunofluorescence studies revealed granular IgG3- λ deposits within the mesangial area and along the glomerular capillary walls. Electron microscopy showed mesangial and subendothelial granular electron-dense deposits. The pattern of deposition was predominantly mesangial. Serum or urine monoclonal proteins were not detected. Middle-dose steroid therapy induced a rapid remission of nephrotic syndrome. We consider that this is the first case of steroid-responsive nephrotic syndrome due to an extremely rare glomerular disease, proliferative glomerulonephritis with monoclonal IgG deposits associated with pure mesangial proliferative features.

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The POEMS syndrome is an infrequently reported multisystem disorder which presents usually as an obscure polyneuropathy, with almost all cases reported in Japan. A 64 yr old caucasian man presented with a 12 mth history of a severe sensorimotor neuropathy in association with dermato-endocrine features. Detection of a monoclonal IgG kappa paraprotein and mixed osteosclerotic/lytic bone lesions consistent with a plasma cell dyscrasia led to diagnosis of the POEMS syndrome. Unique ultrastructural features were present on sural nerve biopsy in addition to the unusual association with monoclonal kappa-light chain. This case illustrates that the POEMS syndrome may also occur in caucasian subjects.

Monoclonal IgG rheumatoid factors (RFs) are identified using a novel immunoblot assay which detects RFs that bind to SDS-denatured Fc on nitrocellulose. Recognition of these self-associating antibodies is by the use of F(ab′) 2 fragments of light chain-specific antisera. In this way, IgG RFs can be easily identified and the precise binding characteristics to different isotypes of IgG, or other antigens, further specified. The assay can also be used to detect other classes of RFs such as IgM RFs. Although less sensitive than the standard ELISA, the use of this immunoblot RF assay (IRFA) will identify IgG RFs and their target antigen with precision.

Summary Cholinergic urticaria is one of the more common physical urticarias. Although it is often fairly mild, severe treatment-resistant disease may occur, with significant associated disability. Omalizumab, a monoclonal IgG anti-IgE antibody licensed for use in severe asthma, has recently been used successfully in several types of urticaria, including in one case of cholinergic urticaria. This paper reports a patient with severe cholinergic urticaria, unresponsive to antihistamines and multiple other treatments, whose disease was also unresponsive to omalizumab.

We report a 74-year-old woman with a slowly progressive sensory motor axonal neuropathy and a monoclonal IgG-kappa that bound to a 68-kd axonal protein identified as the low molecular weight neurofilament protein. The sera of control subjects and disease controls did not bind to neurofilament protein.

A sensitive test for the presence of D-positive fetal red blood cells (RBCs) in the maternal circulation of D-negative women has been developed. It was used to investigate the possibility that the occasional failure in preventing alloimmunization might be due to the administration of inadequate amounts of prophylactic anti-D Rh immune globulin. The standard dose in Australia contains 125μg of antibody, and can suppress immunization by an estimated 6 mL of packed D-positive RBCs. A fetomaternal hemorrhage (FMH) of this volume is detectable in the maternal circulation as approximately 0.25 percent of the total RBCs. Our test utilizes a commercially available human monoclonal IgG anti-D that has been biotinylated and used with a dye-conjugated streptavidin. Flow cytometry is used to quantitate fluorescing D-positive RBCs. To date, 2,288 tests have been performed on blood samples from D-negative women attending local antenatal clinics or at the time of delivery. Evidence for an FMH has been obtained in six cases (0.26%). In one case, the FMH was only 0.1 percent, and in another (confirmed by the Kleihauer-Betke method), fetal cells constituted only 0.2 percent. Additional Rh immune globulin was not given to these patients. In the other four cases, the D-positive fetal cells were estimated to be 0.7, 0.5, 0.5, and 0.4 percent, and additional prophylactic Rh immune globulin was administered. Although the prevalence of FMH is low, screening D-negative women at risk of alloimmunization has proved to be simple, fast, and inexpensive.

We report the case of a woman, who initially presented with an IgG kappa-type monoclonal gammopathy. An IgD-secreting myeloma was diagnosed 2 years later. The patient died of severe renal failure and infection. The discrepancy between the immunoglobulin concentration estimated from the electrophoresis pattern and the immunonephelometric measurement of IgG, IgA and IgM led us to investigate the existence of an IgD myeloma. It was of the IgD kappa type and had electrophoretic characteristics identical to the initial monoclonal IgG. A common clonal origin for these two immunoglobulins is discussed.

