High Prevalence of Anti-Apolipoprotein/A-1 Autoantibodies in Maintenance Hemodialysis and Association With Dialysis Vintage Menno Pruijm, 1 Jan Schmidtko, 1 Anthony Aho, 1 Sabrina Pagano, 2 Pascale Roux-Lombard, 2,3 Daniel Teta, 1 Michel Burnier, 1 and Nicolas Vuilleumier 2 1 Division of Nephrology and Hypertension, Department of Internal Medicine, University Hospital Lausanne, Lausanne, 2 Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine and 3 Division of Immunology and Allergy, Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland Abstract: Autoantibodies to apolipoprotein/A-1 (anti- ApoA-1 IgG) have pro-atherogenic properties in patients at high cardiovascular risk, but its prevalence in patients with end-stage kidney disease is unknown. The aims of this single-center, cross-sectional study were to assess the prevalence of anti-ApoA-1 antibodies in patients on maintenance hemodialysis (MHD), and to examine its correlation with inflammatory biomarkers related to atherosclerotic plaque vulnerability and dialysis vintage. To this purpose, anti-ApoA-1 IgG levels and the concentrations of interleukin-6 (IL-6), interleukin-8 (IL-8), monocyte chemoattractant protein-1 (MCP-1), metalloproteinase-9 (MMP-9), tumor necrosis factor-a, and C-reactive protein (CRP) were assessed in the sera of 66 MHD patients (mean age: 68  14 years, 36% women, 32% diabetics). Anti-ApoA-1 IgG positivity (defined as a blood value  97.5 th percentile of the normal distribution as assessed in healthy blood donors) was 20%. Circulating levels of anti-ApoA-1 IgG correlated positively with dialysis vintage, but not with cardiovascular risk factors or previous cardiovascular events; no significant correlations were found between the anti-ApoA1 IgG levels and circulating levels of IL-6, IL-8, MCP-1, MMP-9, CRP, or low-density lipoprotein-cholesterol. In multivariable linear regression, adjusted for age and sex, only dialysis vintage remained positively and independently associated with anti-ApoA-1 titers (b= 0.05, 95% CI: 0.006; 0.28, P = 0.049). In conclusion, the prevalence of anti-ApoA-1 IgG is raised in the MHD-population, and positively asso- ciated with dialysis vintage, a major determinant of car- diovascular outcome. Whether antiApoA-1 antibodies play a role in the pathophysiology of accelerated athero- sclerosis in the MHD-population merits further study. Key Words: Apolipoprotein/A-1, Atherosclerosis, Autoantibodies, Cardiovascular risk, Inflammation, Main- tenance hemodialysis. End-stage renal disease (ESRD) is associated with a high burden of mortality, mainly due to cardiovas- cular complications (1). Premature cardiovascular disease (CVD) in ESRD and maintenance hemodi- alysis (MHD) patients has been attributed to the superimposition of both traditional CV and non- traditional CV risk factors (2). Among the non- traditional CV risk factors, chronic inflammation may be a major determinant in ESRD-related atheroscle- rosis and cardiovascular complications (3), which is consistent with the current view that atherosclerosis is an immune-inflammatory driven process (4). Indeed, circulating levels of inflammatory markers such as CRP, IL-6, and monocyte chemoattractant protein-1 (MCP-1) are high and correlated with mor- tality in ESRD (5–7). There is also cumulating evi- dence suggesting that both cellular and humoral immune dysfunction are prevalent in ESRD and could contribute to ESRD-related CVD (8). To this respect, low levels of anti-atherogenic antibodies such as anti-phosphorylcholine IgM, were shown to Received February 2012; revised May 2012. Address correspondence and reprint requests to Dr Menno Pruijm, MD, Chef de Clinique, Department of Nephrology and Hypertension, University Hospital Lausanne (CHUV), Rue du Bugnon 17, 1011 Lausanne, Switzerland. Email: mennopruijm@ hotmail.com Therapeutic Apheresis and Dialysis 2012; 16(6):588–594 doi: 10.1111/j.1744-9987.2012.01102.x © 2012 The Authors Therapeutic Apheresis and Dialysis © 2012 International Society for Apheresis 588