Background
Systemic lupus erythematous (SLE) is a chronic autoimmune disease characterized by widespread loss of immune tolerance to self-antigens. Pathogen recognition and subsequent immune responses are potentially the important initiators of autoimmunity in genetically predisposed persons. Emerging evidence indicates that in patients with lupus, exposure to human cytomegalovirus (HCMV) or Epstein-Barr virus (EBV), often precedes the onset of tolerance break [
1‐
3]. EBV is the most studied example for cross-reactive autoantibody-mediated autoimmunity. Cross-reactivity of anti-Epstein Barr virus antigen-1 (EBNA-1) antibody to Ro or spliceosomal proteins has been reported [
4‐
6]. Anti-Sm antibody has been found to cross-react in EBNA-1-immunized animals, underlying the molecular mimicry between these antigens [
7‐
10].
HCMV, a ubiquitous opportunistic pathogen, induces 60 kD/Ro expression on the surface of human keratinocytes [
11]. Immunization of lupus-prone mice by HCMV recombinant glycoprotein B (gB) results in the production of significant autoantibody to the U1-70 kDa spliceosome protein [
12]. Also, the significant correlation between antibody to HCMV and U1 small nuclear ribonucleoprotein (snRNP) in HCMV-infected patients with SLE implies that HCMV infection is associated with the development of SLE [
13]. In addition, immunization of BALB/c mice with a surrogate octapeptide, DWEYSVWLSN, which induces anti-dsDNA antibody, suggests that the shared structural similarity of antigenic determinants among pathogens and self-proteins leads to autoantibody production [
14]. The DNA-interacting amino acids of necrotic cells from post-infected hosts may contribute to induction of anti-dsDNA antibodies [
15].
HCMV phosphoprotein 65 (pp65) is a viral scaffold protein and the most abundant constituent of the extracellular viral particle [
16]. The pp65 is involved in modulating viral kinase activity and attenuating host antiviral responses [
17,
18]. The pp65 protein is a target of both cellular and humoral immunity in healthy individuals, but dominant T cell epitope(s) leads to the robust cellular responses such as cytotoxic T lymphocyte response [
19,
20]. Highly elevated anti-pp65 titers in patients with SLE and immunization of NZB/W F1 mice by pp65 induces early onset of lupus-like symptoms, implying a potential role of pp65 in SLE [
21].
The immunization of truncated pp65
336-439-conjugated C3d has been shown to induce lupus-like autoantibodies and subsequent development of autoimmunity [
22]. The current study aims to further identify the autoantibody-inducing B cell epitope(s) within pp65
386-439 and the potential pathogenic immune response.
Methods
Characteristics of the study populations
All patients were recruited from the clinics of Chang Gung Memorial Hospital, and rheumatology specialists confirmed that all patients fulfilled the 1982 and 1997 American College of Rheumatology (ACR) diagnostic criteria for SLE [
23,
24] This study was approved by the Institutional Review Board of Chang Gung Medical Foundation. The study of methods was carried out in accordance with the relevant guidelines and informed consent was obtained from all subjects.
Mice
Normal female BALB/c mice, 3–5 weeks old, were purchased from the National Laboratory Animal Center (NLAC), Taiwan. Animals were housed in a pathogen-free facility with an independent ventilation cage system at the laboratory animal center of Chang Gung Memorial Hospital. All BALB/c mice were 8 weeks old at inoculation.
Synthetic peptides
For all synthetic peptides, the purity of the peptide was >95%, per the peptide manufacturer (GenScript, NJ, USA). The preparation of peptides followed the manufacturer’s instructions (20 μg/μl), with storage at -80 °C prior to use. Six histidines and one cysteine were added at the C terminus of the peptide as a target or for crosslinking to a carrier protein via a disulfide bond.
Plasmid construction
The full-length pp65 sequence was amplified from pCMV6-pp65 (SKU VC101263, Origene, FJ527563) using the following paired primers (forward 5′GCGGATATCATGGAGAGCCGGGGCCGG, reverse 5′ GCGGGATCCGCCTCTATGCTTCTTGGG). The pp65 sequence was prepared from PCR and digested by EcoRV/BamHI, then ligated into pET30. The murine C3d encoding sequence (GenBank: DQ408205) was PCR-amplified with C3d primers (forward 5′CGCGGATCCATGACCCCCGCAGGCTGTGGG, reverse 5′CGCGCTCGAGGCTACGGCTGGGGAGGTG) and ligated into pET30.
