Introduction
A pathological hallmark of Alzheimer’s disease (AD) and more than 25 other incurable protein misfolding diseases, called the amyloidoses, is the extracellular deposition of amyloid fibrils from unrelated proteins or peptides [
1]. The primary culprits for AD are prefibrillar amyloidogenic assemblies of amyloid beta (Aβ), a proteolyzed transmembrane 39–43 fragment of amyloid precursor protein [
2‐
4]. However, fibril deposition may be the primary toxic event for several non-AD amyloidoses, including primary AL amyloidosis [
5].
Currently, immunotherapy directed against amyloidogenic protein is the primary therapeutic approach for AD and is a recent strategy for other amyloid-associated disorders [
6]. Active vaccination with Aβ or passive administration of anti-Aβ antibodies has shown promise in AD animal models and in some AD patients by inducing neuritic plaque clearance, neutralizing neurotoxic Aβ oligomers, and/or improving cognitive functioning [
7‐
9]. Antibodies that specifically react with pathogenic amyloidogenic aggregates that do not bind to the normally secreted precursor protein are less likely to have adverse effects. Presumably, such natural IgG antibodies contained in intravenous immunoglobulin (IVIG) are at least partly responsible for its promising clinical effects [
10,
11]. We have recently shown that these antibodies cross-react with conformational epitopes on amyloid fibrils and oligomers, including binding to cross-linked β-amyloid protein species (CAPS) [
12]. These antibodies also inhibit in vitro amyloid fibril growth and expedite the clearance of patient-derived amyloid in mice [
12,
13]. The results of our studies on a large number of plasma donor specimens provide new information on the extent and specificity of natural anti-amyloidogenic conformer-reactive IgGs, which are contained in presumably healthy individuals.
Discussion
Given the urgent need for novel therapeutics and diagnostics for amyloid-associated disorders, it is vital that we advance current limited understanding about the prevalence, clinical significance, and physiological function of naturally occurring anti-amyloidogenic conformer IgGs. Our findings demonstrate that these antibodies are inherently present in normal plasma, independent of donor age (∼19–60 years old) or gender. The unique manner in which these IgGs bind to amyloid fibrils and oligomers is evident from their ability to maintain reactivity in the presence of endogenous plasma molecules, several of which bind to Aβ [
15]. Notably, these antibodies are also present in the plasma of children and naïve mice (B. O’Nuallain, A. Solomon, unpublished data, 2009) [
16]. This suggests that they may be part of the innate immune response for clearing endogenous/exogenous “misfolded proteins” by binding to amyloid fibril-like epitopes.
Previous studies have differed on the prevalence and age- and gender-related amyloidogenic conformer reactivity of natural plasma IgGs. [
16‐
18]. These discrepancies presumably reflected the limits of detection by the different assays. In some cases, these detection abilities were reduced when screening against disaggregated soluble Aβ with which natural antibodies are only weakly reactive as a result of a surface-induced amyloid-like epitope [
12] (Figs.
1 and
2). These discrepancies were unlikely due to screening plasma against different aggregated Aβ conformers, because we have shown that natural IgGs cross-react with common conformational epitopes on all amyloid fibrils or oligomers tested [
12,
13]. Although the current study showed no correlation between the age or gender of plasma donors and anti-amyloidogenic activity, it is possible that an association exists beyond the donor population age range of 19 to 60 years old [
17,
18]. However, screening normal plasma from presumably healthy elderly individuals older than 60 years is problematic because these samples are likely to contain an additional population of amyloid-reactive antibodies that are not naturally occurring but generated against pathologic Aβ assemblies, which may be present decades before AD is diagnosed.
The molecular basis for natural antibody–amyloidogenic conformer interactions has not been well defined. The epitopes involved are not exposed on native proteins and presumably contain unique higher-ordered structure and/or novel clusters of amino acids. Given that these IgGs react with conformational epitopes on “misfolded” protein aggregates, their binding may not involve complementary determining regions that are typically involved in antibody–antigen interactions. Preliminary studies using antibody fragments [F(ab’) and F(ab’)2] indicate that the Fc portion and/or hinge region are critical for natural human IgG binding to aggregated Aβ (B. O’Nuallain, A. Solomon, unpublished data, 2009). Such interactions may involve a complementary surface that is exposed on a partially unfolded antibody or a superantigen-like binding by the native protein. Nevertheless, antibody reactivity is not due to insoluble antibody aggregates because the same IgG reactivity with Aβ fibrils was obtained whether plasma was centrifuged or untreated.
The similar EC
50 values that were obtained for high- and low-reactive plasmas are intriguing and indicate that each sample contained a subpopulation of natural IgGs that had comparable avidity for amyloidogenic conformers (Figs.
1 and
2). However, these specimens had diverse maximum binding signal amplitudes, which indicate that each antibody subpopulation differed in its ability to bind to a variety of fibril-related conformational epitopes. Alternatively, this may have reflected the different propensities of the antibody subpopulations for multidentate binding to the same structural repeats.
Conclusions
We have established that natural IgGs contained in normal plasma produce inherent, but diverse, anti-amyloidogenic activity. Thus, the beneficial effect of IVIG in some AD patients [
10,
11] may have been due to the enriched diversity of each patient’s Aβ-reactive IgG pool. This diversity could have improved cognition [
10,
11] by the enhancement of neuritic plaque clearance [
13,
19], inhibition of fibril growth [
13,
20], neutralization of neurotoxic Aβ oligomers [
20], and reduction of Aβ brain pool. Taken together, our studies support future investigations of the clinical significance and physiological function of naturally occurring amyloidogenic conformer-reactive antibodies.
Acknowledgments
The work of Alan Solomon and Brian O’Nuallain was supported by Baxter BioScience. We thank Daniel Kestler, Jon Wall, and Charles Murphy for their helpful discussions.