The presence of anti-neutrophil extracellular trap antibody in patients with microscopic polyangiitis

Objective Although anti-neutrophil cytoplasmic antibody (ANCA) is the major autoantibody in patients with ANCA-associated vasculitis (AAV), previous studies have suggested the presence of anti-neutrophil extracellular trap (NET) antibody in patients with microscopic polyangiitis (MPA), one type of AAV. In this study, we aimed to determine the prevalence and pathogenic role of anti-NET antibody (ANETA) in MPA. Methods We examined the presence or absence of ANETA in sera obtained from 19 MPA patients by indirect immunofluorescence. We compared the clinical parameters, including age, sex, myeloperoxidase (MPO)-ANCA, creatinine, C-reactive protein, MPO-DNA complexes, and vasculitis activity, in ANETA-positive and ANETA-negative MPA patients. We investigated the serum NET induction and degradation abilities of ANETA-positive and ANETA-negative MPA patients with reference to healthy controls (n=8). Furthermore, we assessed the relationship of ANETA with the effect of IgG depletion on the serum NET degradation ability. Results ANETA was present in 10 of the 19 MPA patients. There was no significant difference in the clinical parameters in ANCA-positive and ANCA-negative MPA patients. Although the NET induction ability was higher and the NET degradation ability was lower in MPA sera than those in healthy controls, these abilities were not different between ANETA-positive and ANETA-negative MPA sera. Interestingly, the NET degradation ability in some sera with ANETA was markedly increased by IgG depletion. Conclusion Some MPA patients produce ANETA and some ANETA possess an inhibitory function against the serum NET degradation ability. Although further studies are needed, ANETA is worthy of attention for understanding the pathophysiology of MPA.