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Bizzaro N, Mazzoni A, Carbone T, Cinquanta L, Villalta D, Radice A, Pesce G, Manfredi M, Infantino M. Issues in autoantibody tests used in the classification criteria for autoimmune rheumatic diseases: the laboratory autoimmunologist's perspective. Autoimmun Rev 2024:103604. [PMID: 39187223 DOI: 10.1016/j.autrev.2024.103604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 08/21/2024] [Accepted: 08/21/2024] [Indexed: 08/28/2024]
Abstract
Classification criteria of autoimmune rheumatic diseases are an important means to define homogenous groups of patients that can be compared across studies for clinical trials and research purposes. The measurement of autoantibodies is a relevant aspect in the definition of classification criteria, with a significant weight in the scores necessary to classify patients with autoimmune rheumatic diseases. The impact of autoantibodies has gradually increased over the years, contributing to the evolution and improvement of the classification criteria. However, these criteria often do not take into consideration how autoantibodies are measured, i.e. differences in diagnostic accuracy of the methods. This is a critical point especially when obsolete analytical methods that are no longer used in many clinical laboratories are taken into consideration. In this review we have critically examined assays and methods for the determination of autoantibodies that are (or could be) included among the classification criteria of autoimmune rheumatic diseases in light of more recent evidence and technology evolution.
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Affiliation(s)
- Nicola Bizzaro
- Laboratory of Clinical Pathology, Azienda Sanitaria Universitaria Integrata, Udine, Italy.
| | - Alessio Mazzoni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Flow Cytometry Diagnostic Center and Immunotherapy Unit, Careggi University Hospital, Florence, Italy
| | - Teresa Carbone
- Immunopathology Laboratory, San Carlo Hospital, Potenza, Italy
| | | | - Danilo Villalta
- Immunology and Allergology, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Antonella Radice
- Autoimmunity and Allergology Laboratory, ASST Santi Paolo e Carlo, P.O. San Paolo Hospital, Milan, Italy
| | - Giampaola Pesce
- Autoimmunity Laboratory, IRCCS Ospedale Policlinico San Martino, Genua, Italy; Department of internal Medicine and Specialties (DiMI), University of Genua, Genua, Italy
| | - Mariangela Manfredi
- Immunology and Allergology Laboratory, S. Giovanni di Dio Hospital, Florence, Italy
| | - Maria Infantino
- Immunology and Allergology Laboratory, S. Giovanni di Dio Hospital, Florence, Italy
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2
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McMorrow FK, Anwyll N, Tansley SL. Autoantibody testing in myositis: an update. Curr Opin Rheumatol 2024:00002281-990000000-00134. [PMID: 39155767 DOI: 10.1097/bor.0000000000001039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
PURPOSE OF REVIEW This review aims to provide an update on myositis autoantibody testing strategies. We have focussed on the reliability and usefulness of different myositis autoantibody detection methods, including commonly used solid phase immunoassays and newer discovery techniques. RECENT FINDINGS Several studies have highlighted the limitations of currently available immunoassays, particularly when used in populations with low pretest probability and without supporting clinical evidence. While many autoantibodies, such as anti-Jo1, are detected with high sensitivity and specificity, the low incidence of myositis autoantibodies in tested populations reduces their positive predictive value. The low sensitivity of line immunoassays to detect key myositis autoantibodies, including anti-TIF1γ and rarer antisynthetase autoantibodies, is a concern. SUMMARY Myositis autoantibodies are widely accepted as important clinical tools, and hence, there is a significant demand for reliable, accessible, and affordable detection methods. False positives and negative results have the potential to impact on patient care, particularly for malignancy and lung disease associated autoantibodies. Increased availability of myositis autoantibody testing has led to a rise in requests from a broader range of clinicians. It is critically important that clinicians are aware of specific limitations of tests and interpret results in the context of clinical findings.
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Affiliation(s)
| | - Natalie Anwyll
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals, Bath, UK
| | - Sarah L Tansley
- Department of Life Sciences, University of Bath
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals, Bath, UK
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Tobal R, Potjewijd J, van Doorn D, van Empel V, Damoiseaux J, van Paassen P. High Prevalence of Myositis-Specific and Associated Antibodies in Patients with Pulmonary Hypertension. Diagnostics (Basel) 2024; 14:1471. [PMID: 39061608 PMCID: PMC11276054 DOI: 10.3390/diagnostics14141471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 07/01/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
Pulmonary hypertension (PH) is a serious condition linked to immune-system dysfunction. Myositis-specific/associated antibodies (MSAs/MAAs) play a role in idiopathic inflammatory myopathy (IIM) and interstitial lung disease (ILD), but their significance in PH remains unclear. We believe the presence of these antibodies may be underestimated. This study analyzed adult PH patients without pre-existing IIM for MSA/MAA prevalence using a line-blot assay. We compared PH patients with and without ILD signs to a cohort clinically suspected of IIM/ILD (n = 558). Our PH cohort (n = 121) showed a significantly higher prevalence of overall weak positive MSAs/MAAs and positive overlap syndrome-associated MAAs than the suspected IIM/ILD group (p < 0.001). Notably, MSAs/MAAs were found in PH patients both with and without ILD, though more prevalent in those with ILD. Anti-synthetase and anti-overlap syndrome antibodies were the most common. Our study is the first to systematically show a high MSA/MAA prevalence in PH without IIM presentation. This highlights the need to consider PH when diagnosing MSA/MAA-associated conditions. We recommend MSA/MAA screening for newly diagnosed PH, especially in those with ILD, for early detection and potential immunomodulatory treatment. Further research should explore the link between MSAs/MAAs and PH, and the value of monitoring patients with weak MSA/MAA positivity over time.
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Affiliation(s)
- Rachid Tobal
- Department of Internal Medicine, Division of Nephrology and Clinical and Experimental Immunology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands; (D.v.D.); (P.v.P.)
| | - Judith Potjewijd
- Department of Internal Medicine, Division of Nephrology and Clinical and Experimental Immunology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands; (D.v.D.); (P.v.P.)
| | - Daan van Doorn
- Department of Internal Medicine, Division of Nephrology and Clinical and Experimental Immunology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands; (D.v.D.); (P.v.P.)
| | - Vanessa van Empel
- Department of Cardiology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands;
| | - Jan Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands;
| | - Pieter van Paassen
- Department of Internal Medicine, Division of Nephrology and Clinical and Experimental Immunology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands; (D.v.D.); (P.v.P.)
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Tansley SL, McMorrow F, Cotton CV, Adamali H, Barratt SL, Betteridge ZE, Perurena-Prieto J, Gibbons MA, Kular R, Loganathan A, Lamb JA, Lu H, New RP, Pratt D, Rivera-Ortega P, Sayers R, Steward M, Stranks L, Vital E, Spencer LG, McHugh NJ, Cooper RG. Identification of connective tissue disease autoantibodies and a novel autoantibody anti-annexin A11 in patients with "idiopathic" interstitial lung disease. Clin Immunol 2024; 262:110201. [PMID: 38575043 DOI: 10.1016/j.clim.2024.110201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/07/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Autoantibodies are a hallmark feature of Connective Tissue Diseases (CTD). Their presence in patients with idiopathic interstitial lung disease (ILD) may suggest covert CTD. We aimed to determine the prevalence of CTD autoantibodies in patients diagnosed with idiopathic ILD. METHODS 499 patient sera were analysed: 251 idiopathic pulmonary fibrosis (IPF), 206 idiopathic non-specific interstitial pneumonia (iNSIP) and 42 cryptogenic organising pneumonia (COP). Autoantibody status was determined by immunoprecipitation. RESULTS 2.4% of IPF sera had a CTD-autoantibody compared to 10.2% of iNSIP and 7.3% of COP. 45% of autoantibodies were anti-synthetases. A novel autoantibody targeting an unknown 56 kDa protein was found in seven IPF patients (2.8%) and two NSIP (1%) patients. This was characterised as anti-annexin A11. CONCLUSION Specific guidance on autoantibody testing and interpretation in patients with ILD could improve diagnostic accuracy. Further work is required to determine the clinical significance of anti-annexin A11.
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Affiliation(s)
- Sarah L Tansley
- Department of Life Sciences, University of Bath, Bath, UK; Royal National Hospital for Rheumatic Diseases, Bath, UK.
| | | | | | - Huzaifa Adamali
- Bristol Interstitial Lung Disease service, North Bristol NHS Trust, Bristol, UK
| | - Shaney L Barratt
- Bristol Interstitial Lung Disease service, North Bristol NHS Trust, Bristol, UK
| | | | | | - Michael A Gibbons
- College of Medicine & Health, University of Exeter; Royal Devon University Hospitals Foundation NHS Trust
| | - Raman Kular
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Janine A Lamb
- Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Hui Lu
- Department of Life Sciences, University of Bath, Bath, UK
| | - Robert P New
- Division of Musculoskeletal and dermatological Sciences, University of Manchester, UK
| | - Diane Pratt
- Bristol Interstitial Lung Disease service, North Bristol NHS Trust, Bristol, UK
| | | | - Ross Sayers
- College of Medicine & Health, University of Exeter
| | | | | | - Edward Vital
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Lisa G Spencer
- Liverpool Interstitial Lung Disease Service, Aintree Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Neil J McHugh
- Department of Life Sciences, University of Bath, Bath, UK
| | - Robert G Cooper
- Liverpool Interstitial Lung Disease Service, Aintree Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Chang YC, Yang L, Budhram A. Positive predictive value of myositis antibody line blot testing in patients with suspected idiopathic inflammatory myopathy. Muscle Nerve 2024; 69:626-630. [PMID: 38321821 DOI: 10.1002/mus.28050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 01/16/2024] [Accepted: 01/21/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION/AIMS Line blot (LB) is in widespread use for myositis antibody detection. Yet, studies of its positive predictive value (PPV) in patients with suspected idiopathic inflammatory myopathy (IIM), which would be of particular relevance to neuromuscular clinicians, are lacking. We aimed to determine the PPV of myositis antibody LB testing in patients with suspected IIM, and examine whether PPV was significantly impacted by intensity of antibody positivity. METHODS This was a retrospective study of patients who underwent myositis antibody LB testing for suspected IIM between March 2019 and August 2022. RESULTS Of 70 patients who underwent testing for suspected IIM and had positive myositis antibody LB results, 43 (61%) were female and the median age was 61 years (range: 10-83 years). Forty-four were classified as true-positives, yielding a PPV of 63%. The PPV of patients with weak-positive myositis antibody results (14/30, 47%) was significantly lower than the PPV of patients with moderate-positive or strong-positive myositis antibody results (30/40, 75%) (p = .02). DISCUSSION Our study found that myositis antibody LB testing in patients with suspected IIM had a modest PPV, underscoring the need for antibody interpretation in the context of all available clinical and ancillary test data to avoid misdiagnosis. The significantly lower PPV in patients with weak-positive results emphasizes the particular importance of clinical correlation in such patients. Further study into the diagnostic performance of various LBs for myositis antibody detection is needed to inform their interpretation in clinical practice.
