Antiglobulins, cryoglobulins and glomerulonephritis

RICHARD J. GLASSOCK Introducing a scientific symposium is an uncertain and difficult task. The remarks must not be too specific lest the participant's later contributions be intruded upon, yet an overview of the goals and objectives of the conference should be presented in an inquisitive and stimulating fashion. Perhaps a compromise position would be to make a few general statements and pose a limited number of questions which hopefully would then be addressed dur­ ing the formal or informal portions of the meeting. A conclusion incorpo­ of the relevance of the specific topic to the more rating some perspectives global issues of disease and its consequences might be appropriate. The goals and objectives of this conference, as set forth by its organizers, Professors Ponti celli, D'Amico and Minetti, are rather simple and straight­ forward; namely, to review and elucidate the immunopathophysiology of cryoimmunoglobulins and auto-antibodies to immunoglobulins (lg) and, secondarily, to explore the possible participation of these disordered states in glomerular injury. As such, this conference is principally devoted to an analysis of two properties of certain species of the globulin fraction of serum proteins, specifically the ability to self associate on the basis of immune interactions and to form insoluble aggregates when exposed to reduced ambient temperature. As we shall see, these two properties are often dis­ tinctly related.

Inhalt

I. Physiology and Pathology of Antiglobulins.- 1. Subsets of Rheumatoid Factors Determined by Cross Idiotypes.- 2. Structure and Function of Rheumatoid Factors: Implication For Its Role in The Pathogenesis of Mixed Cryoglobulinemia.- 3. Regulatory Idiotypes and Diseases.- Discussion.- II. Role of Antiglobulins in Experimental Glomerulonephritis.- 4. Pathogenetic Mechanisms of Infective Endocarditis Glomerulonephritis in The Rabbit.- 5. Interactions of Human IgM Rheumatoid Factors With Immune Complexes in Experimental Murine Glomerulonephritis.- 6. Anti-Idiotypic Antibodies in Glomerulonephritis and in Tubulointerstitial Nephritis Models in Immune Renal Injury.- 7. Experimental Analysis of The Generation of Pathogenic Immune Complexes Resulting From Immunoglobulin Interactions.- Discussion.- III. Classification of Cryoglobulins and Biochemical Factors Inducing Cryoprecipitation.- 8. Classification of Cryoglobulinemias.- 9. Intrinsic Properties Inducing Precipitation of Cryoglobulins.- 10. Cryoprecipitation as a Consequence of Globulin-Antiglobulin Interactions.- 11. Fibronectin Is a Regular Component of Single-Type and Mixed Cryoglobulins.- Discussion.- IV. Immunological Aspects of Essential Mixed Cryoglobulinemia.- 12. Complement Activation in Patients With Mixed Cryoglobulinemia.- 13. Human Type II Mixed Cryoglobulins as a Model of Idiotypic Interactions.- 14. Monoclonal Antibodies to Idiotypic Determinants on Monoclonal Rheumatoid Factors.- Discussion.- V. Clinical and Morphological Findings in Essential Mixed Cryoglobulinemia.- 15. Mixed Cryoglobulinemia: An Update of Recent Clinical Experience.- 16. Histological and Himmunohistological Features in Essential Mixed Cryoglobulinemia Glomerulonephritis.- 17. Clinical and Histological Correlations in Essential Mixed Cryoglobulinemia (EMC) Glomerulonephritis.- 18. Ultrastructural Features in Glomerulonephritis in Essential Mixed Cryoglobulinemia.- 19. Prognostic Factors in Essential Mixed Cryoglobulinemia Nephropathy.- Discussion.- VI. Different Therapeutic Regimens in the Management of EMC Patients.- 20. Long-Term Management of Essential Mixed Cryoglobulinemia.- 21. Effects of Cryoapheresis on Plasma Cryoglobulins and Renal Function in Patients With EMC Glomerulonephritis.- 22. Treatment of Renal Disease in Essential Mixed Cryoglobulinemia.- 23. Long Term Treatment of Mixed Cryoglobulinemia (MCG).- Discussion.- Concluding remarks.