MC). Several studies have establishedType-II mixed cryoglobulinemia (MC) is a systemic vasculia striking association between hepatitis C virus (HCV) tis that is generally confined to the skin, although some painfection and MC. The potential role of HCV in the patho-tients develop fulminant multi-system disease that particugenesis of MPGN, which occurs in almost half of the larly involves the kidney with severe glomerulonephritis. cases of MC patients, has not been fully investigated, Circulating cryoglobulins consist of polyclonal immunoglobuand the demonstration of HCV proteins as the antigenic lin (Ig)G complexed with monoclonal IgM endowed with rheuconstituent of the glomerular immune deposits has re-matoid factor (RF) activity. The occurrence of MC in the mained elusive. Kidney biopsy specimens were obtained course of several acute and chronic infections has suggested from 12 HCV RNA, antibody to HCV (anti-HCV)-positive that it may be induced by infectious agents.
patients with MPGN and type-II MC, and from 8 controlsAfter the cloning of hepatitis C virus (HCV) and the devel-(3 HCV RNA, anti-HCV-negative patients with MPGN opment of a specific serologic assay, a wealth of information and MC and 5 with noncryoglobulinemic ''idiopathic'' has been gathered on the role of this virus as the cause of MPGN). Murine monoclonal antibodies developed acute and chronic liver diseases, 2 as well as a variety of nonagainst c22-3, E2/NS1, c33c, c100-3, and NS5 proteins hepatic disorders.3-10 Several investigators 11-14 and ourwere used to detect HCV-related antigens by indirect selves 15,16 have reported a striking association between HCV immunohistochemistry. Acid electroelution of tissue infection and MC. Selective concentration of HCV RNA and sections was performed to enhance the sensitivity of the antibodies to HCV (anti-HCV) in the cryoprecipitates have immunohistochemical method. Specific HCV-related suggested that a specific role in the pathogenesis of MC proteins were detected in glomerular and tubulo-inter-should be assigned to cold-insoluble immune complexes (ICs); stitial vascular structures in 8 (66.7%) HCV-positive MC in those complexes, hepatitis C virions are bound to specific patients and in none of the HCV RNA, anti-HCV-negative IgG antibodies that are cross-linked by IgM with RF activity, controls. HCV immunoreactive deposits displayed the most commonly of the WA type, a germline gene-encoded following two major patterns: 1) a linear, homogeneous product.
deposition along glomerular capillary walls, includingRecent indirect evidence also indicates that HCV may be endothelial cells and sub-endothelial spaces; and 2) a a major cause of cryoglobulinemic and ''idiopathic'' membragranular bead-like appearance with distinct deposits in noproliferative glomerulonephritis (MPGN). [17][18][19][20][21] In this remesangial and paramesangial cells. Immunoglobulin G port, we present immunomorphological evidence of HCV anti-(IgG) and M (IgM) and C3 fraction deposition in adjacent gens in the glomerular and vascular str...