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Affiliation(s)
- Yiu-Chia Chang
- Department of Clinical Neurological Sciences, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Liju Yang
- Department of Pathology and Laboratory Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Adrian Budhram
- Department of Clinical Neurological Sciences, Western University, London Health Sciences Centre, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
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Tebo AE. Autoantibody evaluation in idiopathic inflammatory myopathies. Adv Clin Chem 2024; 120:45-67. [PMID: 38762242 DOI: 10.1016/bs.acc.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2024]
Abstract
Idiopathic inflammatory myopathies (IIM), generally referred to as myositis is a heterogeneous group of diseases characterized by muscle inflammation and/or skin involvement, diverse extramuscular manifestations with variable risk for malignancy and response to treatment. Contemporary clinico-serologic categorization identifies 5 main clinical groups which can be further stratified based on age, specific clinical manifestations and/or risk for cancer. The serological biomarkers for this classification are generally known as myositis-specific (MSAs) and myositis-associated antibodies. Based on the use of these antibodies, IIM patients are classified into anti-synthetase syndrome, dermatomyositis, immune-mediated necrotizing myopathy, inclusion body myositis, and overlap myositis. The current classification criteria for IIM requires clinical findings, laboratory measurements, and histological findings of the muscles. However, the use MSAs and myositis-associated autoantibodies as an adjunct for disease evaluation is thought to provide a cost-effective personalized approach that may not only guide diagnosis but aid in stratification and/or prognosis of patients. This review provides a comprehensive overview of contemporary autoantibodies that are specific or associated myositis. In addition, it highlights possible pathways for the detection and interpretation of these antibodies with limitations for routine clinical use.
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Affiliation(s)
- Anne E Tebo
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, United States.
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Lu X, Peng Q, Wang G. Anti-MDA5 antibody-positive dermatomyositis: pathogenesis and clinical progress. Nat Rev Rheumatol 2024; 20:48-62. [PMID: 38057474 DOI: 10.1038/s41584-023-01054-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/08/2023]
Abstract
Anti-melanoma differentiation-associated protein 5 (MDA5) antibody-positive dermatomyositis (MDA5-DM) is a subtype of dermatomyositis. Although the aetiology and pathology remain unclear, increasing evidence suggests that viral infection is a potential trigger of MDA5-DM. Multiple factors, including T cells, B cells, neutrophils and macrophages, are implicated in the pathophysiology of MDA5-DM. Distinctive skin rashes, rapidly progressive interstitial lung disease, peripheral lymphopenia and elevated serum ferritin levels are the most prominent clinical and laboratory features of MDA5-DM. Concomitant infection is a common complication of MDA5-DM. The proper evaluation of patients with MDA5-DM requires knowledge of the disease heterogeneity and clinical course variability. Several biomarkers, including serum levels of anti-MDA5 antibodies and biomarkers related to macrophage activation, have been identified as useful tools for monitoring disease activity and prognosis. MDA5-DM shows a poor response to conventional glucocorticoid and immunosuppressant therapy and has a poor overall prognosis. Therefore, there is an urgent need to explore the key pathogenic mechanisms of MDA5-DM and develop novel therapeutic options for patients. This Review discusses recent clinical progress and pathogenic findings of MDA5-DM.
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Affiliation(s)
- Xin Lu
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China
| | - Qinglin Peng
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China
| | - Guochun Wang
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, China.
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Papadopoulou C, Chew C, Wilkinson MGL, McCann L, Wedderburn LR. Juvenile idiopathic inflammatory myositis: an update on pathophysiology and clinical care. Nat Rev Rheumatol 2023; 19:343-362. [PMID: 37188756 PMCID: PMC10184643 DOI: 10.1038/s41584-023-00967-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 05/17/2023]
Abstract
The childhood-onset or juvenile idiopathic inflammatory myopathies (JIIMs) are a heterogenous group of rare and serious autoimmune diseases of children and young people that predominantly affect the muscles and skin but can also involve other organs, including the lungs, gut, joints, heart and central nervous system. Different myositis-specific autoantibodies have been identified that are associated with different muscle biopsy features, as well as with different clinical characteristics, prognoses and treatment responses. Thus, myositis-specific autoantibodies can be used to subset JIIMs into sub-phenotypes; some of these sub-phenotypes parallel disease seen in adults, whereas others are distinct from adult-onset idiopathic inflammatory myopathies. Although treatments and management have much improved over the past decade, evidence is still lacking for many of the current treatments and few validated prognostic biomarkers are available with which to predict response to treatment, comorbidities (such as calcinosis) or outcome. Emerging data on the pathogenesis of the JIIMs are leading to proposals for new trials and tools for monitoring disease.
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Affiliation(s)
- Charalampia Papadopoulou
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH), London, UK
- Rare Diseases Theme NIHR Biomedical Research Centre at GOSH, London, UK
| | - Christine Chew
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Meredyth G Ll Wilkinson
- Rare Diseases Theme NIHR Biomedical Research Centre at GOSH, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, London, UK
- Infection Immunity and Inflammation Research and Teaching Department, UCL GOS Institute of Child Health, London, UK
| | - Liza McCann
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Lucy R Wedderburn
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH), London, UK.
- Rare Diseases Theme NIHR Biomedical Research Centre at GOSH, London, UK.
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, London, UK.
- Infection Immunity and Inflammation Research and Teaching Department, UCL GOS Institute of Child Health, London, UK.
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Schepens N, Herroelen PH, Decavele AS, Vanacker A. Severe rhabdomyolysis due to idiopathic inflammatory myopathies, a wary manifestation of a heterogenous pathology. Acta Clin Belg 2023; 78:160-164. [PMID: 35491881 DOI: 10.1080/17843286.2022.2070974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Idiopathic inflammatory myopathies (IIM) are historically classified by The Bohan and Peter criteria. The presentation of IIM is versatile and clinical-serological findings can aid in diagnosing the underlying form of IIM. Over the past years, the discovery and the use of myositis-specific autoantibodies (MSA) and myositis-associated autoantibodies (MAA) have led to a more heterogeneous classification by the European League Against Rheumatism and American College of Rheumatology (EULAR/ACR).This paper describes a case of dermatomyositis sine dermatitis. A 70-year -old woman presented with complaints of muscle weakness and was admitted because of severe oliguric renal failure due to rhabdomyolysis. Despite treatment with hemodialysis and initial recovery, her clinic worsened again. The disease course in combination with electromyography findings, PET-scan results, and positive myositis-specific autoantibodies, that is, anti-NXP-2 antibodies, ultimately led to the diagnosis.Today, commercial kits based on line immunoassay and dot blot have mostly replaced the labor-intensive immunoprecipitation of RNA and/or proteins for detecting MSA. Though it makes routine testing of multiple MSA easy to implement in clinical practice, more validation studies are required and clinicians should be aware of its limitations, including false-positive results. When clinical suspicion for IIM is high, a negative screening for antinuclear antibodies (ANA) result does not exclude IIM and the first test of choice remains a multi-specific immunoassay for the whole spectrum of MSA.In this paper, we want to underline that there is no shortcut in diagnosing IIM. Caution is required in interpreting different EMG, PET-scan, histological, and laboratory findings. Especially in the case of rhabdomyolysis, as this is a severe and wary manifestation of myositis.
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Affiliation(s)
- Niels Schepens
- Department of Nephrology, AZ Delta General Hospital, Roeselare, Belgium
| | - Pauline H Herroelen
- AZ Delta Medical Laboratories, AZ Delta General Hospital, Roeselare, Belgium
| | - An-Sofie Decavele
- AZ Delta Medical Laboratories, AZ Delta General Hospital, Roeselare, Belgium
| | - An Vanacker
- Department of Nephrology, AZ Delta General Hospital, Roeselare, Belgium
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Troelnikov A, Choo XJ, Beroukas D, Limaye V. Neither cancer nor myositis are common in patients testing positive for anti-TIF1γ by line blot in real-world laboratory settings. Int J Rheum Dis 2023; 26:586-590. [PMID: 36584990 DOI: 10.1111/1756-185x.14552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 01/01/2023]
Affiliation(s)
- Alexander Troelnikov
- Immunopathology Department, SA Pathology, Adelaide, South Australia, Australia.,Flinders University, Adelaide, South Australia, Australia
| | - Xin Jing Choo
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Dimitra Beroukas
- Immunopathology Department, SA Pathology, Adelaide, South Australia, Australia.,Flinders University, Adelaide, South Australia, Australia
| | - Vidya Limaye
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,Rheumatology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Sambataro G, Orlandi M, Fagone E, Fruciano M, Gili E, Libra A, Palmucci S, Vancheri C, Malatino L, Colaci M, Sambataro D. Myositis-Specific and Myositis-Associated Antibodies in Fibromyalgia Patients: A Prospective Study. Biomedicines 2023; 11:biomedicines11030658. [PMID: 36979638 PMCID: PMC10045737 DOI: 10.3390/biomedicines11030658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/08/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
Fibromyalgia (FM) is a common rheumatologic disorder characterised by widespread muscular pain. Myalgia is also a common clinical feature in Connective Tissue Disease (CTD), and FM should be studied for the concomitant presence of a CTD. The aim of this study is to evaluate the prevalence of Myositis-Specific and Myositis-Associated Antibodies (MSA/MAA) in a cohort of FM patients. We enrolled 233 consecutive FM patients (defined according to the 2016 criteria) that did not report clinical signs of autoimmune disorders and followed them for at least one year. The patients were tested for MSA/MAA with immunoblotting. FM patients were seropositive for Antinuclear Antibodies (ANA) in 24% of cases, for MSA in 9%, and for MAA in 6%. A specific diagnosis of CTD was made in 12 patients (5.2%), namely, 5 cases of primary Sjögren’s Syndrome and 7 of Idiopathic Inflammatory Myopathy. Seropositive patients showed clinical features similar to those who were seronegative at baseline. A CTD diagnosis was associated with ANA positivity (p = 0.03, X2 4.9), the presence of a speckled pattern (p = 0.02, X2 5.3), positivity for MAA (p = 0.004, X2 8.1), and MSA (p = 0.003, X2 9.2). In conclusion, a non-negligible proportion of FM patients may be seropositive for MSA/MAA, and that seropositivity might suggest a diagnosis of CTD.
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Affiliation(s)
- Gianluca Sambataro
- Artroreuma s.r.l., Rheumatology Outpatient Clinic, 95030 Mascalucia, CT, Italy
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
- Correspondence:
| | - Martina Orlandi
- Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC Careggi, University of Florence, 50134 Florence, Italy
| | - Evelina Fagone
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
| | - Mary Fruciano
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
| | - Elisa Gili
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
| | - Alessandro Libra
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy
| | - Lorenzo Malatino
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, Division of Rheumatology, Cannizzaro Hospital, University of Catania, 95123 Catania, Italy
| | - Michele Colaci
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, Division of Rheumatology, Cannizzaro Hospital, University of Catania, 95123 Catania, Italy
| | - Domenico Sambataro
- Artroreuma s.r.l., Rheumatology Outpatient Clinic, 95030 Mascalucia, CT, Italy
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Performance of cut-offs adjusted with positive control band intensity in line-blot assays for myositis-specific antibodies. Rheumatol Int 2023:10.1007/s00296-023-05287-5. [PMID: 36809556 DOI: 10.1007/s00296-023-05287-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/06/2023] [Indexed: 02/23/2023]
Abstract
The diagnostic performance of band intensity (BI) cut-offs, adjusted by a positive control band (PCB) in a line-blot assay (LBA) for myositis-related autoantibodies (MRAs) is investigated. Sera from 153 idiopathic inflammatory myositis (IIM) patients with available immunoprecipitation assay (IPA) data and 79 healthy controls were tested using the EUROLINE panel. Strips were evaluated for BI using the EUROLineScan software, and the coefficient of variation (CV) was calculated. Sensitivity and specificity, area under the curve (AUC), and the Youden's index (YI) were estimated at non-adjusted or PCB-adjusted cut-off values. Kappa statistics were calculated for IPA and LBA. Although inter-assay CV for PCB BI was 3.9%, CV was 12.9% in all samples, and a significant correlation was found between BIs of PCB and seven MRAs (all P < 0.05). At adjusted BI (aBI) > 10, the negative conversion rate of myositis-specific autoantibody (MSA)-positivity at BI > 10 was 11.5% in controls and 1.3% in patients. The specificity, AUC, and YI for MSAs at aBI > 10 or > 20 were higher than those at non-adjusted cut-off values. Additionally, AUC (0.720), YI (0.440), and the prevalence of MRAs with kappa > 0.60 (58.3%) were the highest at aBI > 20. The overall sensitivity and specificity for MSAs were 50.3% and 93.7% at aBI > 20, respectively, and 59.5% and 65.8% with BI > 10, respectively. The diagnostic performance of LBA can be improved using PCB-adjusted BIs. aBI > 20 is the optimal cut-off for IIM diagnosis using the EUROLINE LBA panel.
