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Azurocidin is a novel antigen for anti‐neutrophil cytoplasmic autoantibodies (ANCA) in systemic vasculitis

We isolated a 27‐kD protein using cation exchange chromatography from an acid extract of neutrophil granules. N‐terminal amino acid sequence analysis of the first 10 residues showed that this protein is azurocidin, a member of the family of neutral serine proteinase found in the neutrophil, which shares amino acid sequence homology with the three other neutral serine proteinases, elastase, proteinase 3 (PR3) and cathepsin G, but unlike them is without proteolytic activity. To test whether, in addition to these proteases, azurocidin might be a target for the humoral autoimmune responses associated with human vasculitis, 185 indirect immunofluorescence (IIF)‐positive ANCA sera, made up of four groups of sera with specificities for PR3 (n= 37), myeloperoxidase (MPO; n= 50), bactericidal/permeability‐increasing protein (BPI; n= 41) and sera that recognized none of them (triple negative, n= 57), and 46 normal sera were screened for IgG anti‐azurocidin antibodies using an ELISA incorporating purified azurocidin. Twenty of the 185 IIF‐positive sera and 2/46 normal sera displayed reactivity with azurocidin. Positive sera could blot the 27‐kD band by Western blot analysis. Further study of the 20 positive sera revealed that: (i) 10 also had autoreactivity for MPO, of which six additionally recognized lactoferrin; (ii) two had reactivity with BPI; (iii) the remaining eight sera were positive only for azurocidin. All 20 sera were from patients with systemic vasculitis, and four of the six sera with triple reactivity (for azurocidin, MPO and lactoferrin) were from patients with hydralazine‐induced vasculitis. We concluded that: (i) azurocidin is a novel ANCA antigen; (ii) anti‐azurocidin antibodies from a subgroup of patients might represent the consequence of a drug‐induced multi‐clone activation.