Antigen preparation
The C3d biotinylation (Pierce, Thermo Scientific, IL, USA) and streptavidin (SA) (Pierce) conjugation were performed as per the manufacturers’ protocol. In brief, maleimide-activated streptavidin (Pierce) was conjugated with peptide containing reduced disulfide bonds from a disulfide reducing gel (Pierce) and mixed with biotinylated C3d to form the peptide-SA-biotin-C3d tetramer, including pp65386-403, pp65422-439 and SA-C3d only. Tetramers were generated and prepared for immunization within 4 hours.
Immunization and serum collection
Female BALB/c mice (n = 28) were randomly separated into groups receiving pp65386-403- (n = 9), pp65422-439-C3d (n = 9), SA-C3d (n = 5) or PBS (n = 5). Mice were inoculated subcutaneously with 100 μg (2 μg/μl) pp65386-403-C3d, pp65422-439-C3d, SA-C3d or 50 μl PBS in complete Freund’s adjuvant (CFA, Sigma Aldrich, MO, USA) at day 0, respectively. Boosting was performed with antigens in incomplete Freund’s adjuvant (IFA, Sigma Aldrich) at day 14, day 28 and day 42. Mice were bled via the retro orbital vein one day prior to each assay and at 2-week intervals. Unused serum was stored at -80 °C and the PBS-diluted seruma was kept at 4 °C.
Antibody preparation, biotinylation and streptavidin conjugation
Recombinant proteins were over-expressed in
Escherichia coli with 1 mM isopropyl β-D-thiogalactoside induction (IPTG, Sigma Aldrich) and purified by a nickel affinity column (Sigma Aldrich). Antibody preparation was performed as previously described [
22]. In brief, moderated cyanogen bromide (CnBr) powder (Sigma Aldrich) was activated following the manufacturer’s protocol. A total of 2 mg of four tandem repeats of the pp65
422-439 peptides (GGGSGGGAMAGASTSAGRKRKS) was dissolved by gentle rotation in a coupling buffer (0.1 M NaHCO
3, 0.5 M NaCl, pH 8.3) with activated CnBr gel at 4 °C overnight. The free active groups on CnBr were deactivated by 0.1 M Tris-HCl (pH 8.0) at room temperature (RT) for 2 hours. After deactivation, CnBr gel was washed with alternating buffer (0.1 M NaAc, 0.5 M NaCl, pH 4.0 and 0.1 M Tris-HCl, 0.5 M NaCl, pH 8.0) twice and washed with 10 ml PBS once. For purification, 10 ml of serum from twenty dsDNA-positive or dsDNA-negative patients with SLE with pp65
422-439 antibody in 20 ml PBS, respectively, were added to pp65
422-439-conjugated CnBr gel and rolled at 4 °C overnight. The flow-through was collected and concentrated as a negative control, while bound antibodies were eluted by 1 ml of 0.1 M glycine (pH 2.0). The eluted samples were neutralized immediately with 30 μl of neutralizing buffer (1 M Tris-HCl, 2 M NaCl, pH 8.8).
Enzyme-linked immunosorbent assay (ELISA)
ELISA was performed as previous described [
22]. Briefly, for the anti-pp65 peptide (pp65
386-439, pp65
386-403, pp65
396-413, pp65
404-421, pp65
414-431, pp65
422-439 and nine pp65
422-439-derived decapeptides) or anti-dsDNA antibody assay, 1 μg/well of synthetic peptide or purified calf thymus dsDNA (Sigma Aldrich) in coating buffer (150 mM Na
2CO
3, 150 mM NaHCO
3, pH 9.6) was coated to a microtiter 96-well plate (Greiner Bio-One, CA, USA) at 4 °C overnight. After blocking with 5% skimmed milk, 250× diluted human or mice serum, 3 μg purified pp65
422-439 antibody or 1 μg monoclonal antibodies in PBS were added and incubated at 37 °C for 2 hours.