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13
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Loarce-Martos J, Calvo Sanz L, Garrote-Corral S, Ballester González R, Pariente Rodríguez R, Rita CG, García-Soidan A, Bachiller-Corral J, Roy Ariño G. Myositis autoantibodies detected by line blot immunoassay: clinical associations and correlation with antibody signal intensity. Rheumatol Int 2023; 43:1101-1109. [PMID: 36763166 DOI: 10.1007/s00296-023-05279-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/15/2023] [Indexed: 02/11/2023]
Abstract
The aim of this study is to assess the relationship between myositis specific (MSA) and myositis associated (MAA) antibodies and diagnosis (including idiopathic inflammatory myopathies [IIM] and other systemic autoimmune diseases [SAID]), and to explore the impact of antibody signal intensity in diagnostic accuracy. We retrospectively reviewed all the serum samples obtained from patients tested for MSA/MAA by line immunoassay (LIA) between 01/01/2018 and 31/12/2020 in Ramón y Cajal University Hospital (Spain). Clinical true positive (CTP) MSAs and MAAs were defined as those patients with IIM or SAID with phenotypes expected of that MSA/MAA. Patients who did not have a phenotype compatible with that antibody were classified as clinical false positive (CFP). One hundred and thirty positive samples were analysed. Forty-six patients (33.38%) were classified as IIM, forty-two (32.3%) as SAID and forty-two (32.3%) as non-IIM/SAID. Among these 130 patients, 164 MSA/MAA were detected. Eighty-five (51.8%) positive MSA/MAA were classified as CTP, and seventy-nine (48.2%) as CFP. Strongly positive antibodies were more frequently CTP (35/47, 74.5%) than weak positives (54/68, 36.8%), (p ˂ 0.001). Antibodies classified as CTP had a higher signal intensity than CFP (36.77 AU vs 20.00 AU, CI95% 7.79-22.09, p ˂ 0.001). The probability of a CFP was associated to negative ANA, low ANA titer, and multiple positive MSA/MAA (p ˂ 0.001). In this study, we confirmed that CFP results using LIA are frequent, and are associated with low signal intensity MSA/MAA, negative ANA, lower titer ANA, and with multiple positive samples.
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Affiliation(s)
- Jesús Loarce-Martos
- Department of Rheumatology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - Laura Calvo Sanz
- Department of Rheumatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | | | - Ana García-Soidan
- Department of Immunology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Garbiñe Roy Ariño
- Department of Immunology, Hospital Universitario Ramón y Cajal, Madrid, Spain
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14
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Hosono Y, Sie B, Pinal-Fernandez I, Pak K, Mecoli CA, Casal-Dominguez M, Warner BM, Kaplan MJ, Albayda J, Danoff S, Lloyd TE, Paik JJ, Tiniakou E, Aggarwal R, Oddis CV, Moghadam-Kia S, Carmona-Rivera C, Milisenda JC, Grau-Junyent JM, Selva-O'Callaghan A, Christopher-Stine L, Larman HB, Mammen AL. Coexisting autoantibodies against transcription factor Sp4 are associated with decreased cancer risk in patients with dermatomyositis with anti-TIF1γ autoantibodies. Ann Rheum Dis 2023; 82:246-252. [PMID: 36008132 PMCID: PMC9870850 DOI: 10.1136/ard-2022-222441] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/11/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES In dermatomyositis (DM), autoantibodies are associated with unique clinical phenotypes. For example, anti-TIF1γ autoantibodies are associated with an increased risk of cancer. The purpose of this study was to discover novel DM autoantibodies. METHODS Phage ImmunoPrecipitation Sequencing using sera from 43 patients with DM suggested that transcription factor Sp4 is a novel autoantigen; this was confirmed by showing that patient sera immunoprecipitated full-length Sp4 protein. Sera from 371 Johns Hopkins patients with myositis (255 with DM, 28 with antisynthetase syndrome, 40 with immune-mediated necrotising myopathy, 29 with inclusion body myositis and 19 with polymyositis), 80 rheumatological disease controls (25 with Sjogren's syndrome, 25 with systemic lupus erythematosus and 30 with rheumatoid arthritis (RA)) and 200 healthy comparators were screened for anti-SP4 autoantibodies by ELISA. A validation cohort of 46 anti-TIF1γ-positive patient sera from the University of Pittsburgh was also screened for anti-Sp4 autoantibodies. RESULTS Anti-Sp4 autoantibodies were present in 27 (10.5%) patients with DM and 1 (3.3%) patient with RA but not in other clinical groups. In patients with DM, 96.3% of anti-Sp4 autoantibodies were detected in those with anti-TIF1γ autoantibodies. Among 26 TIF1γ-positive patients with anti-Sp4 autoantibodies, none (0%) had cancer. In contrast, among 35 TIF1γ-positive patients without anti-Sp4 autoantibodies, 5 (14%, p=0.04) had cancer. In the validation cohort, among 15 TIF1γ-positive patients with anti-Sp4 autoantibodies, 2 (13.3%) had cancer. By comparison, among 31 TIF1γ-positive patients without anti-Sp4 autoantibodies, 21 (67.7%, p<0.001) had cancer. CONCLUSIONS Anti-Sp4 autoantibodies appear to identify a subgroup of anti-TIF1γ-positive DM patients with lower cancer risk.
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Affiliation(s)
- Yuji Hosono
- Muscle Disease Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Brandon Sie
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Iago Pinal-Fernandez
- Muscle Disease Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
- Department of Neurology and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Katherine Pak
- Muscle Disease Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Christopher A Mecoli
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maria Casal-Dominguez
- Muscle Disease Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
- Department of Neurology and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Blake M Warner
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Mariana J Kaplan
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Jemima Albayda
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sonye Danoff
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thomas E Lloyd
- Department of Neurology and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Julie J Paik
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eleni Tiniakou
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rohit Aggarwal
- Department of Medicine, Division of Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Chester V Oddis
- Department of Medicine, Division of Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Siamak Moghadam-Kia
- Department of Medicine, Division of Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Carmelo Carmona-Rivera
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | | | - Lisa Christopher-Stine
- Department of Neurology and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - H Benjamin Larman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew Lee Mammen
- Muscle Disease Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
- Department of Neurology and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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15
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Fritzler MJ, Bentow C, Satoh M, McHugh N, Ghirardello A, Mahler M. Deciphering the Autoantibody Response to the OJ Antigenic Complex. Diagnostics (Basel) 2023; 13:diagnostics13010156. [PMID: 36611448 PMCID: PMC9818932 DOI: 10.3390/diagnostics13010156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/10/2022] [Accepted: 12/23/2022] [Indexed: 01/04/2023] Open
Abstract
(1) Background: Myositis specific antibodies (MSA) are important diagnostic biomarkers. Among the rarest and most challenging MSA are anti-OJ antibodies which are associated with anti-synthetase syndrome (ASS). In contrast to the other tRNA synthetases that are targets of ASS autoantibodies (e.g Jo-1, PL-7, PL-12, EJ, KS, Zo), OJ represents a macromolecular complex with several ribonucleoprotein subunits. Therefore, the choice of the antigen in autoantibody assays can be challenging. (2) Methods: We collected two independent cohorts with anti-OJ antibodies, one based on a commercial line immunoassay (LIA) (n = 39), the second based on protein immunoprecipitation (IP) (n = 15). Samples were tested using a particle-based multi-analyte technology (PMAT) system that allows for the simultaneous detection of antibodies to various autoantigens. For the detection of anti-OJ antibodies, two different antigens were deployed (KARS, IARS) on PMAT. The reactivity to the two antigens KARS and IARS was analyzed individually and combined in a score (sum of the median fluorescence intensities). (3) Results: In the cohort selection based on LIA, 3/39 (7.7%) samples were positive for anti-KARS and 7/39 (17.9%) for anti-IARS and 14/39 (35.9%) when the two antigens were combined. In contrast, in samples selected by IP the sensitivity of anti-KARS was higher: 6/15 (40.0%) samples were positive for anti-KARS, 4/15 (26.7%) for anti-IARS and 12/15 (80.0%) for the combination of the two antigens. 18/39 (46.2%) of the LIA samples generated a cytoplasmic IIF pattern (compatible with anti-synthetase antibodies), but there was no association with the antibody levels, neither with LIA nor with PMAT. (4) Conclusions: The combination of IARS and KARS might represent a promising approach for the detection of anti-OJ antibodies on a fully automated platform.
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Affiliation(s)
- Marvin J. Fritzler
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | | | - Minoru Satoh
- Department of Human, Information and Science, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
- Department of Medicine, Kitakyushu Yahata-Higashi Hospital, Kitakyushu 805-0071, Japan
| | - Neil McHugh
- Department Pharmacy and Pharmacology, University of Bath, Bath BA2 7AY, UK
| | - Anna Ghirardello
- Unit of Rheumatology, Department of Medicine, University of Padova, 35122 Padua, Italy
| | - Michael Mahler
- Werfen Autoimmunity, San Diego, CA 92131, USA
- Correspondence:
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16
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Teo K, Chen D, Hsu J, Lai Y, Chang C, Hsueh P, Lan J, Hsu J. Screening and characterization of myositis-related autoantibodies in COVID-19 patients. Clin Transl Sci 2022; 16:140-150. [PMID: 36271647 PMCID: PMC9841303 DOI: 10.1111/cts.13434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/06/2022] [Accepted: 09/27/2022] [Indexed: 02/06/2023] Open
Abstract
An efficient host immune response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) appears to be crucial for controlling and resolving this viral infection. However, many studies have reported autoimmune characteristics in severe COVID-19 patients. Moreover, clinical observations have revealed that COVID-19-associated acute distress respiratory syndrome shares many features in common with inflammatory myopathy including interstitial lung disease (ILD), most particularly rapidly progressive (RP)-ILD. This study explored this phenomenon by seeking to identify and characterize myositis-specific and related autoantibodies in 25 COVID-19 patients with mild or severe symptoms. Line blot analysis with the EUROLINE Myopathies Ag kit identified 9 (36%) patients with COVID-19 with one or more autoantibodies against several myositis-related antigens (Jo-1, Ku, Mi-2β, PL-7, PL-12, PM-Scl 75, PM-Scl 100, Ro-52, and SRP); no anti-MDA5 antibodies were detected. As the presence of antibodies identified by line blots was unrelated to disease severity, we further characterized the autoantibodies by radioimmunoassay, in which [35 S]methionine-labeled K562 cellular antigens were precipitated and visualized by gel electrophoresis. This result was confirmed by an immunoprecipitation assay and immunoblotting; 2 patients exhibited anti-Ku70 and anti-Ku80 antibodies. Our data suggest that it is necessary to use more than one method to characterize and evaluate autoantibodies in people recovered from COVID-19, in order to avoid misinterpreting those autoantibodies as diagnostic markers for autoimmune diseases.
