Polyclonal immunoglobulin G deposition disease: A unique entity

A 70‐year‐old Japanese man with diabetes mellitus was referred to our hospital for treatment of renal dysfunction. Renal biopsy revealed that the tubular basement membrane (TBM) showed extreme thickening histologically, and selective polyclonal immunoglobulin G deposition on the thickened TBM, whereas no immunoglobulin deposition was found in the glomeruli in an immunofluorescence study. In electron microscopy, a powdery type of electron dense material, which was similar to that seen in Randall‐type monoclonal immunoglobulin deposition disease (MIDD), was observed on the tubular epithelial side of the TBM. However, the present case was differentiated from MIDD, because polyclonal deposition with both kappa and lambda deposition on the TBM was observed. Moreover, there was no noticeable glomerular deposition, which is usually found in cases of MIDD. Anti‐TBM disease was also considered as a differential diagnosis, in which polyclonal immunoglobulin deposits selectively on the TBM. However, in the present case, prominent interstitial nephritis was not observed. A similar case with a history of diabetes mellitus has been reported, which was diagnosed as Polyclonal Immunoglobulin G Deposition Disease. No further reports of this case have emerged thereafter; we present this case as the second report supporting this article.

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Polyclonal immunoglobulin G deposition on the tubular basement membrane in a diabetic nephropathy: A case report

Watanabe

Takeuchi

Taniuchi

et al. 2020

Pathology International

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IgG-positive cells surround pancreatic ducts and form multiple layers after streptozotocin treatment

Tong

Liu

2013

Autoimmunity

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Although numerous studies of diabetes have focused on cell-mediated immunity to pancreatic islet cells, little is known about immune cells in the pancreatic duct region. In this study, we found that membrane immunoglobulin G (IgG)-positive cells comprised about 1.4% of the total pancreatic cells in mice, forming a thin septum that surrounds large and medium pancreatic ducts. The IgG-positive cells showed low expression of beta-catenin and were amylase-, cytokeratin-, insulin-, and glucagon-negative. Flow cytometric analysis showed that the IgG-positive cells were also positive for CD45, Sca-1, c-Kit, CD49f, and CD133, and negative for Flk-1, suggesting that they were undifferentiated hematopoietic cells. On day 5 after streptozotocin treatment, the percentage of periductal IgG-positive cells increased to 3.37% of total pancreatic cells, and the periductal IgG-positive cells formed multiple layers (beta-catenin-low, and amylase-, cytokeratin-, insulin-, glucagon-negative). These cells were Ki67-negative, suggesting they were recruited from hematopoietic cells. We further found that IgG-positive cells formed multiple layers around large ducts of pancreas from NOD mice. Our findings reveal the existence of periductal IgG-positive cells in the adult mouse pancreas, which were activated during streptozotocin-induced diabetes, adding a new dimension to our understanding of immunity in diabetes.

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Polyclonal immunoglobulin G deposition disease: A unique entity

Cited by 2 publications

References 2 publications

Polyclonal immunoglobulin G deposition on the tubular basement membrane in a diabetic nephropathy: A case report

Polyclonal immunoglobulin G deposition on the tubular basement membrane in a diabetic nephropathy: A case report

IgG-positive cells surround pancreatic ducts and form multiple layers after streptozotocin treatment

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