For the competitive inhibition assay, anti-pp65422-439 purified antibody was co-incubated with 1 μg pp65422-439 or dsDNA in 200 μl PBS at RT for one hour. The mixture was transferred to one well of a 96-well plate coated with dsDNA or pp65422-439 for incubation at 37 °C for 2 hours. At the end of the incubation, the microtiter plate was washed four times with PBST (PBS with 0.05% Tween 20) and bound antibody was detected by horseradish peroxidase (HRP)-conjugated anti-human/mouse G/M or anti-mouse IgG subclasses (IgG1, IgG2a, IgG2b and IgG3) at a dilution of 1:5000 (Jackson ImmunoResearch Laboratories, PA, USA) at 37 °C for 2 hours. For detection of cross-reactivity to host proteins, 1 μg/well of homogenized HEK293T cell lysate was coated on a microtiter plate at 4 °C overnight. After blocking, mice serum was diluted and bound antibodies were detected as described above. O-phenylenediamine dihydrochloride (OPD, Sigma Aldrich) was used as the substrate in ELISA buffer (250 mM Na2HPO4, 175 mM C6H8O7, pH 5.0) and HRP activity was read at 450 nm with a micro ELISA reader (Molecular Devices).
Western blot/slot blot
Full-length pp65 protein (40 μg/per gel) was separated by 12% SDS-PAGE (slab gel format). Separated protein was transferred to nitrocellulose paper, blocked by 5% skimmed milk and then analyzed with 1 μg/ml anti-His-tag antibody (eBioscience, CA. USA), 100× diluted human sera or 3 μg purified pp65422-439 antibody in PBS at RT for 2 hours. Antibody reactivity was detected by HRP-conjugated secondary antibody (Jackson ImmunoResearch Laboratories) and chemiluminescent detection reagent (Millipore, MA. USA).
Anti-nuclear antibodies, C. luciliae and kidney immunofluorescence stain
Mouse serum was tested for anti-nuclear antibodies (ANAs) at 1:100 dilutions in PBS using a standard anti-nuclear antibody (ANA) test (Diasorin, Saluggia, Italy). The reactivity of anti-dsDNA antibody was examined by immunofluorescence stain using the C. luciliae test (Diasorin) at dilutions of 1:20, 1:40 and 1:80 in PBS, as per manufacturer’s instruction. In brief, 30 μl of diluted mice serum, 3 μg purified pp65422-439 antibody or 1 μg monoclonal antibodies were incubated on a slide coated with HEp-2 or C. luciliae at RT for 30 minutes in a humidified chamber. Slides were washed three times in 50 ml PBS at RT for 10 minutes each.
Bound antibodies were detected by 100× diluted FITC-conjugated anti-mouse IgG/M (Jackson ImmunoResearch Laboratories) at RT for 30 minutes in a darkened and humidified chamber. For nuclear visualization, the HEp-2 slide was incubated in 30 μl of 4',6-diamidino-2-phenylindole (DAPI) (1 mg/ml, Sigma Aldrich) at RT for 5 minutes in the dark. At the end of staining, slides were washed with PBS for 30 seconds and mounted via mounting medium (Diasorin) for investigation by fluorescence microscopy (Olympus DP72). For immunofluorescence staining of the glomerulus, kidneys were removed from the mice, immediately placed in optimal cutting temperature (OCT) gel and frozen at -80 °C for 24 hours. The 5-μm-thick frozen sections were stained with FITC-conjugated anti-mouse IgM/G (Jackson ImmunoResearch Laboratories) at a 1:100 dilution in PBS at RT for 30 minutes in a humidified chamber in the dark. After PBS washing, coverslips with mounting medium (Diasorin) on tissue slides were prepared for investigation by fluorescence microscopy.
Hybridoma preparation
The hybridoma was prepared following the manufacturer’s instructions (Roche, Basel, Switzerland) with minor modifications. Briefly, the mouse spleen cells were mixed at a ratio to Sp2/0-Ag14 of 5:1 (ATCC, VA, USA) in a sterile 50-ml conical tube, which was centrifuged to pellet the cells at 800 rpm for 10 minutes. After discarding the supernatant, 1 ml of 50% PEG 1500 (Roche) was slowly added to the cell pellet dropwise over a 1-minute period and the cells were swirled for 90 seconds in a 37 °C water bath. Cell fusion was stopped by adding Roswell Park Memorial Institute medium (RPMI) 1640 (Gibco, CA, USA) containing 10% fetal bovine serum (FBS, Invitrogen, CA, USA) with gentle swirling at RT for 10 minutes. After washing with RPMI 1640 twice, cells were suspended in 30 ml of RPMI1640 supplemented with 10% FBS, 10% BM Condimed H1 (Roche) and 1x HAT (Gibco), plated 2.5 ml per well in a 6-well culture dish and incubated at 37 °C in a 5% CO2 incubator. Limiting dilution was carried out for selection of a single colony, which was amplified in RPMI 1640 supplemented with 10% FBS, 10% BM Condimed H1 (Roche), 1× HT (Gibco) and 1x hybridoma fusion & cloning supplement (Roche). The supernatant was harvested for ELISA of antibody activity to pp65422-439.
