Substrate specificity of antinuclear antibodies in scleroderma

Stefania Jabłońska (1920-2017): A giant in 20th century dermatology

Stefania Jabłońska (1920-2017) is remembered as a physician extraordinaire, outstanding medical scientist, and superb professor of dermatology. She served as Professor and Chairman of Dermatology at the Warsaw Medical School. Not only is she one of the most cited of Polish physicians, she also was world renowned, being elected to honorary membership in innumerable dermatology societies. Jabłońska in 1972 was the first to describe the relationship between the human papillomavirus and skin cancer in epidermodysplasia verruciformis. She collaborated with Professor Gérard Charles Jacques Orth (1936-), with whom she characterized the molecular structure of the oncogenic virus to be the first to be discovered in dermatologic diseases. They also showed that a viral infection could not spread to people with different genetic patterns. For this discovery, Jabłońska and Orth in 1985 were awarded the Robert Koch Medal, which was presented to them by the President of the Federal Republic of Germany, Richard Karl Freiherr von Weizsäcker (1920-2015). Jabłońska is the only Polish scientist to be so honored.

Antinuclear Antibodies in Systemic Sclerosis: an Update

Systemic sclerosis is an autoimmune disease characterized by fibrosis of skin and internal organs, vasculopathy, and dysregulation of immune system. A diagnostically important feature of immunological abnormalities in systemic sclerosis is the presence of circulating antinuclear antibodies, which may be detected in 90-95% of patients with either of the four main laboratory methods: immunofluorescence, enzyme-linked immunosorbent assay, immunodiffusion, and immunoblotting. There are several antinuclear antibodies specific for systemic sclerosis. These include antibodies against topoisomerase (anti-TOPO I), kinetochore proteins (ACA), RNA polymerase enzyme (anti-RNAP III), ribonuclear proteins (anti-U11/U12 RNP, anti-U1 RNP, anti-U3 RNP) and nucleolar antigens (anti-Th/To, anti-NOR 90, anti-Ku, antiRuvBL1/2, and anti-PM/Scl). Autoantibodies specific for systemic sclerosis have been linked to distinct clinical features. Therefore, detecting a particular antibody type is important in predicting a possible organ involvement and prognosis and may have an impact on monitoring and treatment.

Importance of detection of SS-A/Ro autoantibody in screening immunofluorescence tests for autoantibodies to nuclear antigens

SS-A/Ro autoantibodies are related to Sjögren's syndrome and to several clinical subsets of lupus erythematosus. The most widely used laboratory procedure for ANA screening is the indirect immunofluorescence test (IF-ANA); the laboratory detection of anti-SS-A/Ro requires implementation and adherence to several technical and quality assurance recommendations. Using appropriate substrate cells containing the SS-A/Ro antigen, many so-called "ANA-negative" lupus erythematosus patients will demonstrate a positive IF-ANA.

Evaluation of methods for detection of anticentromere antibodies and other antinuclear antibodies

Our immunologic studies of twenty-five patients with acrosclerosis with severe acral involvement, twenty-seven patients with most or all of the signs of CREST syndrome, twenty-two patients with systemic lupus erythematosus as positive controls, and ninety-one blood donors as negative controls centered on an evaluation of eight antigenic substrates, including four types of human cells for the detection of anticentromere antibodies (ACA) and other antinuclear antibodies (ANA). The ACA, which occurred only among the patients with most or all of the signs of CREST syndrome, could be detected reliably on human cell lines HEp-2 and KB but not on a mouse cell line or on the three types of tissue sections examined. Comparisons of human HEp-2 and KB cell lines from four sources indicated that HEp-2 cells are the best of the substrates tested for detection of ACA. Since rodent tissue sections give negative reactions with ACA, they are indicated for confirmation. In general, results varied with the type and source of antigen used. Thus ANA findings need to be expressed not only in terms of the titers of the antibodies and the pattern(s) of their reactions but also in terms of the type of antigen or substrate used, its source, and the diagnostic significance of findings in the given test system.

Antinuclear antibodies in the relatives of patients with systemic sclerosis

Antinuclear antibodies were studied by indirect immunofluorescence and double immunodiffusion in 21 patients with systemic sclerosis and 35 of their relatives. When HEp-2 cells were used as the substrate, the frequency of antinuclear antibodies in the patients' sera was 100% and that in the relatives was 26%. When rat liver sections were used, the values were 86% and 17%, respectively. Anticentromere antibody was detected in the serum from the mother of one patient whose serum had anti-Scl-70 antibody. Antibody to n-RNP was positive in the sera from the brother and daughter of another patient whose serum was positive for anti-n-RNP and anti-Scl-70 antibodies. The high frequency of antinuclear antibodies in the sera from the relatives of systemic sclerosis patients suggests that immunological abnormalities play a part in the pathogenesis of this condition.