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Affiliation(s)
- Kai‐Fa Teo
- Graduate Institute of Biomedical SciencesChina Medical UniversityTaichungTaiwan
| | - Der‐Yuan Chen
- School of MedicineChina Medical UniversityTaichungTaiwan,Translational Medicine LaboratoryChina Medical University HospitalTaichungTaiwan,Rheumatology and Immunology CenterChina Medical University HospitalTaichungTaiwan
| | - Jeh‐Ting Hsu
- Department of Information ManagementHsing Wu UniversityNew TaipeiTaiwan
| | - Yi‐Hua Lai
- School of MedicineChina Medical UniversityTaichungTaiwan,Rheumatology and Immunology CenterChina Medical University HospitalTaichungTaiwan,Rheumatic Diseases Research CenterChina Medical University HospitalTaichungTaiwan
| | - Ching‐Kun Chang
- Translational Medicine LaboratoryChina Medical University HospitalTaichungTaiwan,Rheumatology and Immunology CenterChina Medical University HospitalTaichungTaiwan
| | - Po‐Ren Hsueh
- School of MedicineChina Medical UniversityTaichungTaiwan,Departments of Laboratory Medicine and Internal MedicineChina Medical University HospitalTaichungTaiwan,Ph.D. Program for Aging, School of MedicineChina Medical UniversityTaichungTaiwan,Departments of Laboratory Medicine and Internal MedicineNational Taiwan University Hospital, National Taiwan University College of MedicineTaipeiTaiwan
| | - Joung‐Liang Lan
- School of MedicineChina Medical UniversityTaichungTaiwan,Rheumatology and Immunology CenterChina Medical University HospitalTaichungTaiwan,Rheumatic Diseases Research CenterChina Medical University HospitalTaichungTaiwan
| | - Jye‐Lin Hsu
- Graduate Institute of Biomedical SciencesChina Medical UniversityTaichungTaiwan,Drug Development CenterChina Medical UniversityTaichungTaiwan
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17
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Damoiseaux J, Mammen AL, Piette Y, Benveniste O, Allenbach Y. 256 th ENMC international workshop: Myositis specific and associated autoantibodies (MSA-ab): Amsterdam, The Netherlands, 8-10 October 2021. Neuromuscul Disord 2022; 32:594-608. [PMID: 35644723 DOI: 10.1016/j.nmd.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/12/2022] [Accepted: 05/17/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Jan Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Andrew L Mammen
- Muscle Disease Unit. Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, United States
| | - Yves Piette
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, INSERM, UMR974, Pitié-Salpêtrière University Hospital, Paris, France
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, INSERM, UMR974, Pitié-Salpêtrière University Hospital, Paris, France
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18
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Selickaja S, Galindo-Feria AS, Dani L, Mimori T, Rönnelid J, Holmqvist M, Lundberg IE, Venalis P. ELISA, protein immunoprecipitation and line blot assays for anti-TIF1-gamma autoantibody detection in cancer-associated dermatomyositis. Rheumatology (Oxford) 2022; 61:4991-4996. [PMID: 35579337 PMCID: PMC9707101 DOI: 10.1093/rheumatology/keac288] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/24/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Anti-TIF1-gamma autoantibodies can be detected with immunoprecipitation (IP), line blot (LB) and ELISA. We compared assay performance in patients with DM and the potential of these assays to detect anti-TIF1-gamma positive cancer-associated DM (CADM). METHODS We included sera from 131 patients with DM followed at Karolinska University Hospital, Stockholm, Sweden and 82 healthy controls. Serum samples taken at DM diagnosis were tested for anti-TIF1-gamma autoantibodies with IP, two ELISAs (in-house and commercial) and LB. Cancer diagnosis and dates were obtained from the Swedish national cancer register. CADM was defined as a malignancy that developed within 3 years of DM diagnosis. RESULTS Anti-TIF1-gamma autoantibodies were detected in 19/101 (18.8%), 15/113 (13.2%), 34/131 (26%) and 45/131 (34.4%) of the patients with IP, LB, in-house and commercial ELISA, respectively. The anti-TIF1-gamma results from the in-house ELISA were confirmed with IP in 93 of 101 (92%) cases, κ = 0.76, with a commercial ELISA in 110 of 131 (84%) cases, κ = 0.63, and with LB in 101 of 113 (89.3%) cases, κ = 0.67. Anti-TIF1-gamma results with IP were confirmed with LB in 85 of 92 (92.4%) cases, κ = 0.73. For detecting CADM, the anti-TIF1-gamma in-house ELISA had a sensitivity of 58% and specificity of 86%, the commercial ELISA had a sensitivity of 63% and specificity of 82%, IP had a sensitivity of 52% and specificity of 92%, LB had a sensitivity of 40% and specificity of 96%. CONCLUSION The two anti-TIF1-gamma ELISA assays had advantages both for autoantibody detection and to identify anti-TIF1-gamma-positive CADM.
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Affiliation(s)
- Sandra Selickaja
- Correspondence to: Sandra Selickaja, Center for Innovative Medicine, Santariskiu st. 5, Vilnius LT-08410, Lithuania. E-mail:
| | - Angeles S Galindo-Feria
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet,Center for Molecular Medicine, Karolinska Institutet and Karolinska University Hospital Solna
| | - Lara Dani
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet,Division of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate school of Medicine,Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Johan Rönnelid
- Department Immunology, Genetics and Pathology, Uppsala University, Uppsala
| | - Marie Holmqvist
- Division of Rheumatology, Karolinska University Hospital, Stockholm, Sweden,Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet
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19
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Sambataro G, Ferrara CA, Spadaro C, Torrisi SE, Vignigni G, Vancheri A, Muscato G, Del Papa N, Colaci M, Malatino L, Palmucci S, Cavagna L, Zanframundo G, Ferro F, Baldini C, Sambataro D, Vancheri C. A New Method for the Assessment of Myalgia in Interstitial Lung Disease: Association with Positivity for Myositis-Specific and Myositis-Associated Antibodies. Diagnostics (Basel) 2022; 12:1139. [PMID: 35626295 PMCID: PMC9140063 DOI: 10.3390/diagnostics12051139] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/01/2022] [Accepted: 05/02/2022] [Indexed: 02/05/2023] Open
Abstract
In this study, it was found that myositis-specific and myositis-associated antibodies (MSAs and MAAs) improved the recognition of idiopathic inflammatory myopathies (IIMs) in interstitial lung disease (ILD) patients. The objective of this study is to propose a clinical method to evaluate myalgia in respiratory settings as a possible tool for the recognition of MSA/MAA positivity in ILD patients. We prospectively enrolled 167 ILD patients with suspected myositis, of which 63 had myalgia evoked at specific points (M+ILD+). We also enrolled in a 174 patients with only myalgia (M+ILD-) in a rheumatological setting. The patients were assessed jointly by rheumatologists and pulmonologists and were tested for autoantibodies. M+ILD+ patients were positive for at least one MAA/MSA in 68.3% of cases, as were M-ILD+ patients in 48.1% of cases and M+ILD- patients in 17.2% of cases (p = 0.01 and <0.0001, respectively). A diagnosis of IIM was made in 39.7% of M+ILD+ patients and in 23.1% of the M-ILD+ group (p = 0.02). Myalgia was significantly associated with positivity for MSA/MAAs in ILD patients (p = 0.01, X2: 6.47). In conclusion, myalgia in ILD patients with suspected myositis is associated with MSA/MAA positivity, and could support a diagnosis of IIM. A significant proportion of M+ILD- patients also had MSA/MAA positivity, a phenomenon warranting further study to evaluate its clinical meaning.
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Affiliation(s)
- Gianluca Sambataro
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. “Policlinico-San Marco”, University of Catania, 95123 Catania, Italy; (C.A.F.); (C.S.); (S.E.T.); (G.V.); (A.V.); (G.M.); (C.V.)
- Outpatient Clinic of Rheumatology, Artroreuma S.R.L., Corso S. Vito 53, 95030 Mascalucia (CT), Italy;
| | - Chiara Alfia Ferrara
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. “Policlinico-San Marco”, University of Catania, 95123 Catania, Italy; (C.A.F.); (C.S.); (S.E.T.); (G.V.); (A.V.); (G.M.); (C.V.)
| | - Carla Spadaro
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. “Policlinico-San Marco”, University of Catania, 95123 Catania, Italy; (C.A.F.); (C.S.); (S.E.T.); (G.V.); (A.V.); (G.M.); (C.V.)
| | - Sebastiano Emanuele Torrisi
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. “Policlinico-San Marco”, University of Catania, 95123 Catania, Italy; (C.A.F.); (C.S.); (S.E.T.); (G.V.); (A.V.); (G.M.); (C.V.)
| | - Giovanna Vignigni
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. “Policlinico-San Marco”, University of Catania, 95123 Catania, Italy; (C.A.F.); (C.S.); (S.E.T.); (G.V.); (A.V.); (G.M.); (C.V.)
| | - Ada Vancheri
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. “Policlinico-San Marco”, University of Catania, 95123 Catania, Italy; (C.A.F.); (C.S.); (S.E.T.); (G.V.); (A.V.); (G.M.); (C.V.)
| | - Giuseppe Muscato
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. “Policlinico-San Marco”, University of Catania, 95123 Catania, Italy; (C.A.F.); (C.S.); (S.E.T.); (G.V.); (A.V.); (G.M.); (C.V.)
| | - Nicoletta Del Papa
- Day Hospital of Rheumatology, Department of Rheumatology, ASST G.Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy;
| | - Michele Colaci
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, Cannizzaro Hospital, University of Catania, Via Messina 829, 95100 Catania, Italy; (M.C.); (L.M.)
| | - Lorenzo Malatino
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, Cannizzaro Hospital, University of Catania, Via Messina 829, 95100 Catania, Italy; (M.C.); (L.M.)
| | - Stefano Palmucci
- Department of Medical, Surgical Sciences and Advanced Technologies, “G.F. Ingrassia”, University of Catania, Via S. Sofia 68 Catania, 95123 Catania, Italy;
| | - Lorenzo Cavagna
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo, Piazzale C. Golgi 19, 27100 Pavia, Italy; (L.C.); (G.Z.)
| | - Giovanni Zanframundo
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo, Piazzale C. Golgi 19, 27100 Pavia, Italy; (L.C.); (G.Z.)
| | - Francesco Ferro
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Via Roma 24, 56126 Pisa, Italy; (F.F.); (C.B.)
| | - Chiara Baldini
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Via Roma 24, 56126 Pisa, Italy; (F.F.); (C.B.)
| | - Domenico Sambataro
- Outpatient Clinic of Rheumatology, Artroreuma S.R.L., Corso S. Vito 53, 95030 Mascalucia (CT), Italy;
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. “Policlinico-San Marco”, University of Catania, 95123 Catania, Italy; (C.A.F.); (C.S.); (S.E.T.); (G.V.); (A.V.); (G.M.); (C.V.)
