Connective tissue activation. xxxvi. the origin, variety, distribution, and biologic fate of connective tissue activating peptide–iii isoforms: characteristics in patients with rheumatic, renal, and arterial disease

Abstract

Objective. To determine the origin, distribution, and biologic fate of platelet-derived connective tissue activating peptide–III (CTAP-III), to define the relative amounts of the antigen forms (CTAP-III, betathromboglobulin [Β-TG], neutrophil activating peptide–2 [NAP-2]) in plasma of normal persons and those with rheumatic or end-stage renal disease, and to define the isoforms of CTAP-III in platelets, plasma, transudates, and tissue deposits. Methods. CTAP-III in plasma was measured by enzyme-linked immunosorbent assay, and growth promoting activity of CTAP-III isoforms was tested in synovial and peritoneal cell cultures by measuring increased synthesis of 14 C-glycosaminoglycan ( 14 C-GAG) and 3 H-DNA. Isolated CTAP-III was characterized by Western blotting, microsequencing, and mass spectrometry. Results. CTAP-III was the primary isoform of this antigen family in normal platelets and platelet-rich plasma; Β-TG and NAP-2 accounted for <1% of CTAP-III isoforms. Previously undescribed isoforms, i.e., CTAP-III des 1, des 1–2, des 1–3, and a phosphate adduct of CTAP-III, were observed in varying amounts. Elevated plasma levels of CTAP-III antigen were found in a substantial fraction of rheumatic disease patients: 24% of those with rheumatoid arthritis, 36% of those with systemic sclerosis, and 15% of those with systemic lupus erythematosus. All 10 patients with end-stage kidney disease had marked elevations of plasma CTAP-III levels, which stimulated DNA and GAG synthesis by peritoneal cells in culture. Only large isoforms (such as CTAP-III) were detected in venous plasma of normal subjects, rheumatic disease patients, and patients receiving long-term dialysis. Normal human spleen and kidney contained substantial (Μ/gm) amounts of CTAP-III and traces of an isoform with the electrophoretic mobility of CTAP-III des 1–15/NAP-2. Liver, lung, and urine contained lesser (ng/gm) amounts of CTAP-III. Conclusion. These data show that, among the 10 known isoforms, intact CTAP-III itself was the major circulating isoform (>90%), and Β-TG was the most rare (0–1%). Deposition of CTAP-III in tissues, such as synovium, spleen, and kidney, is associated with partial processing to NAP-2–like isoforms and the potential to induce neutrophil and fibroblast activation in patients with rheumatic or end-stage renal disease.