Relationships between antinuclear and anti-Ro/SS-A antibodies in subacute cutaneous lupus erythematosus

A certain degree of confusion has arisen regarding the relationship between patients having subacute cutaneous lupus erythematosus (SCLE) and those with "antinuclear antibody-negative" systemic lupus erythematosus (ANA-negative SLE). One of the confusing issues relates to published differences in the autoimmune serologic findings of these two patient groups. In order to clarify this issue, we have screened the sera from thirty-seven patients with SCLE for the presence of fluorescent antinuclear antibodies (FANA) on two different substrates--human Hep-2 tissue culture cells and mouse kidney sections. In addition, these same sera were assayed for anti-Ro/SS-A precipitin antibodies. Seventy-eight percent of the sera were FANA-positive at a titer of 1:10 or greater when tested on human Hep-2 cells, whereas 76% were positive at a titer of 1:80 or greater. Fifty-one percent were positive on mouse kidney sections at a titer of 1:10 or greater, whereas 46% were positive at a titer of 1:20 or greater. Twenty-two percent of these sera were completely FANA-negative on both human and mouse substrates. None of these sera that were negative on both substrates contained anti-Ro/SS-A antibodies. However, 69% of the sera that were FANA-positive on both human and mouse substrates were found to have detectable anti-Ro/SS-A antibodies. Ninety percent of the SCLE sera that were FANA-positive on human Hep-2 cells, but negative on mouse kidney sections, contained anti-Ro/SS-A antibodies. These sera gave a speckle-like, or particulate, nuclear immunofluorescence staining pattern.(ABSTRACT TRUNCATED AT 250 WORDS)

Antinuclear antibody determinations in Ro(SSA)-positive, antinuclear antibody--negative lupus and Sjögren's syndrome patients

Antinuclear antibody determinations were performed on the sera of twenty-eight Ro(SSA)-positive patients, who failed to demonstrate significant antinuclear antibody titers on mouse liver, with the use of various heterologous and homologous substrates. These studies demonstrated the following: (1) The existence of substrate specificity among various tissues and cells employed in the detection of antinuclear antibodies in Ro(SSA)-positive patients. (2) The existence of a significant group of Ro(SSA)-positive lupus patients with prominent cutaneous findings and systemic disease who, despite the employment of a variety of antinuclear substrates, failed to demonstrate significant antinuclear antibody titer.

Anticentromere antibody. Clinical Correlations and association with favorable prognosis in patients with scleroderma variants

The presence of antibody to the chromosomal centromere appears to be associated with a subset of patients with the limited CREST form of scleroderma. To further define the prognostic value of this autoantibody, 27 patients, who were identified as having anticentromere antibody by screening antinuclear antibody tests using HEp-2 cell substrates, were followed clinically and serologically for 2 years. The presence of anticentromere antibody is common in the limited CREST forms of systemic sclerosis, and it is often the only autoantibody specificity present in the sera of patients with the CREST variant. When compared with other patients who exhibit speckled or nucleolar antinuclear antibody patterns, those with anticentromere antibody had significantly less major organ system involvement.

The immunopathology of progressive systemic sclerosis (PSS)

Progressive systemic (sclerosis) is one of the most enigmatic of the rheumatic diseases. It is a connective tissue disorder of unknown etiology characterized by fibrosis in skin and internal organs. Although similar lesions are found with increased prevalence in workers exposed to coal, gold, silica, and polyvinyl chloride, most patients have had no known predisposing factors. Select reports of a familial occurrence of PSS have been observed but a definitive genetic basis is lacking and no clear associations with the major histocompatability complex have been demonstrated. Moreover, although a variety of immunologic abnormalities in patients with PSS have been reported, they are generally diffuse and non-diagnostic. Such abnormalities include defects in cell mediated immunity, increases in sera immunoglobulins, antinuclear antibodies, and cryoglobulins. In contrast to these non-specific findings, there appears to be significant evidence of a relationship between cell mediated immunity to collagen and appearance of scleroderma. For example, peripheral blood lymphocytes in patients with scleroderma undergo lymphocyte transformation when cultured with specific collagen preparations. The pathology of skin and internal organs in PSS generally reflects both collagen deposition and small vessel occlusion. All organ systems may be involved but mortality significantly increases with involvement of heart, kidney, or lung. Unfortunately, at present a reliable experimental model of PSS has not been found although similar immunopathology can be induced in homologous disease of rats and in chronic graft vs host disease of humans.

Three siblings with scleroderma (systemic sclerosis) and two with Raynaud's phenomenon from a single kindred

A kindred is reported which contains 3 siblings with scleroderma, 2 siblings with Raynaud's phenomenon, and 2 first-degree relatives with histories suggestive of connective tissue syndromes. Studies of microvascular morphology and flow, serum endothelial cytotoxic activity, antinuclear antibodies, and HLA haplotypes in 18 relatives and 6 spouses revealed that 4 of 5 affected siblings expressed the HLA-DRw4 antigen, which was also present in 2 of 3 asymptomatic relatives whose serum contained endothelial cytotoxic activity. The evidence for an inherited susceptibility to scleroderma is reviewed.