Background: A modified single antigen bead (SAB) assay measuring C1q binding to human leukocyte antigen antibodies has recently been introduced. The aim of this study was to investigate the determinants of C1q binding on SAB.
Methods: Sera from 73 sensitized patients were analyzed by the generic IgGpan as well as IgG subclass specific SAB assays and correlated with the standard and an anti-human globulin (AHG) enhanced C1q test.
Results: Among 2,665 SABs with positive IgGpan results (mean fluorescence intensity [MFI]>500), strong complement-binding IgG1 and IgG3 subclasses accounted for a median of 99% (interquartile range, 76%–100%) of the total IgG amount. IgGpan MFI alone showed a very strong association with standard C1q positivity (r2=0.72), which was superior to a model including all IgG subclass MFI (r2=0.62). Combining all IgG subclass MFI and IgGpan MFI only marginally improved the prediction of standard C1q positivity compared with IgGpan MFI alone (Δr2=0.02). IgGpan MFI greater than 14,154 predicted standard C1q positivity, with 92% sensitivity and 96% specificity. Notably, 1,840 (93%) of the 1,974 C1q-negative SABs contained human leukocyte antigen antibodies with strong complement-binding IgG1 and IgG3 subclasses. Anti–human globulin significantly enhanced the signal in the C1q assay, but the association of AHG C1q positivity with IgGpan MFI was less strong (r2=0.51).
Conclusion: C1q binding on SAB is strongly associated with IgGpan MFI. IgG subclass information only marginally improves prediction of C1q binding likely because complement-binding IgG1 and IgG3 subclasses dominate regarding frequency and relative amounts. A negative C1q assay result does not indicate the absence of strong complement-binding IgG subclasses.
1 Transplantation Immunology and Nephrology, University Hospital Basel, Switzerland.
2 Clinical Epidemiology, University Hospital Basel, Switzerland.
3 Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
4 Address correspondence to: Robert Liwski, M.D., Ph.D., F.R.C.P.C., HLA Typing Laboratory, Queen Elizabeth II Health Sciences Centre, Department of Pathology and Microbiology & Immunology, Dalhousie University, 5788 University Ave, B3H 1V8, Halifax, Nova Scotia, Canada.
S.S. is supported by the Swiss National Foundation (grant 32473B_125482/1).
The authors declare no conflicts of interest.
S.S., G.H., R.L., and P.A. participated in the research design. S.S., G.H., R.L., and P.A. participated in the writing of the paper. G.H., R.L., and P.A. participated in the performance of the research. S.S., M.T.K., and R.L. participated in the data analysis. M.T.K. and R.L. contributed analytic tools.
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Received 20 January 2014. Revision requested 4 February 2014.
Accepted 25 March 2014.