Association of Autoantibody to Rods and Rings with Hepatitis C Outcome and Viral Load

The value of anti-rods and rings antibodies in Chinese population of Dalian City: A retrospective study

The study aimed to investigate the clinical significance of anti-rods and rings (anti-RR) antibodies in antinuclear antibodies (ANAs) test samples retrospectively. The laboratory data and clinical details of patients with positive anti-RR antibodies were collected and analysed between December 2017 and May 2022 in the First Affiliated Hospital of Dalian Medical University. A total of 72 665 patients were tested for ANAs. There were 45 632 patients discovered with positive ANAs (62.80%), only 131 patients presented with anti-RR antibodies (0.18%), among which only 68 patients were hospitalized patients with a definitive diagnosis. Among the 68 patients with a definitive diagnosis, 8 of 68 (11.8%) had autoimmune diseases, and 19 of 68 (27.9%) had renal diseases. Other diseases included liver disease, pulmonary disease, cerebral ischemia, cerebral infarction, chronic cardiac failure and venous thromboembolism. The detection rate of high titre(≥1:1000) anti-RR antibodies is significantly higher in autoimmune diseases.

The clinical value of indirect immunofluorescence for screening anti-rods and rings antibodies: A retrospective study of two centers in China

Objective

To investigate the distribution and clinical significance of the rods and rings (RR) pattern in various diseases.

Methods

A total of 169,891 patients in Peking Union Medical College Hospital (PUMCH) and 29,458 patients in Inner Mongolia People’s Hospital (IMPH) from January 2018 to December 2020 were included, and the results of ANA (antinuclear antibodies) and special antibodies were analyzed retrospectively.

Results

The positive rates of ANA and RR patterns were 34.84%, 0.16% in PUMCH, and 44.73%, 0.23% in IMPH. Anti-RR antibodies mainly appear in adults (≥ 41 years), mostly of low or medium fluorescence titers. Isolated RR patterns were mostly presented (60.30% and 69.12%, respectively), and the RR pattern mixed with the speckled pattern was most commonly observed among patients having two or more patterns. The RR pattern existed in a variety of diseases including hepatitis C, AIDs, pulmonary diseases, nephropathy diseases, and even healthy people. The highest prevalence of the RR pattern was observed in hepatic diseases, such as hepatic dysfunction (0.79%), hepatic cirrhosis (1.05%), PBC (0.85%), and AIH (0.65%), etc. The positive rate of specific antibodies in RR pattern cases was 31.25%, and anti-Ro52 (27, 20.61%) was the most common target antibody.

Conclusion

The RR pattern had a low prevalence in ANAs test samples and varied in different nationalities and regions. Except for hepatitis C, it could be observed in AIDs, pulmonary diseases, nephropathy, other hepatic diseases, and even healthy people, but the positive rate was slightly higher in hepatic diseases. Its mechanism of action and clinical relevance still need clarification.

The value of anti-rods and rings antibodies in patients with nonhepatitis virus infection: A single-center retrospective study from Southwest China

ABSTRACT

The aim of this study was to retrospectively investigate the clinical significance of anti-rods and rings (anti-RR) antibodies in nonhepatitis virus infection patients from Southwest China.Anti-RR antibodies were determined by indirect immunofluorescence assay in a group of 19,935 individuals with antinuclear antibodies test from January 2017 to December 2019. The laboratory and clinical data were collected. Finally, 66 samples with anti-RR antibodies (0.33%) were detected.In Wilcoxon rank sum test, gamma glutamyl transferase (Z = -3.364, P = .001), alpha-l-fucosidase (AFU) (Z = -2.312, P = .021), uric acid (Z = -1.634, P = .047) and red blood cell distribution width (Z = -2.285, P = .022) were higher in metabolic disease group than nonmetabolic disease group. In independent-samples t test, endogenous creatinine clearance was higher in metabolic disease group than nonmetabolic disease group (t = 2.061, P = .045). During the follow-up period of 37 patients with anti-RR antibodies for 1 to 60 months, the titers of anti-RR were significantly increased in the metabolic disease group (Z = -2.346, P = .019). In binary logistic regression analysis, triglycerides (odds ratio 3.679, 95% confidence interval 1.467-24.779, P = .048) was associated with elevated titers of anti-RR antibodies.In summary, anti-RR in non-hepatitis patients may be a manifestation of metabolic disorders, and has a certain correlation with routine laboratory indicators, which is worthy of the attention from clinicians.