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20
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Notarnicola A, Preger C, Lundström SL, Renard N, Wigren E, Van Gompel E, Galindo-Feria AS, Persson H, Fathi M, Grunewald J, Jakobsson PJ, Gräslund S, Lundberg IE, Fernandes-Cerqueira C. Longitudinal assessment of reactivity and affinity profile of anti-Jo1 autoantibodies to distinct HisRS domains and a splice variant in a cohort of patients with myositis and anti-synthetase syndrome. Arthritis Res Ther 2022; 24:62. [PMID: 35236390 PMCID: PMC8889758 DOI: 10.1186/s13075-022-02745-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 02/13/2022] [Indexed: 02/08/2023] Open
Abstract
Background To address the reactivity and affinity against histidyl-transfer RNA synthetase (HisRS) autoantigen of anti-Jo1 autoantibodies from serum and bronchoalveolar lavage fluid (BALF) in patients with idiopathic inflammatory myopathies/anti-synthetase syndrome (IIM/ASSD). To investigate the associations between the reactivity profile and clinical data over time. Methods Samples and clinical data were obtained from (i) 25 anti-Jo1+ patients (19 sera with 16 longitudinal samples and 6 BALF/matching sera at diagnosis), (ii) 29 anti-Jo1− patients (25 sera and 4 BALF/matching sera at diagnosis), and (iii) 27 age/gender-matched healthy controls (24 sera and 3 BALF/matching sera). Reactivity towards HisRS full-length (HisRS-FL), three HisRS domains (WHEP, antigen binding domain (ABD), and catalytic domain (CD)), and the HisRS splice variant (SV) was tested. Anti-Jo1 IgG reactivity was evaluated by ELISA and western blot using IgG purified from serum by affinity chromatography. In paired serum-BALF, anti-Jo1 IgG and IgA reactivity was analyzed by ELISA. Autoantibody affinity was measured by surface plasmon resonance using IgG purified from sera. Correlations between autoantibody reactivity and clinical data were evaluated at diagnosis and longitudinally. Results Anti-Jo1 IgG from serum and BALF bound HisRS-FL, WHEP, and SV with high reactivity at the time of diagnosis and recognized both conformation-dependent and conformation-independent HisRS epitopes. Anti-HisRS-FL IgG displayed high affinity early in the disease. At the time of IIM/ASSD diagnosis, the highest autoantibody levels against HisRS-FL were found in patients ever developing interstitial lung disease (ILD) and arthritis, but with less skin involvement. Moreover, the reactivity of anti-WHEP IgG in BALF correlated with poor pulmonary function. Levels of autoantibodies against HisRS-FL, HisRS domains, and HisRS splice variant generally decreased over time. With some exceptions, longitudinal anti-HisRS-FL antibody levels changed in line with ILD activity. Conclusion High levels and high-affinity anti-Jo1 autoantibodies towards HisRS-FL were found early in disease in sera and BALF. In combination with the correlation of anti-HisRS-FL antibody levels with ILD and ILD activity in longitudinal samples as well as of anti-WHEP IgG in BALF with poor pulmonary function, this supports the previously raised hypothesis that the lung might have a role in the immune reaction in anti-Jo1-positive patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02745-6.
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Affiliation(s)
- Antonella Notarnicola
- Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, SE-171 64, Solna, Stockholm, Sweden. .,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Charlotta Preger
- Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, SE-171 64, Solna, Stockholm, Sweden.,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Structural Genomics Consortium, Toronto, Canada
| | - Susanna L Lundström
- Division of Physiological Chemistry I, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Solnavägen 9, SE-171 77, Stockholm, Sweden
| | - Nuria Renard
- Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, SE-171 64, Solna, Stockholm, Sweden.,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Edvard Wigren
- Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, SE-171 64, Solna, Stockholm, Sweden.,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Structural Genomics Consortium, Toronto, Canada
| | - Eveline Van Gompel
- Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, SE-171 64, Solna, Stockholm, Sweden.,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, KULeuven, Leuven, Belgium
| | - Angeles S Galindo-Feria
- Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, SE-171 64, Solna, Stockholm, Sweden.,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Helena Persson
- Science for Life Laboratory, Drug Discovery and Development, Stockholm, Sweden.,School of Engineering Sciences in Chemistry, Biotechnology and Health, Royal Institute of Technology (KTH), Stockholm, Sweden
| | - Maryam Fathi
- Department of Respiratory Medicine and Allergy, J7:30, Bioclinicum, Karolinska University Hospital, Karolinska Institutet, SE-171 76, Stockholm, Sweden
| | - Johan Grunewald
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Respiratory Medicine and Allergy, J7:30, Bioclinicum, Karolinska University Hospital, Karolinska Institutet, SE-171 76, Stockholm, Sweden
| | - Per-Johan Jakobsson
- Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, SE-171 64, Solna, Stockholm, Sweden.,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Susanne Gräslund
- Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, SE-171 64, Solna, Stockholm, Sweden.,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Structural Genomics Consortium, Toronto, Canada
| | - Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, SE-171 64, Solna, Stockholm, Sweden.,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Cátia Fernandes-Cerqueira
- Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, SE-171 64, Solna, Stockholm, Sweden.,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,4Dcell, 14 rue de la Beaune, 93100, Montreuil, France
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21
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Bonroy C, Piette Y, Allenbach Y, Bossuyt X, Damoiseaux J. Positioning of myositis-specific and associated autoantibody (MSA/MAA) testing in disease criteria and routine diagnostic work-up. J Transl Autoimmun 2022; 5:100148. [PMID: 35243286 PMCID: PMC8881476 DOI: 10.1016/j.jtauto.2022.100148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 11/25/2022] Open
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22
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Mulhearn B, Li D, McMorrow F, Lu H, McHugh NJ, Tansley SL. A Commercial Anti-TIF1γ ELISA Is Superior to Line and Dot Blot and Should Be Considered as Part of Routine Myositis-Specific Antibody Testing. Front Immunol 2022; 13:804037. [PMID: 35154119 PMCID: PMC8831764 DOI: 10.3389/fimmu.2022.804037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/12/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives Anti-TIF1γ is an important autoantibody in the diagnosis of cancer-associated dermatomyositis and the most common autoantibody in juvenile onset dermatomyositis. Its reliable detection is important to instigate further investigations into underlying malignancy in adults. We previously showed that commercial assays using line and dot blots do not reliably detect anti-TIF1γ. We aimed to test a new commercial ELISA and compare with previously obtained protein immunoprecipitation. Methods Radio-labelled immunoprecipitation had previously been used to determine the autoantibody status of patients with immune-mediated inflammatory myopathies and several healthy controls. ELISA was undertaken on healthy control and anti-TIF1γ sera and compared to previous immunoprecipitation data. Results A total of 110 serum samples were analysed: 42 myositis patients with anti- TIF1γ and 68 autoantibody negative healthy control sera. Anti-TIF1γ was detected by ELISA in 41 out of 42 of the anti-TIF1γ-positive samples by immunoprecipitation, and in none of the healthy controls, giving a sensitivity of 97.6% and specificity of 100%. The false negative rate was 2%. Conclusion ELISA is an affordable and time-efficient method which is accurate in detecting anti-TIF1γ.
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Affiliation(s)
- Ben Mulhearn
- Department and Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals, Bath, United Kingdom
- *Correspondence: Ben Mulhearn,
| | - Danyang Li
- Department and Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
| | - Fionnuala McMorrow
- Department and Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
| | - Hui Lu
- Department and Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
| | - Neil J. McHugh
- Department and Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
| | - Sarah L. Tansley
- Department and Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals, Bath, United Kingdom
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23
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Fredi M, Cavazzana I, Ceribelli A, Cavagna L, Barsotti S, Bartoloni E, Benucci M, De Stefano L, Doria A, Emmi G, Fabris M, Fornaro M, Furini F, Giudizi MG, Govoni M, Ghirardello A, Iaccarino L, Iannone F, Infantino M, Isailovic N, Lazzaroni MG, Manfredi M, Mathieu A, Marasco E, Migliorini P, Montecucco C, Palterer B, Parronchi P, Piga M, Pratesi F, Riccieri V, Selmi C, Tampoia M, Tripoli A, Zanframundo G, Radice A, Gerli R, Franceschini F. An Italian Multicenter Study on Anti-NXP2 Antibodies: Clinical and Serological Associations. Clin Rev Allergy Immunol 2022; 63:240-250. [PMID: 35092577 PMCID: PMC9464148 DOI: 10.1007/s12016-021-08920-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 01/13/2023]
Abstract
The identification of anti-NXP2 antibodies is considered a serological marker of dermatomyositis (DM), with calcinosis, severe myositis and, in some reports, with cancer. Historically, these associations with anti-NXP2 antibodies have been detected by immunoprecipitation (IP), but in the last few years commercial immunoblotting assays have been released. The aim of this collaborative project was to analyse the clinical features associated to anti-NXP2 antibodies, both with commercial line blot (LB) and IP. Myositis-specific and myositis-associated autoantibodies were detected in single centres by commercial line blot (LB); available sera were evaluated in a single centre by protein and RNA immunoprecipitation (IP), and IP-Western blot. Sixty patients anti-NXP2+ (NXP2+) positive by LB were compared with 211 patients anti-NXP2 negative with idiopathic inflammatory myositis (IIM). NXP2+ showed a younger age at IIM onset (p = 0.0014), more frequent diagnosis of dermatomyositis (p = 0.026) and inclusion-body myositis (p = 0.009), and lower rate of anti-synthetase syndrome (p < 0.0001). As for clinical features, NXP2+ more frequently develop specific skin manifestations and less frequently features related with overlap myositis and anti-synthetase syndrome. IP confirmed NXP2 positivity in 31 of 52 available sera (62%). Most clinical associations were confirmed comparing NXP2 LB+/IP+ versus NXP2-negative myositis, with the following exceptions: inclusion-body myositis diagnosis was not detected, whilst dysphagia and myositis were found more frequently in NXP2 LB+/IP+ patients. The 21 LB+ /IP-myositis patients did not show differences in clinical features when compared with the NXP2-myositis patients and more frequently displayed multiple positivity at LB. Risk of developing cancer-associated myositis was similar between NXP2-positive and NXP2-negative myositis patients, either when detected by LB or IP. Protein-IP confirmed NXP2 antibodies in nearly 60% of sera positive for the same specificity with commercial assay. Double-positive cases rarely occurred in myositis patients with a clinical diagnosis other than dermatomyositis. Patients only positive by LB (LB+/IP-) did not display clinical features typical of NXP2. NXP2 positivity by LB should be confirmed by other methods in order to correctly diagnose and characterize patients affected by idiopathic inflammatory myositis.