Primary orthostatic tremor is of unknown aetiology and is believed to be a distinct entity rather than a subtype of essential tremor. We describe the first patient with a typical phenotype of primary orthostatic tremor who has a persistent isolated monoclonal immunoglobulin G band in the cerebrospinal fluid.

A 68-year-old Caucasian woman presented with acute renal failure, hypercalcaemia and serum monoclonal IgG κ. Computed tomography (CT) of her abdomen revealed bilateral nephromegaly with no evidence of obstruction (fig 1). Despite normal plain radiography, three dimensional tomographic reconstruction of her pelvis and lumbar spine showed multiple dramatic and punctated lesions, …

We evaluated the clinical characteristics and electromyographic features of 39 patients with monoclonal gammopathy of undetermined significance (MGUS) and neuropathy. Twenty-three patients had a monoclonal IgM protein, 13 had an IgG, and three had an IgA. In 15 patients of the IgM group, the M protein reacted with myelin-associated glycoprotein (MAG). Comparing IgM-MGUS and IgG-MGUS neuropathies, we found the following differences: (1) There was a statistically significant higher frequency of sensory loss in the IgM group. (2) Nine attributes of nerve conduction abnormality were statistically worse in the IgM group, with slowing of conduction velocities and prolonged distal latencies. (3) The frequency of monoclonal IgM was overrepresented in the MGUS neuropathy group. In general, the clinical and electrophysiologic features of the IgM-MGUS MAG-reactive group were not significantly different than the MAG-nonreactive group. Our cases are similar to those previously reported and suggest that monoclonal IgM-MGUS should be separated conceptually from monoclonal IgG neuropathies.

Monoclonal IgG components were found in the serum of 5 of 40 patients with chronic myelocytic leukemia (12.5%), as well as in 2 of 15 patients with acute myelocytic leukemia (13.3%). These findings may represent an involvement of the lymphoplasmacytic system in myeloproliferative disorders. The significance of this association is discussed.

This is the first reported of a patient with hemarthrosis due to invasion of the synovial membrane by myeloma cells. With angiographic studies of the affected joint it was apparent that the tumor tissue extended from the destructive bone lesion of the femoral condyle into the synovial membrane. Intraarticular spontaneous bleeding was the first manifestation of a monoclonal IgG multiple myeloma; the hemarthrosis recurred after drainage but was controlled with local roentgen therapy.

A murine monoclonal IgG antibody (MAb) to column-isolated traumainduced suppressor active peptide (SAP) was produced and utilized in these studies for the further characterization of SAP. Specificity of the antibody was confirmed by enzyme-linked immunosorbant assay (ELISA), passive immunoblotting

There is paucity of information regarding the prolonged plasma thrombin time known to occur in some patients with systemic lupus erythematosus. Detailed investigations of plasma from two such patients disclosed that IgG accounted for this defect in each case. IgG isolated from plasma of either patient possessed the property of delaying fibrin aggregation and prolonging the clotting times of fibrinogen. Preincubation of IgG from either patient with anti-IgG or anti-Fab (rabbit) serum abolished this anticoagulant property. Moreover, the anticoagulant IgG from the first patient was neutralized with anit-k chain and anti-IgG3, that from the second patient with anti-lambda chain and anti-IgG1 serum. These anticoagulants were also dissimilar with respect to their interactions with fibrin(ogen). IgG from the first patient had no anticoagulant activity against fibrin(ogen) species lacking intact Aalpha chains. IgG from the second patient displayed undiminished anticoagulant effect on such fibrin(ogen) species. We conclude that each anticoagulant interacted with a distinct region(s) on the fibrinogen molecule and that these interactions affect or involve sites that participate in the fibrin self-assembly process.

Non-myelomatous monoclonal IgG-L gammapathy has been proved in the synovial fluid and blood serum of a 58-year-old woman patient with rheumatoid arthritis. An analysis of synovial fluid by gel filtration demonstrated IgG-L paraprotein in the second peak of the elution curve; the activity of the rheumatoid factor was found only in the first peak of the curve.

A 57-year-old man with skin psoriasis and psoriatic arthropathy, in whom an IgG-K monoclonal immunoglobulin was identified, is reported. A 7-year follow-up did not disclose any evidence of malignancy. The significance of this unusual occurrence is described.

We report the association of monoclonal mu-heavy chain and a monoclonal IgG K paraprotein in a patient with systemic lupus erythematosus (SLE). This association and the apparently benign nature of this biclonal gammopathy has not been previously reported.

A case of a plasmacytoma arising in the left ovary of a 56-year-old woman is reported. The diagnosis is supported by the unequivocal histology and the detection of a monoclonal IgG/Kappa cell population by an immunoperoxidase PAP technique.