The relevance between anti-rods/rings antibody and different treatment regimens in chronic hepatitis C virus infection

The antibodies and other issues associated with immunity in chronic hepatitis C virus (HCV) have been widely investigated, especially non-organ-specific antinuclear antibodies. Rods-rings (RR) antibody patterns are frequently observed due to pegylated IFN-α (PEG-IFN)/ribavirin (RBV) treatment by indirect immunofluorescence (IIF). We evaluated the relevance between anti-RR and PEG-IFN/RBV and/or direct-acting antiviral (DAA) regimens in chronic HCV. Sampling was done after achieving a sustained virological response (SVR) for 178 patients (aged >18 years). Patients were grouped according to treatment protocols (Group 1 [G1]: PEG-IFN/RBV [n = 53], Group 2 [G2]: PEG-IFN/RBV and Telaprevir or Boceprevir [n = 31], Group 3 [G3]: second- and third-wave DAA and previously received PEG-IFN/RBV (n = 38), and Group 4 [G4]: second- and third-wave DAA [n = 56]). Anti-RR was investigated by IIF (Euroimmun AG) test. Overall, 27 (15.16%) patients were anti-RR positive and received PEG-IFN/RBV. The numbers of anti-RR positivity for G1/2/3/4 (%) were 16/3/8/0 (30.2/9.6/21/0), respectively (p < .001). The anti-RR positivity rate for G1/2/3 was 22.13% (27/122, p = .088). Anti-RR was positive in 17.5% (11/63) of G1/2/3 patients who did not achieve SVR after the first treatment. This rate was 27.1% (16/59) in patients with SVR after the first treatment in G1/2 and there was no difference between these two classified groups in terms of antibody titers (p = .915). Anti-RR was detected up to 172 months after SVR. In summary, anti-RR was positive in high rates in patients receiving PEG-IFN/RBV therapy. Frequent monitoring is needed during patient follow-up to get more data on the relationship between anti-RR titer, treatment regimens, and SVR.

Anti-rods/rings autoantibody and IMPDH filaments: an update after fifteen years of discovery

Autoantibodies to unknown subcellular rod and ring-shaped structures were first discovered in sera from hepatitis C patients in 2005. Early studies showed a strong association between these anti-rods/rings antibodies (anti-RR) and the standard of care interferon-α plus ribavirin combination therapy (IFN/RBV), suggesting that anti-RR are drug-induced autoantibodies. In the context of hepatitis C, anti-RR have been linked with relapse from or lack of response to IFN/RBV in some patient cohorts. However, examples of anti-RR in other diseases and healthy individuals have also been reported over the years, although anti-RR remains a rare autoantibody response in general. The advent of new direct-acting antiviral drugs for chronic hepatitis C and studies of anti-RR from different parts of the world are also beginning to change the perception of anti-RR. The nucleotide biosynthetic enzyme inosine monophosphate dehydrogenase (IMPDH) has been identified as the major autoantigen recognized by anti-RR. Coincidentally, the assembly of IMPDH into micron-scale rod and ring-shaped structures was discovered around the same time as anti-RR. Knowledge of the fundamental biological properties and cellular functions of these structures, referred to as "IMPDH filaments" by cell biologists, has advanced in parallel to anti-RR antibodies. Recent studies have revealed that IMPDH filament assembly is a mechanism to prevent feedback inhibition of IMPDH and is therefore important for the increased nucleotide production required in hyperproliferating cells, like activated T cells. Fifteen years later, we review the history and current knowledge in both the anti-RR autoantibody and IMPDH filament fields. TAKE-HOME MESSAGE: Anti-rods/rings are recognized as an example of a drug-induced autoantibody in hepatitis C patients treated with interferon and ribavirin, although new studies suggest anti-rods/rings may be detected in other contexts and may depend on unknown environmental or genetic factors in different populations. Recent data suggest that the assembly of IMPDH into rod and ring structures, the targets of anti-rods/rings autoantibody, is a mechanism for hyperproliferating cells, like activated T cells, to maintain increased guanine nucleotide levels to support rapid cell division.

Anti-rod and ring antibodies in patients with chronic hepatitis C using direct-acting antivirals

Anti-rods and rings (anti-RR) antibody induction is related to the combination of interferon and ribavirin in the treatment of hepatitis C virus (HCV) infection. If the main factor leading to this autoimmune reaction is the combination of these drugs, is not well known, but in vitro studies shows that ribavirin alone can induce rods and rings structures. New direct-acting antivirals (DAAs) permit HCV treatment without needing interferon but may be associated with ribavirin in the most difficult-to-treat patients. The aim of this study is to evaluate the occurrence of anti-RR in patients with chronic HCV infection, before and after 12 weeks of treatment with DAAs, with and without ribavirin. From Jun 2016 to Oct 2017, 52 HCV-infected patients were screened for anti-RR before and after DAA therapy, including sofosbuvir, daclatasvir, simeprevir, and ribavirin. Serum samples were analyzed using indirect immunofluorescence. The anti-RR was present in 11 (21%) of the 52 patients (51.9% male and mean age of 59.1 years) before using DAAs. All of them had been previously treated and previous exposed to interferon/ribavirin, with exposure time to ribavirin associated with the presence of anti-RR. After 12 weeks of DAA treatment, 3 patients (5.7%) developed the antibody in low titers, and two of them (66%) were interferon/ribavirin experienced. Only one of the 29 naïve patients (3.44%) developed anti-RR during the current treatment. Anti-RR was present in patients previously treated with interferon/ribavirin and can emerge after DAA treatment probably at a lower frequency than after interferon/ribavirin treatment.