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Affiliation(s)
- Micaela Fredi
- grid.7637.50000000417571846Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Ilaria Cavazzana
- grid.7637.50000000417571846Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Angela Ceribelli
- grid.417728.f0000 0004 1756 8807Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano (Mi), Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Rozzano (Mi), Italy
| | - Lorenzo Cavagna
- grid.419425.f0000 0004 1760 3027Division of Rheumatology, University and IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Simone Barsotti
- grid.5395.a0000 0004 1757 3729Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elena Bartoloni
- grid.9027.c0000 0004 1757 3630Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Maurizio Benucci
- grid.511672.60000 0004 5995 4917Immunology and Allergy Laboratory Unit S. Giovanni Di Dio Hospital, Azienda USL Toscana Centro, Firenze, Italy
| | - Ludovico De Stefano
- grid.419425.f0000 0004 1760 3027Division of Rheumatology, University and IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Andrea Doria
- grid.5608.b0000 0004 1757 3470Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Giacomo Emmi
- grid.8404.80000 0004 1757 2304Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Martina Fabris
- grid.411492.bInstitute of Clinical Pathology, Department of Laboratory Medicine, University Hospital of Udine, Udine, Italy
| | - Marco Fornaro
- grid.7644.10000 0001 0120 3326Unit of Rheumatology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Federica Furini
- grid.8484.00000 0004 1757 2064Department of Medical Sciences, Rheumatology Unit, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Cona (Ferrara), Italy
| | - Maria Grazia Giudizi
- grid.8404.80000 0004 1757 2304Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Marcello Govoni
- grid.8484.00000 0004 1757 2064Department of Medical Sciences, Rheumatology Unit, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Cona (Ferrara), Italy
| | - Anna Ghirardello
- grid.5608.b0000 0004 1757 3470Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Luca Iaccarino
- grid.5608.b0000 0004 1757 3470Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Fiorenzo Iannone
- grid.7644.10000 0001 0120 3326Unit of Rheumatology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Maria Infantino
- grid.511672.60000 0004 5995 4917Immunology and Allergy Laboratory Unit S. Giovanni Di Dio Hospital, Azienda USL Toscana Centro, Firenze, Italy
| | - Natasa Isailovic
- grid.417728.f0000 0004 1756 8807Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano (Mi), Italy
| | - Maria Grazia Lazzaroni
- grid.7637.50000000417571846Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Mariangela Manfredi
- grid.511672.60000 0004 5995 4917Immunology and Allergy Laboratory Unit S. Giovanni Di Dio Hospital, Azienda USL Toscana Centro, Firenze, Italy
| | - Alessandro Mathieu
- grid.7763.50000 0004 1755 3242Rheumatology Unit, Department of Medical Sciences and Public Health, University of Cagliari and AOU University Clinic, Cagliari, Italy
| | - Emiliano Marasco
- grid.419425.f0000 0004 1760 3027Division of Rheumatology, University and IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Paola Migliorini
- grid.5395.a0000 0004 1757 3729Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Carlomaurizio Montecucco
- grid.419425.f0000 0004 1760 3027Division of Rheumatology, University and IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Boaz Palterer
- grid.8404.80000 0004 1757 2304Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Paola Parronchi
- grid.8404.80000 0004 1757 2304Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Matteo Piga
- grid.7763.50000 0004 1755 3242Rheumatology Unit, Department of Medical Sciences and Public Health, University of Cagliari and AOU University Clinic, Cagliari, Italy
| | - Federico Pratesi
- grid.5395.a0000 0004 1757 3729Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valeria Riccieri
- grid.7841.aDepartment of Rheumatology, Sapienza-University of Rome, Rome, Italy
| | - Carlo Selmi
- grid.417728.f0000 0004 1756 8807Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center - IRCCS, Rozzano (Mi), Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Rozzano (Mi), Italy
| | - Marilina Tampoia
- Clinical Pathology Unit, Department of Biomedical Sciences and Human Oncology, University “Aldo Moro” of Bari, Bari, Italy
| | - Alessandra Tripoli
- grid.5395.a0000 0004 1757 3729Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giovanni Zanframundo
- grid.419425.f0000 0004 1760 3027Division of Rheumatology, University and IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Antonella Radice
- grid.416325.7Department of Microbiology and Virology, ASST Santi Paolo E Carlo, San Carlo Hospital, Milan, Italy
| | - Roberto Gerli
- grid.9027.c0000 0004 1757 3630Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Franco Franceschini
- grid.7637.50000000417571846Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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24
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Shinoda K, Okumura M, Yamaguchi S, Matsui A, Tsuda R, Hounoki H, Suzuki S, Tobe K. A Comparison of Line Blots, Enzyme-linked Immunosorbent, and RNA-immunoprecipitation Assays of Antisynthetase Antibodies in Serum Samples from 44 Patients. Intern Med 2022; 61:313-322. [PMID: 35110513 PMCID: PMC8866784 DOI: 10.2169/internalmedicine.7824-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To determine the differences between anti-aminoacyl tRNA synthetase (ARS) antibodies among line blots, enzyme-linked immunosorbent assay (ELISA) anti-ARS tests, and RNA-immunoprecipitation (IP) assays. Methods Sera from patients with confirmed or suspected antisynthetase syndrome (ASS) that were positive for either the anti-ARS test or the line-blot assay were used to perform an RNA-IP assay and ELISA to detect individual anti-ARS antibodies. Results Among the 44 patients, 10 were positive only in line-blot assays, 6 were positive only in the anti-ARS test, and 28 were positive in both assays. We compared the accuracy of these assays against the gold standard RNA-IP assay. The κ coefficient was 0.23 in the line-blot assay, but this increased to 0.75 when the cut-off was increased from 1+ to 2+. The κ coefficient was 0.73 in the anti-ARS test. The κ coefficient was 0.85 for positivity in both assays. Patients with ASS that was positive in an RNA-IP assay more frequently had mechanic's hand (62.1% vs. 20%: p=0.031), myositis (51.7 vs. 10%: p=0.028) and more ASS symptoms than those who were positive only in line-blot assays (3.48 vs. 2.2: p=0.019). Conclusions Clinicians need to understand the features of each assay and determine diagnoses by also considering clinical presentations. Diagnoses should not be judged based only on the results of line-blot assays due to the risk of a misdiagnosis from false positives.
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Affiliation(s)
- Koichiro Shinoda
- First Department of Internal Medicine, University of Toyama, Japan
| | - Maiko Okumura
- First Department of Internal Medicine, University of Toyama, Japan
| | | | - Atsushi Matsui
- First Department of Internal Medicine, University of Toyama, Japan
| | - Reina Tsuda
- First Department of Internal Medicine, University of Toyama, Japan
| | - Hiroyuki Hounoki
- First Department of Internal Medicine, University of Toyama, Japan
| | - Shigeaki Suzuki
- Department of Neurology, Keio University School of Medicine, Japan
| | - Kazuyuki Tobe
- First Department of Internal Medicine, University of Toyama, Japan
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25
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Ichimura Y, Konishi R, Shobo M, Inoue S, Okune M, Maeda A, Tanaka R, Kubota N, Matsumoto I, Ishii A, Tamaoka A, Shimbo A, Mori M, Morio T, Kishi T, Miyamae T, Tanboon J, Inoue M, Nishino I, Fujimoto M, Nomura T, Okiyama N. Reliability of antinuclear matrix protein 2 antibody assays in idiopathic inflammatory myopathies is dependent on target protein properties. J Dermatol 2021; 49:441-447. [PMID: 34967032 DOI: 10.1111/1346-8138.16295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/11/2021] [Accepted: 12/20/2021] [Indexed: 11/26/2022]
Abstract
A line blotting assay (LB) is currently used to detect myositis-specific autoantibodies (MSAs) in patients with idiopathic inflammatory myopathies (IIMs), because of its simplicity; however, the sensitivity and specificity of this assay is low. The aim of this study is to evaluate the accuracy of the commercial LB in detection of antinuclear matrix protein 2 (NXP2) antibody. Seventy-seven serum samples from patients with IIMs, in which anti-NXP2 antibodies were detected through immunoprecipitation and western blotting (IP-WB) using K562 cell lysate, were enrolled. All samples were assessed by LB and IP-WB using recombinant human NXP2 whole protein (rNXP2) produced by insect cells, and the positive rates of each assay were compared. Thirty-two samples (41.6%) showed false-negativity by LB, which includes 11 samples with negative results by IP-WB using rNXP2. Relative intensities of IP-WB using cell lysate were significantly higher in the samples with positive results by both LB and IP-WB using rNXP2, compared to samples with positive by IP-WB using rNXP2 but negative by LB. Three of 11 samples with negative results by both LB and IP-WB using rNXP2 revealed high antibody titers. Further, differences in post-transcriptional SUMOylation were observed between recombinant and natural NXP2 proteins. In conclusion, the LB showed low sensitivity for detection of anti-NXP2 antibody, an effect exacerbated at low titers of anti-NXP2 antibodies. Moreover, there appears to be differences in the reactivities of antibodies to recombinant and natural NXP2 proteins with different post-transcriptional modifications.
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Affiliation(s)
- Yuki Ichimura
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Risa Konishi
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Miwako Shobo
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Sae Inoue
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Mari Okune
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Akemi Maeda
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Ryota Tanaka
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Noriko Kubota
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Isao Matsumoto
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Akiko Ishii
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Akira Tamaoka
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Asami Shimbo
- Department of Pediatrics and Development Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaaki Mori
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomohiro Morio
- Department of Pediatrics and Development Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takayuki Kishi
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.,Department of Pediatrics, Tokyo Women's Medical University, Tokyo, Japan
| | - Takako Miyamae
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.,Department of Pediatrics, Tokyo Women's Medical University, Tokyo, Japan
| | - Jantima Tanboon
- Department of Neuromuscular Research, National Center of Neurology and Psychiatry, National Institute of Neuroscience, Tokyo, Japan.,Medical Genome Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Michio Inoue
- Department of Neuromuscular Research, National Center of Neurology and Psychiatry, National Institute of Neuroscience, Tokyo, Japan.,Medical Genome Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Center of Neurology and Psychiatry, National Institute of Neuroscience, Tokyo, Japan.,Medical Genome Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Toshifumi Nomura
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Naoko Okiyama
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Sreevilasan SK, Devarasetti P, Narahari NK, Desai A, Rajasekhar L. Clinical profile and treatment outcomes in antisynthetase syndrome: a tertiary centre experience. Rheumatol Adv Pract 2021; 5:ii10-ii18. [PMID: 34755025 PMCID: PMC8570161 DOI: 10.1093/rap/rkab054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/18/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim was to describe the clinical profile and outcomes in patients with antisynthetase syndrome (ASS) from a tertiary care centre. METHODS The clinical data and investigations of all patients classified as ASS by Connors criteria over 5 years were recorded, and they were followed up prospectively. The median (interquartile range) was used for descriptive statistics. Clinical variables between the Jo-1 and non-Jo-1 groups and between patients with and without anti-Ro52 antibodies were compared using the χ2 test. Survival analysis was done using the log rank test. RESULTS The 28 patients (23 females) had a median age of 42.5 (34.8-52.3) years, with a disease duration of 1.75 (0.6-3.8) years at diagnosis, and had a follow-up of 2 (0.25-4.25) years. Seronegative arthritis was seen in 23 of 28 patients. Non-specific interstitial pneumonia was seen in 19 patients with interstitial lung disease (ILD). Antibodies to Jo-1 (n = 17) were more frequent than non-Jo-1 antibodies (n = 11; five anti-PL-12, four anti-PL-7 and two anti-EJ). There was no significant difference in the prevalence of myositis (P = 0.07) or ILD (P = 0.11) between groups. Anti-Ro52 antibodies were more frequently found in the non-Jo-1 group (P = 0.006, ϕ = 0.51). A partial or complete improvement with treatment was seen in three-quarters of the patients. Five patients succumbed to the illness. Better survival was seen in the Jo-1 group (P = 0.05). CONCLUSION The most typical presenting manifestation of ASS in our cohort was isolated seronegative arthritis. Non-specific interstitial pneumonia was the commonest ILD pattern. Patients with antibodies to Jo-1 had better survival compared with non-Jo-1. The non-Jo-1 aminoacyl-transfer RNA synthetases had a strong association with anti-Ro52 antibodies.
