Measurement of anti-dsDNA: a comparative study of two ELISA and the Crithidia assay

Detection of Antibodies to dsDNA: An Overview of Laboratory Assays

This brief review is focused on different methodologies available for detection of anti-dsDNA antibodies with respect to the best adequacy between biological results of laboratory and clinical significance. A large array of assays has been developed for the measurement of anti-dsDNA. New assays continually introduced have reflected not only technical innovations to avoid difficulties of some assays, but even more with hope to correlate better with systemic lupus erythematosus (SLE), particularly with its clinical course and exacerbations. Finally, with the development of micro arrays technology new insights into the pathophysiology of autoimmune disease processes should be revealed.

Clinical significance of ELISA positive and immunofluorescence negative anti-dsDNA antibody

BACKGROUND

Positivity for anti-dsDNA antibody is a diagnostic criterion of systemic lupus erythematosus (SLE). In the present study, the significance of ELISA positive and Crithidia luciliae immunofluorescence test (CLIFT) negative anti-dsDNA sera was evaluated.

METHODS

There were 371 consecutive serum samples submitted to for anti-dsDNA testing that were assayed using anti-dsDNA ELISA and CLIFT. Sera showing discrepant results were collected and then examined using 3 commercial anti-dsDNA and anti-ssDNA ELISA kits and by Farr assay. Medical records were reviewed for those patients who were ELISA positive and CLIFT negative for anti-dsDNA.

RESULTS

Fifty-two patients of 100 anti-dsDNA ELISA positive patients were negative by CLIFT. For ELISA positive and CLIFT negative sera, Farr assays showed the highest positive rate (72.7%) for the 4 different anti-dsDNA assays (3 commercial kits and the Farr assay). Nearly 80% of 44 ELISA positive and CLIFT negative patients met >or=3 of the SLE classification criteria (excluding the anti-dsDNA criterion).

CONCLUSION

Some anti-dsDNA ELISA kits have diagnostic efficiencies that are similar to that of the Farr assay. Moreover, the study identifies a group of patients that are ELISA positive but CLIFT negative for anti-dsDNA, and indicates that the majority of these patients have clinically relevant SLE.

Detection of anti-dsDNA by ELISA using different sources of antigens

AIM

To compare different sources of DNA for use in ELISA-based assays for anti-dsDNA antibody detection in systemic lupus erythematosus (SLE) diagnosis.

METHOD

Bacterial genomic DNA from Flavobacterium menignosepticum, Proteus vulgalis, Seratia marcescens, Streptococcus pyogenes and Salmonella typhimurium and genomic DNA from human blood were used as antigens for IgG anti-dsDNA detection by enzyme-linked immunosorbent assay (ELISA). Eighty-six sera were tested, 28 derived from patients with SLE, 28 from patients with other rheumatic diseases and 30 from normal human subjects.

RESULTS

Genomic DNA from Flavobacterium menignosepticum and human blood had high sensitivity (75%, 82%) and specificity (91%, 91%) for anti-dsDNA detection in diagnosis of SLE. However, human genomic DNA was the most effective antigen of all antigens studied. The assay had a higher sensitivity but lower specificity than commercial ELISA (61% sensitivity and 95% specificity). There was a high level of correlation between commercial ELISA and ELISA using human genomic DNA as antigen (r=0.776, p<0.001) and they exhibited a high level of diagnostic agreement with each other (kappa=0.890, p<0.001).

CONCLUSION

The genomic DNA from human blood is a potentially useful source of antigen for the detection of anti-dsDNA by ELISA. However, further studies are required to compare the performance of ELISA using this source of antigen against commercial radioimmunoassays for anti-dsDNA detection.