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Little is known about the function of natural IgM autoantibodies, especially that of IgM anti-leukocyte autoantibodies (IgM-ALA). Natural IgM-ALA are present at birth and characteristically increase during inflammatory and infective conditions. Our prior clinical observations and those of other investigators showing fewer rejections in renal and cardiac allografts transplanted into recipients with high levels of IgM-ALA led us to investigate whether IgM-ALA regulate the inflammatory response. In this review, we show that IgM, in physiologic doses, inhibit pro-inflammatory cell function in-vitro. We also show in an IgM knockout murine model, with intact B cells and regulatory T cells, that there is more severe inflammation and loss of function in the absence of IgM after renal ischemia reperfusion injury and cardiac allograft rejection. Replenishing IgM in IgM knockout mice or increasing the levels of IgM-ALA in wild-type B6 mice significantly attenuated the inflammation in both of these inflammatory models that involve IFN-γ and IL-17. The protective effect on renal ischemia reperfusion injury Is mediated by IgM ALA as protection was lost when using IgM pre-adsorbed with leukocytes to remove IgM-ALA. We provide data to show that the anti-inflammatory effect of IgM is mediated, in part, by inhibiting TLR-4-induced NF-κB translocation into the nucleus and inhibiting differentiation of activated T cells into Th-1 and Th-17 cells. In additional studies, we also show that intra-peritoneal administration of IgM prevents NOD mice from developing autoimmune insulitis which also involves Th-1 and Th-17 cells. These observations highlight the importance of IgM-ALA in regulating excess inflammation mediated by both innate and adaptive immune mechanisms and where the inflammatory response involves Th-17 cells that are not effectively regulated by T regs, B regs, and IL-10. IgM-ALA may in part regulate inflammation by altering dendritic cell function, as dendritic cells pre-treated in-vitro with polyclonal IgM protected mice from renal IRI. The latter findings may have relevance for cell-based therapy.

Natural IgM Anti-leucocyte Autoantibodies (IgM-ALA) Regulate Inflammation Induced by Innate and Adaptive Immune Mechanisms