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Affiliation(s)
| | | | - Narendra Kumar Narahari
- Department of Pulmonary Medicine, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Anitha Desai
- Department of Clinical Immunology and Rheumatology
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Gensous N, Zanardo L, Martinroche G, Victor J, Fabien N, Duffau P, Contin-Bordes C. Cross-reactive anti-CENP-A autoantibodies induce analytic interference in anti-TIF1γ detection using line-dot immunoassay. Rheumatology (Oxford) 2021; 60:4942-4944. [PMID: 34022038 DOI: 10.1093/rheumatology/keab451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/08/2021] [Accepted: 05/11/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Noémie Gensous
- Immunology Department.,Internal Medicine Department, Bordeaux University Hospital.,Department of Immunology, University Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, Bordeaux
| | | | | | - Judith Victor
- Internal Medicine Department, Bordeaux University Hospital
| | - Nicole Fabien
- Department of Immunology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Pierre Duffau
- Internal Medicine Department, Bordeaux University Hospital.,Department of Immunology, University Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, Bordeaux
| | - Cécile Contin-Bordes
- Immunology Department.,Department of Immunology, University Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, Bordeaux
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Xu A, Ye Y, Fu Q, Lian X, Chen S, Guo Q, Lu LJ, Dai M, Lv X, Bao C. Prognostic values of anti-Ro52 antibodies in anti-MDA5-positive clinically amyopathic dermatomyositis associated with interstitial lung disease. Rheumatology (Oxford) 2021; 60:3343-3351. [PMID: 33331866 DOI: 10.1093/rheumatology/keaa786] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/11/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Anti-Ro52 antibody often co-occurs with anti-Jo1 antibody in antisynthetase syndrome and their co-occurrence correlates with a more aggressive clinical phenotype and poorer prognosis. The strong association of anti-Ro52 antibody with anti-melanoma differentiation-associated protein-5 (anti-MDA5) antibody has been indicated in juvenile myositis. The aim of this study was to assess the clinical significance of anti-Ro52 antibody in a cohort of adult patients with anti-MDA5-positive clinically amyopathic dermatomyositis with interstitial lung disease (CADM-ILD). METHODS We assessed a cohort of 83 consecutive patients with anti-MDA5-positive CADM-ILD. Anti-MDA5 antibodies and anti-Ro52 antibodies were detected in immunoblotting and semi-quantitatively analysed by densitometry. Clinical features and the 24 month survival were compared between anti-MDA5-positive patients with and without anti-Ro52 antibodies. RESULTS Anti-Ro52 antibodies were found in 74.7% of anti-MDA5-positive CADM-ILD patients and were associated with an increased frequency of rapidly progressive interstitial lung disease (RP-ILD; 54.8% vs 23.8%; P = 0.014) and cutaneous ulcerations (27.4% vs 4.8%; P = 0.033). The cumulative 24 month survival rate tended to be lower in patients with anti-Ro52 antibodies than patients without (59.9% vs 85.7%; P = 0.051). The combination of anti-Ro52 antibody status and anti-MDA5 antibody levels further stratified patients' survival rates, showing that the survival rate of patients who were dual positive for anti-MDA5 antibody and anti-Ro52 antibody was significantly lower than patients with mild positive anti-MDA5 antibody alone (59.9% vs 100%; P = 0.019). CONCLUSION Anti-Ro52 antibody is highly prevalent in anti-MDA5-positive CADM-ILD patients and their coexistence correlates with a subgroup of patients with more aggressive phenotypes. The combination of anti-MDA5 antibody levels and anti-Ro52 antibody status could help to predict patients' prognosis and guide risk-based therapy.
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Affiliation(s)
- Antao Xu
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Ye
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiong Fu
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinyue Lian
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sheng Chen
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiang Guo
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liang-Jing Lu
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Dai
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xia Lv
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chunde Bao
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Immune recognition of lysyl-tRNA synthetase and isoleucyl-tRNA synthetase by anti-OJ antibody-positive sera. J Autoimmun 2021; 122:102680. [PMID: 34120070 DOI: 10.1016/j.jaut.2021.102680] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Anti-aminoacyl-tRNA synthetase (anti-ARS) antibodies are useful for identifying a clinical subset of patients with idiopathic inflammatory myopathies (IIMs). Anti-OJ antibodies, which recognize multi-enzyme synthetase complexes including isoleucyl-tRNA synthetase (IARS) and lysyl-tRNA synthetase (KARS), are among the anti-ARS antibodies. Although testing antibodies to other ARSs have been used clinically, no validated immunoassays for detecting anti-OJ antibodies are available. We aimed to establish an anti-OJ ELISA. METHODS Serum samples were collected from 279 patients with IIMs and 22 patients with idiopathic interstitial pneumonia. Sixty-four of the samples that had been confirmed to be negative for anti-OJ by standard immunoprecipitation were used as the negative control, and 12 anti-OJ-positive reference sera were used as the positive control. Antibodies to IARS and KARS were assayed by ELISA using biotinylated recombinant proteins generated by in vitro transcription/translation. RESULTS The anti-OJ-positive sera strongly reacted with the KARS and IARS recombinant proteins in ELISA. Although all 12 reference sera were positive in the anti-KARS ELISA, 4 of the 64 anti-OJ-negative sera were also weakly positive. The sensitivity and the specificity were 100% and 93.8%, respectively. Since our anti-KARS ELISA performed well, showing a high agreement with the results for immunoprecipitation (Cohen's κ > 0.8), the remaining 237 samples were also tested. Thirteen anti-KARS-positive sera were newly found by ELISA, all of which were anti-OJ positive by immunoprecipitation. CONCLUSION Immunoassays for detecting anti-OJ antibodies using KARS and IARS recombinant proteins were developed. Our ELISAs performed well, with very high agreement of the results by immunoprecipitation and can be applied to the first reliable, easy-to-use measurement assays for anti-OJ antibodies.
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Turnier JL, Pachman LM, Lowe L, Tsoi LC, Elhaj S, Menon R, Amoruso MC, Morgan GA, Gudjonsson JE, Berthier CC, Kahlenberg JM. Comparison of Lesional Juvenile Myositis and Lupus Skin Reveals Overlapping Yet Unique Disease Pathophysiology. Arthritis Rheumatol 2021; 73:1062-1072. [PMID: 33305541 DOI: 10.1002/art.41615] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 12/03/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Skin inflammation heralds systemic disease in juvenile myositis, yet we lack an understanding of pathogenic mechanisms driving skin inflammation in this disease. We undertook this study to define cutaneous gene expression signatures in juvenile myositis and identify key genes and pathways that differentiate skin disease in juvenile myositis from childhood-onset systemic lupus erythematosus (SLE). METHODS We used formalin-fixed paraffin-embedded skin biopsy samples from 15 patients with juvenile myositis (9 lesional, 6 nonlesional), 5 patients with childhood-onset SLE, and 8 controls to perform transcriptomic analysis and identify significantly differentially expressed genes (DEGs; q ≤ 5%) between patient groups. We used Ingenuity Pathway Analysis (IPA) to highlight enriched biologic pathways and validated DEGs by immunohistochemistry and quantitative real-time polymerase chain reaction. RESULTS Comparison of lesional juvenile myositis to control samples revealed 221 DEGs, with the majority of up-regulated genes representing interferon (IFN)-stimulated genes. CXCL10, CXCL9, and IFI44L represented the top 3 DEGs (fold change 23.2, 13.3, and 13.0, respectively; q < 0.0001). IPA revealed IFN signaling as the top canonical pathway. When compared to childhood-onset SLE, lesional juvenile myositis skin shared a similar gene expression pattern, with only 28 unique DEGs, including FBLN2, CHKA, and SLURP1. Notably, patients with juvenile myositis who were positive for nuclear matrix protein 2 (NXP-2) autoantibodies exhibited the strongest IFN signature and also demonstrated the most extensive Mx-1 immunostaining, both in keratinocytes and perivascular regions. CONCLUSION Lesional juvenile myositis skin demonstrates a striking IFN signature similar to that previously reported in juvenile myositis muscle and peripheral blood. Further investigation into the association of a higher IFN score with NXP-2 autoantibodies may provide insight into disease endotypes and pathogenesis.
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Affiliation(s)
| | - Lauren M Pachman
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | | | - Maria C Amoruso
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Casal-Dominguez M, Pinal-Fernandez I, Derfoul A, Graf R, Michelle H, Albayda J, Tiniakou E, Adler B, Danoff SK, Lloyd TE, Christoper-Stine L, Paik JJ, Mammen AL. The phenotype of myositis patients with anti-Ku autoantibodies. Semin Arthritis Rheum 2021; 51:728-734. [PMID: 34144382 DOI: 10.1016/j.semarthrit.2021.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/31/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To define the clinical features of anti-Ku-positive myositis patients and to determine the reliability of the Euroline assay to detect anti-Ku autoantibodies. METHODS Serum samples were screened for anti-Ku autoantibodies by Euroline and positive samples were confirmed by ELISA. The prevalence and severity of clinical features at onset and during follow-up in patients with anti-Ku-positive myositis were compared to those with dermatomyositis, immune-mediated necrotizing myopathy (IMNM), the antisynthetase syndrome (AS), inclusion body myositis (IBM), anti-U1-RNP-positive myositis, and anti-PM/Scl-positive myositis. RESULTS 72 (2.9%) of 2475 samples were anti-Ku positive by Euroline using the manufacturer's recommended cutoff of >15. Just 17 (23.6%) of these were confirmed by ELISA and considered anti-Ku-positive for the analysis. Comparators included 169 IMNM, 168 AS, 387 IBM, 20 anti-U1-RNP-positive, and 47 anti-PM/Scl-positive patients. Muscle weakness was a presenting feature in 38% of anti-Ku-positive patients; 81% developed weakness during follow-up. Anti-Ku-positive patients had increased distal weakness compared to the non-IBM comparators. Interstitial lung disease (ILD) was present in 19% of anti-Ku-positive patients at the first visit and eventually developed in 56% of them. Throughout the course of disease, Gottron's papules and/or heliotrope rashes were less common in anti-Ku-positive patients (19%) compared to those with dermatomyositis (94%) or anti-PM/Scl-positive myositis (89%). Anti-Ku-positive patients never developed calcinosis. CONCLUSIONS The phenotype of anti-Ku positive myositis is distinguished by distal weakness, frequent ILD, infrequent rash, and no calcinosis. When used according to the current manufacturer's instructions, the Euroline assay has a high false-positive rate for anti-Ku autoantibodies.
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Affiliation(s)
- Maria Casal-Dominguez
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD USA; Johns Hopkins University School of Medicine, Baltimore, Maryland USA.
| | - Iago Pinal-Fernandez
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD USA; Johns Hopkins University School of Medicine, Baltimore, Maryland USA; Faculty of Health Sciences and Faculty of Computer Science, Multimedia and Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Assia Derfoul
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD USA
| | - Rose Graf
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD USA
| | - Harlan Michelle
- Johns Hopkins University School of Medicine, Baltimore, Maryland USA
| | - Jemima Albayda
- Johns Hopkins University School of Medicine, Baltimore, Maryland USA
| | - Eleni Tiniakou
- Johns Hopkins University School of Medicine, Baltimore, Maryland USA
| | - Brittany Adler
- Johns Hopkins University School of Medicine, Baltimore, Maryland USA
| | - Sonye K Danoff
- Johns Hopkins University School of Medicine, Baltimore, Maryland USA
| | - Thomas E Lloyd
- Johns Hopkins University School of Medicine, Baltimore, Maryland USA
| | | | - Julie J Paik
- Johns Hopkins University School of Medicine, Baltimore, Maryland USA
| | - Andrew L Mammen
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD USA; Johns Hopkins University School of Medicine, Baltimore, Maryland USA.