Statistical analysis
Statistical differences in titer and prevalence were analyzed using GraphPad Prism (GraphPad Software Inc.). The Student t test, two-tailed Fisher’s test, and Mann-Whitney test were used for these comparisons with graphs depicting mean ± SEM. A 5% level of significance for p values was used for all analyses.
Discussion
Viral peptide-induced autoimmunity in animal models is an emerging field but the underlying mechanisms are not well-understood. Immunization of EBNA-1 or its fragment has been demonstrated to elicit not only immune response to viral antigen, but also IgG activity to 60 kD Ro, SmB/B’ and dsDNA [
4,
26,
27]. Herein, we report the high prevalence of serum anti-pp65
422-439 antibody in patients with SLE. Also, immunization of BALB/c mice with pp65
422-439-induced cross-reactive autoantibodies against nuclear antigens of host cells, particularly dsDNA, and developed initial signs of nephritis with Ig deposition at 14 weeks post immunization. However, our mapping is unable to completely exclude the possibility that there were discontinuous epitopes, because the B cell epitopes were examined from pp65
386-439 to pp65
422-439. The higher incidence of anti-pp65
422-439 activity in patients with SLE and the instigation of autoimmune-like antibodies through immunization of pp65
422-439 in BALB/c mice suggested that immunity to pp65
422-439 might drive pathogenic potential for SLE through epitope spreading and triggering autoantibody production in genetically susceptible individuals.
In our competitive inhibitor assay (Fig.
2b, c), pp65
422-439 antibody from SLE-dsDNA(+) cross-reactive with dsDNA was not inhibited completely by pp65
422-439, suggesting that more complex antibody repertoires, for example antibodies that recognize discontinuous epitopes, were obtained from SLE-dsDNA(+) through affinity purification by four tandem-repeats of pp65
422-439. In addition, pp65
422-439 antibody from SLE-dsDNA(-) exhibited anti-dsDNA reactivity, but was negative on
C. luciliae stain. These results were suggested that the anti-dsDNA activity in the ELISA might be due to relatively weak anti-dsDNA reactivity of concentrated anti-pp65
422-439 antibody from SLE-dsDNA(-). On the other hand, the increase in antibodies to HEK293 and dsDNA observed in SA-C3d-immunized mice at 8 week post-immunization might result from polyclonal B cell activation. However, we did not observe this phenomenon in our analysis of anti-pp65
422-439 antibody against pp65
386-439. The absorption and analysis of the B cell repertoire in response to pp65
422-439 may play a critical part in autoimmunity require further validation.
HCMVpp65 is a well-known T cell antigen in healthy individuals [
19,
20]. HCMV pp65 and pp65
336-439-induced weak humoral responses were verified in healthy humans and BALB/c mice [
21,
22]. Unlike normal or other disease controls, anti-pp65
422-439 antibody occurs more frequently and has higher specificity in patients with SLE, particularly in anti-dsDNA-positive patients. Elevated anti-pp65
336-439 antibody titers were measured in patients with SLE, but there was no statistically significant relationship between anti-pp65
336-439 reactivity and serum dsDNA antibody [
22].
These observations imply that pp65
422-439 may contain one more representative epitope, which is associated with the production of anti-dsDNA antibody. Regarding the improvement of immunogenicity of pp65 peptides in the BALB/c model, mouse C3d acts as molecular adjuvant for interplay between innate and adaptive immunity [
25]. Immunization of truncated pp65
336-439 attached to C3d has been demonstrated to induce the development of autoimmunity [
22]. In contrast, complete Freund’s adjuvant alone was unable to elicit chronic autoimmunity (data not shown). Immunization of pp65
422-439 with C3d to BALB/c mice was sufficient to induce anti-pp65
422-439 antibody. The transient humoral response to pp65
422-439, also observed in pp65
336-439-immunized BALB/c mice, indicates that genetic background plays a vital role in exacerbation of SLE.
