DNA Release and Appearance of Antinuclear Antibodies in Chronic Hemodialysis Patients

Abstract

The presence of free serum DNA and/or antibodies against nuclear antigens was studied in 65 patients in chronic hemodialysis. Most of patients showed increased levels of both free single-stranded DNA (ss DNA) (28 out of 29) and native (double-stranded) DNA (n DNA) (25 out of 28) at the beginning of each dialysis session (69 ± 26 vs. 119 ± 15, p < 0.05) suggesting a rapid in vivo degradation of the n DNA released. 15 out of 65 patients (23%) developed low anti-ss DNA antibody titers by Millipore filtration assay. 2 of them presented anti-n DNA antibodies simultaneously. Isolated anti-n DNA, anti-Sm and anti-RNP antibodies were systematically negative in all patients. No relationship was found between the presence of anti-ss DNA antibodies and the type of nephropathy, the duration of treatment and the method of dialysis. The fate of a renal allograft was studied in 12 patients after having measured serum-free DNA and anti-DNA antibodies. The 4 patients with good graft function after 2 years of transplantation had significantly higher circulating ss-DNA levels than the other 8 patients whose grafts were rejected.

Delayed onset of systemic lupus erythematosus in patients with ”full-house" nephropathy

“…Development of ANA and anti-ds DNA antibodies secondary to the release of nuclear antigens into the blood stream during hemodialysis treatment has been reported in the literature. Typically these patients become sensitized against nuclear antigens but do not develop clinical symptoms of systemic diseases [9,10]. In contrast, our patient developed a typical flare-up 1 year later, confirming the diagnosis of SLE.…”

Haemodialysis as a model for studying endogenous plasma DNA: oligonucleosome-like structure and clearance

“…Moreover, the reported concurrence in SLE of an tidsDNA and anli-hislonc antibodies [11] would also implicate a similar complex as the relevant immunogen lor anti-dsDNA production in SLE. Thus, failure to find anti-dsDNA [33] in mosl haemodialysed individuals following chronic exposure to very large amounts of such complexes can be taken as evidenee against the hypothesis [14] that such exposure alone is sufficient to account for this autoimtnune phenomenon, thereby implicating additional factors, some of which arc presumably genetic. However, it remains distinctly possible that other (actors, such as dosage of.…”