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Induction of in vitro heart block is not restricted to affinity purified anti-52 kDa Ro/SSA antibody from mothers of children with neonatal lupus

Division of Rheumatic Diseases, University of São Paulo, SP 01246-903 Brazil

S Garcia

J HM Nascimento

Instituto de Biofisica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, RJ 21949-900 Brazil

K B Elkon

Hospital for Special Surgery, Cornell University, NY 10072

N Brot

Institute of Molecular Biology, Roche Center, NJ 07110

A C Campos de Carvalho

Instituto de Biofisica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, RJ 21949-900 Brazil

E Bonfá

Division of Rheumatic Diseases, University of São Paulo, SP 01246-903 Brazil

The ability of affinity purified anti-52 kDa Ro/SSA antibody from patients without obstetric history of neonatal lupus to cause heart block using an experimental model was investigated. IgG-enriched fractions from sera of 20 systemic lupus erythematosus (SLE) and one Sjögren's syndrome (SS) all positives for anti-Ro/SSA antibodies as detected by CIE, were perfused on isolated whole rabbit hearts. Only six (29%) samples induced A-V block, five of them presenting low anti-Ro/SSA titre. All of them recognized the 52 kDa isoform on ELISA whereas only one had a concomitant binding to the 60 kDa protein. Moreover, affinity purified antibodies from two sera previously known to induce A-V block were obtained by affinity chromatography using a column containing the full-length 52 kDa Ro/SSA fusion protein. Paired eluate and effluent devoid of anti-52 kDa activity from the same patient were individually perfused in whole hearts. The ability to cause cardiac blockade was restricted to the affinity anti-52 kDa eluates. In addition, anti-52 kDa eluates from three IgG fractions that primarily failed to induce blockade remained ineffective. The present study has added to our knowledge that affinity anti-52 kDa Ro/SSA antibodies from mothers with healthy infants are capable of causing in vitro cardiac conduction disturbances. A prospective follow up of these patients will better delineate the clinical usefulness of this experimental model.

Key Words: systemic lupus erythematosus • neonatal lupus erythematosus • congenital heart block • autoimmunity • autoantibodies

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