Anti-dsDNA antibody has served as a critical immunological biomarker and diagnostic criterion for SLE [
23,
24]. BALB/c mice challenged by a surrogate peptide have been reported to induce anti-dsDNA antibodies [
14]. The nephritogenicity of anti-dsDNA antibody has been shown to mediate cross-reactivity to alpha actinin and annexin II [
28,
29]. Also, lupus autoantibodies binding to DNA/nucleosome fragments released from apoptotic cells were observed in the glomerular matrix [
30]. Immunization using pp65 or its truncated form has been previously shown to induce multiple anti-nuclear antibodies and anti-dsDNA antibody in BALB/c mice [
22]. As expected, anti-dsDNA serum from patients with SLE had anti-pp65 reactivity, particularly to the pp65
422-439 region. Notably, patients with SLE were double positive to pp65, and simultaneously dsDNA chromatin/nucleosome stain was positive. The anti-pp65 antibody that reacted to dsDNA and chromatin/nucleosome was previously verified in animals immunized for pp65
336-439 [
22].
It has been suggested that anti-nucleosome antibodies are sensitive and specific for lupus nephropathy and the correlation of the antibody titers represent a better biomarker of SLE global disease activity [
31,
32]. These consistent results of human and animal studies imply that pp65
422-439 peptide may possess one critical epitope contributing to the development of SLE. However, the limitations of the present study using stored serum from a cross-sectional study require future study to document their clinical associations with lupus nephropathy and the SLE disease activity damage index.
Following immunization of pp65
422-439, antigen-specific IgG and IgM were analyzed at 4, 8 and 14 weeks post immunization. This pp65
422-439 immunization scheme elicited antibodies reactive against antigens from HEK293T cells and produced ANA stain patterns resembling those found in anti-pp65
422-439-purified antibody stains from patients with SLE. The appearance of autoantibodies in patients with SLE is an indicator of subsequent lupus disease onset [
33]. The anti-dsDNA antibodies play critical roles in lupus nephritis; however, elevation of autoantibodies, particularly anti-dsDNA antibodies, has been identified in double-transgenic BALB/c mice expressing both the R4A-gamma2b heavy chain and the anti-apoptotic bcl-2 gene, but the mice did not develop nephritis [
34]. In the current study ELISA and the
C. luciliae assay demonstrated anti-dsDNA reactivity to pp65-purified human antibodies and pp65
422-439-immunized serum. The pp65
422-439 immunization scheme not only elicited anti-dsDNA antibodies, but also initiated early-phase kidney damage in BALB/c mice. In the near future, we speculate that pp65
422-439 reactivity in combination with anti-chromatin/nucleosome and dsDNA antibodies may better fit as a surrogate biomarker of lupus nephropathy inflammation and damage [
35,
36].
On terms IgG isotype analysis, both dsDNA and pp65
422-439-specific IgG were detected in serum from immunized animals, with IgG
1 and IgG
3 isotypes. Mouse IgG
3 is involved in the pathogenic autoimmunity, especially immune complex depositions and glomerulonephritis [
37]. IgG
3 production has been proposed as a critical factor in nephritis among MRL/lpr mice [
38]. Similar to human IgG
2, T-cell-independent mouse IgG
3 mainly recognizes carbohydrate epitopes [
39]. Human IgG
1 and IgG
2 isotypes of anti-nucleohistone and anti-dsDNA antibodies are the predominant isotypes found in plasma from patients with lupus who have renal disease [
40]. In pp65
422-439 immunization, elevated serum titers of anti-dsDNA IgG
1 and IgG
3 antibodies positively correlated with the severity of immunoglobulin deposition in glomeruli. Nevertheless, the current study did not provide sufficient evidence to fully explain the causal relationship between pp65-induced anti-dsDNA antibodies and nephritis development in BALB/c mice. The role of pp65
422-439-induced autoantibodies in glomerular injury required verification by further study.
