Granulocyte immunofluorescence test has proven to be the best screening procedure for the detection https://www.selleckchem.com/products/RO4929097.html of neutrophil-specific antibodies [18, 19]. These direct and indirect methods

have the advantage of avoiding the non-specific binding of IgG and IgG immune complexes to the neutrophils [20]. Furthermore, flow cytometric analysis of GIFT can be used to detect antibodies of any subclass directly on the patient’s neutrophils or indirectly on donor neutrophils after incubation with the patient’s serum [21]. This study showed that autoantibodies bound to immature CD13-positive myeloid cells, resulting in myeloid lineage maturation arrest in the bone marrow. In addition, GIFT revealed that autoantibodies to neutrophils were produced and were associated with quantitative variation over time during the clinical course of the patient. Autoimmune neutropenia became increasingly severe as antibodies were directed against not only peripheral neutrophils, but also earlier precursors. Agglutination is the major neutrophil response to anti-neutrophil antibodies, and an activated complement system can cause neutrophil aggregation and adherence to endothelial cells [17]. Phagocytosis of neutrophils that are coated with anti-neutrophil antibodies is another probable mechanism for neutrophil destruction [17]. Furthermore, anti-neutrophil antibodies might have a role in the myelosuppression by inhibiting

the growth of granulocyte/macrophage colony-forming unit, or inhibition of bone marrow granulopoiesis by proinflammatory cytokines [16, 22]. In the buy LEE011 light of these considerations, we speculated that newly produced autoantibodies bound to either immature myeloid cells or circulating neutrophils and might have caused severe neutropenia in our patient. D-GIFT was negative in all subjects, even in the patient’s leukocytes obtained 89 days after onset when the KS inflammation had completely subsided. However, because of the retrospective analysis, we could not perform D-GIFT using the patient’s leukocytes in the middle of the KS inflammation. Given that the antibodies bound to immature CD13-positive myeloid

cells, we speculated that the maturational-specific antigens of the autoantibody on the myeloid precursor or neutrophil membrane increased during the acute or subacute phase of KS inflammation, Ergoloid and then gradually decreasing after the KS inflammation had subsided. We also revealed that the amount of autoantibody produced inversely correlated with the patient’s neutrophil counts throughout the patient’s hospitalization and outpatient clinic visits. Immune activation is a significant part of the pathogenesis of KS, characterized by an immunoregulatory imbalance that consists of an increased number of activated helper T cells and monocytes, a decreased number of CD8+ suppressor/cytotoxic T cells and marked polyclonal B cell activation [23].