Three dominant immunological epitopes, pp65425-434, pp65428-437 and pp65430-439, elicited IgG and/or IgM activities at different immunological stages. In the first 4 weeks of immunization, IgG was targeting pp65428-437. By 8 weeks post immunization, IgG reacted to pp65425-434, pp65428-437 and pp65430-439, likely as a consequence of epitope spreading. After 14 weeks post immunization, IgG remained active in response to pp65425-434 and pp65430-439 but lost its activity in response to pp65428-437. These findings correlated with our mAb, which had reactivity to pp65425-434 and pp65430-439. The positive response of mAb P1 and P2 to both dsDNA and pp65430-439 suggests that pp65430-439 may contain elements that induce the anti-dsDNA response. The anti-dsDNA IgG activities were detected at 4 weeks post immunization with pp65425-434 and pp65428-437. As mAb P3 and P4 did not possess anti-dsDNA activity, this implies a strong association between anti-pp65428-437 and anti-dsDNA activity. Moreover, the anti-pp65428-437 activity was well-aligned with anti-dsDNA responses, as seen at weeks 4, 8 and 14 post immunization (Table 2). In humans, pp65428-437 is a target for pp65 and dsDNA-specific serum from patients with SLE. These findings suggest that pp65428-437 is a potential candidate epitope for promoting anti-dsDNA responses.
The issues of possible factors involved in molecular mimicry and epitope spreading have been widely discussed. The specific amino acid residues interacting with DNA, arginine (R), asparagine (N) and lysine (K), from either virus or necrotic cells, for somatic mutation, occurred during clonal expansion supports the hypothesis that peptide antigen has the potential to elicit the generation of anti-dsDNA antibody [
15]. The amino acid 428-439, ASTSAGRKRKSA, of pp65 may contain one hot spot to provoke anti-dsDNA antibody production. However, this hypothesis cannot fully explain the discrepancy in the function of anti-pp65
422-439 antibodies in dsDNA-positive and dsDNA-negative patients with SLE. We speculate that genetic background bias and preference of major histocompatibility complex (MHC) presentation may be together implicated in autoantibody production and subsequent SLE development.
Over the past few decades, study of HCMV has focused on the high-passage HCMV strain Towne, and AD169, and research into their potential capacity through efficient replication in human fibroblasts. In HCMV infection, pp65 is transported into the nucleus immediately through two nuclear localization sequences, pp65
418-438 and pp65
537-561 [
41]. The binding of pp65 to metaphase-arrested chromosomes in pp65-expressing fibroblasts during virus infection implies that pp65 may not bind to host proteins, but also forms immune-complex to genetic materials and nuclear components [
42]. The SV40 large T-antigen of human polyomaviruses has been demonstrated to form a T-antigen/nucleosome complex, subsequently targeted by host immune responses and accelerates the generation of cross-reactive antibodies against both virus and host during viral replication [
43]. Therefore, full-length or fragmented pp65 binding to immune-complexes formed from nuclear binding proteins may not only be targeted by antiviral antibodies but also increase the opportunity for B cell epitope spreading and lead to autoimmunity in genetically susceptible individuals. It is worth mentioning that pp65 shares high homology among different HCMV strains and the fragment of pp65
428-437, GASTSAGRKR, is highly conserved in HCMV strains such as Towne (pp65
418-427), AD169 (pp65
428-437) and Toledo (pp65
428-437).
In patients with SLE, dsDNA-reactive IgM has been proposed as a protective mechanism that ameliorates autoimmunity and exhibits a negative association with lupus nephritis [
44]. Up to now, three possible hypotheses have been proposed to explain how IgM antibody modulates autoimmunity. First, the elevated titer of IgM antibody acts as a competitive role binding to circulating antigens to decrease the formation of the IgG immune complex [
45]. Second, IgM antibody downregulates autoreactive B cells to reduce the secretion of pathogenic IgG antibody [
46]. Third, the uptake of IgM immune complex by phagocytic cells is more effective in preventing glomerular deposition of immune complex [
47]. In pp65
422-439 immunization, after immunization IgM initially targets the entire pp65
422-439 with elevated titers to pp65
425-434. Elevation of IgM to pp65
428-437 at 8 weeks post immunization was detected after major elevation of IgG response to the same epitope. The IgM response to pp65
428-437 is linked to anti-dsDNA activities (Additional file
4: Figure S3). However, after autoreactive anti-pp65
428-437 IgG production, the upregulated IgM subsequently reduced anti-pp65
428-437 IgG levels, suggesting that pp65
428-437-specific IgM may be involved in alleviating the autoimmune response through the immune system in the non-autoimmune strain of BALB/c mice. More studies are needed to test the correlation between different classes of Ig and immune responses to specific autoantigens.