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Phuong TNT, Ngoc LNT, Rönnelid J, Padyukov L, Lundberg IE. Clinical characteristics of Vietnamese patients with idiopathic inflammatory myopathies and autoantibodies to aminoacyl-transfer RNA synthetases. Int J Rheum Dis 2021; 24:663-670. [PMID: 33788398 DOI: 10.1111/1756-185x.14105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/02/2021] [Accepted: 03/06/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess clinical phenotypes of anti-aminoacyl-transfer RNA synthetases (aaRS) autoantibodies in Vietnamese patients of Kinh ethnicity with idiopathic inflammatory myopathies (IIM). METHODS In a cross-sectional study 23 patients with anti-aaRS autoantibodies were compared to 36 patients with other myositis-specific antibodies and to 69 seronegative patients with IIM. Assessments included muscle performance, extra-muscular involvement, and disease activity according to the International Myositis Assessment and Clinical Studies (IMACS). Sera were tested by a line immunoassay (Euroline Myositis Profile 4). RESULTS The frequency of anti-Jo-1 antibodies was 56.5%, anti-EJ antibodies 26.1%, and anti-PL-7 antibodies 17.4%, while anti-PL-12 and anti-OJ antibodies were not present in any case. All patients with anti-aaRS autoantibodies had signs of myositis. At time of investigation 22/23 patients had muscle weakness, 52.2% arthritis, 34.8% Raynaud's phenomenon, 73.9% fever, 14.3% mechanic's hands and 56.5% dysphagia. Interstitial lung disease was present in 52.2%, and pulmonary hypertension in 56.5%. The anti-aaRS autoantibody positive group had higher disease activity in the domains of skin and pulmonary disease compared to the seronegative group and had lower disease activity in skeletal disease compared to the anti-melanoma differentiation-associated protein 5-positive patients. The clinical presentation of antisynthetase syndrome was similar between the aaRS autoantibody specificities with the exception of more frequent pulmonary hypertension in anti-Jo-1 positive patients. CONCLUSIONS Different aaRS autoantibody specificities may vary between different ethnic populations for reasons that still need to be clarified. Furthermore, the high frequency of pulmonary hypertension is noteworthy but otherwise clinical manifestations associated with aaRS autoantibodies did not differ from other ethnic populations.
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Affiliation(s)
- Thuy Nguyen Thi Phuong
- Rheumatology Department, Bach Mai Hospital, Hanoi, Vietnam.,Internal Medicine Department, Hanoi Medical University, Hanoi, Vietnam
| | | | - Johan Rönnelid
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Leonid Padyukov
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Rheumatology clinic, Karolinska University Hospital, Stockholm, Sweden
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Hodgkinson LM, Wu TT, Fiorentino DF. Dermatomyositis autoantibodies: how can we maximize utility? ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:433. [PMID: 33842654 PMCID: PMC8033377 DOI: 10.21037/atm-20-5175] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The past 15 years has seen significant advances in the characterization of myositis-specific autoantibodies (MSAs) and their associated phenotypes in patients with dermatomyositis (DM). As more careful studies are performed, it is clear that unique combinations of clinical and pathological phenotypes are associated with each MSA, despite the fact that there is considerable heterogeneity within antibody classes as well as overlap across the groups. Because risk for interstitial lung disease (ILD), internal malignancy, adverse disease trajectory, and, potentially response to therapy differ by DM MSA group, a deeper understanding of MSAs and validation and standardization of assays used for detection are critical for optimizing diagnosis and treatment. Like any test, the diagnostic sensitivity and specificity of assays for various MSAs is not perfect. Currently tests for MSAs are helpful at minimum for a clinician to assess relative risk or contribute to diagnosis and perhaps counsel the appropriate patient about what to expect. With international standardization and larger studies it is likely that more antibody tests will make their way into formal schemata for diagnosis and actionable risk assessment in DM. In this review, we summarize key considerations for interpreting the clinical and pathologic associations with MSA in DM and identify critical gaps in knowledge and practice that will maximize their clinical utility and utility for understanding disease pathogenesis.
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Affiliation(s)
| | - Tiffany Tingshuen Wu
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA
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Vulsteke JB, Blockmans D, Moons V, Vijgen S, Bossuyt X, De Langhe E. Detection of anti-Mi-2 autoantibodies before dermatomyositis-specific manifestations. Rheumatology (Oxford) 2021; 59:e60-e62. [PMID: 32118269 DOI: 10.1093/rheumatology/keaa055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/19/2019] [Accepted: 01/20/2020] [Indexed: 02/05/2023] Open
Affiliation(s)
- Jean-Baptiste Vulsteke
- Department of Rheumatology, University Hospitals Leuven, Leuven.,Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven
| | - Daniël Blockmans
- Department of General Internal Medicine, University Hospitals Leuven, Leuven
| | | | - Sara Vijgen
- Department of Laboratory Medicine, Jessa Hospital, Hasselt
| | - Xavier Bossuyt
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven.,Department of Microbiology, Immunology and Transplantation, Clinical and Diagnostic Immunology, KU Leuven, Leuven, Belgium
| | - Ellen De Langhe
- Department of Rheumatology, University Hospitals Leuven, Leuven.,Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven
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Tansley SL, Li D, Betteridge ZE, McHugh NJ. The reliability of immunoassays to detect autoantibodies in patients with myositis is dependent on autoantibody specificity. Rheumatology (Oxford) 2021; 59:2109-2114. [PMID: 32030410 PMCID: PMC7382594 DOI: 10.1093/rheumatology/keaa021] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/30/2019] [Indexed: 12/18/2022] Open
Abstract
Objectives In order to address the reliability of commercial assays to identify myositis-specific and -associated autoantibodies, we aimed to compare the results of two commercial immunoassays with the results obtained by protein immunoprecipitation. Methods Autoantibody status was determined using radio-labelled protein immunoprecipitation for patients referred to our laboratory for myositis autoantibody characterization. For each autoantibody of interest, the sera from 25 different patients were analysed by line blot (Euroline Myositis Antigen Profile 4, EuroImmun, Lübeck, Germany) and dot blot (D-Tek BlueDiver, Diagnostic Technology, Belrose, NSW, Australia). Sera from 134 adult healthy controls were analysed. Results Overall commercial assays performed reasonably well, with high agreement (Cohen’s κ >0.8). Notable exceptions were the detection of rarer anti-synthetases with κ < 0.2 and detection of anti-TIF1γ, where κ was 0.70 for the line blot and 0.31 for dot blot. Further analysis suggested that the proportion of patients with anti-TIF1γ may recognize a conformational epitope, limiting the ability of blotting-based assays that utilize denatured antigen to detect this clinically important autoantibody. A false-positive result occurred in 13.7% of samples analysed by line blot and 12.1% analysed by dot blot. Conclusion The assays analysed do not perform well for all myositis-specific and -associated autoantibodies and overall false positives are relatively common. It is crucial that clinicians are aware of the limitations of the methods used by their local laboratory. Results must be interpreted within the clinical context and immunoprecipitation should still be considered in selected cases, such as apparently autoantibody-negative patients where anti-synthetase syndrome is suspected.
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Affiliation(s)
- Sarah L Tansley
- Department of Pharmacy and pharmacology, University of Bath, Bath, UK
- Correspondence to: Sarah Tansley, University of Bath, Claverton Down, Bath BA2 7AY, UK. E-mail:
| | - Danyang Li
- Department of Pharmacy and pharmacology, University of Bath, Bath, UK
| | - Zoe E Betteridge
- Department of Pharmacy and pharmacology, University of Bath, Bath, UK
| | - Neil J McHugh
- Department of Pharmacy and pharmacology, University of Bath, Bath, UK
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Lackner A, Tiefenthaler V, Mirzayeva J, Posch F, Rossmann C, Kastrati K, Radner H, Demel U, Gretler J, Stotz M, Graninger WB, Stradner MH. The use and diagnostic value of testing myositis-specific and myositis-associated autoantibodies by line immuno-assay: a retrospective study. Ther Adv Musculoskelet Dis 2020; 12:1759720X20975907. [PMID: 33343724 PMCID: PMC7727081 DOI: 10.1177/1759720x20975907] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/03/2020] [Indexed: 11/21/2022] Open
Abstract
AIMS Line immune-assays (LIA) for the detection of myositis-specific antibodies (MSA) are used widely for characterization of idiopathic inflammatory myopathies (IIM). Their current use and significance for the diagnosis of IIM remains unclear. METHODS In this retrospective analysis, we retrieved clinical diagnoses of patients tested for MSA and myositis-associated antibodies (MAA) Jo-1, Mi-2α, Mi-2β, TIF1γ, SRP, MDA-5, NXP-2, SAE, PL-7, PL-12, EJ, OJ, PM-Scl100, PM-Scl75 and Ku. We calculated clinical specificity, clinical sensitivity, negative- and positive predictive values (PPV) as well as positive and negative likelihood ratios. RESULTS In total, we analyzed 3167 samples. After exclusion of repeated measurements and patients with insufficient clinical information, data of 1118 patients were available for analysis. A total of 242 patients tested positive for at least one antibody, of which 45 patients had a diagnosis of IIM; 25 IIM patients were negative for all MSA/MAA. Clinical specificity of MSA/MAA for the diagnosis of IIM ranged between 94.2% and 99.9%. Clinical sensitivity and PPV across all antibodies tested ranged from 0.0% to 12.9% and 0.0% to 72.7%, respectively. CONCLUSION In clinical practice MSA/MAA are used widely for diagnostic work-up of IIM, resulting in a low pre-test probability. Clinicians should be aware that PPVs for most MSA/MAA are low.
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Affiliation(s)
- Angelika Lackner
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, Graz, Steiermark, Austria
| | - Viktoria Tiefenthaler
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, Graz, Steiermark, Austria
| | - Jalia Mirzayeva
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, Graz, Steiermark, Austria
| | - Florian Posch
- Division of Clinical Oncology, Department of Internal Medicine, Medical University Graz, Graz, Steiermark, Austria
| | - Christopher Rossmann
- Division of Clinical Oncology, Department of Internal Medicine, Medical University Graz, Graz, Steiermark, Austria
| | - Kastriot Kastrati
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Helga Radner
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Ulrike Demel
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, Graz, Steiermark, Austria
| | - Judith Gretler
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, Graz, Steiermark, Austria
| | - Michael Stotz
- Division of Clinical Oncology, Department of Internal Medicine, Medical University Graz, Graz, Steiermark, Austria
| | - Winfried B Graninger
- Division of Rheumatology and Immunology, Department of Internal Medicine, Medical University of Graz, Graz, Steiermark, Austria
| | - Martin H Stradner
- Department of Rheumatology & Immunology, Medical University of Graz, Auenbruggerplatz 15, Graz, Steiermark 8036, Austria
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Espinosa‐Ortega F, Holmqvist M, Dastmalchi M, Lundberg IE, Alexanderson H. Factors associated with treatment response in patients with idiopathic inflammatory myopathies. A registry-based study. Arthritis Care Res (Hoboken) 2020; 74:468-477. [PMID: 33105033 PMCID: PMC9304210 DOI: 10.1002/acr.24498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 10/09/2020] [Accepted: 10/22/2020] [Indexed: 11/29/2022]
Abstract
Objective To identify predictors of response to immunosuppressive therapy after 1 year, with a focus on autoantibodies, in patients newly diagnosed with idiopathic inflammatory myopathies (IIM) followed longitudinally in an electronic registry. Methods We assessed the association between autoantibody‐defined groups and improvement according to American College of Rheumatology/European Alliance of Associations for Rheumatology 2016 response criteria. Results We identified 156 patients; of those, 111 (71%) were positive for any autoantibody tested, 90% received glucocorticoid treatment at baseline, and 78% received immunosuppressive drugs at some follow‐up point. After 1 year from the index date, the overall median improvement score was 27.5 (interquartile range 10–51). No differences were observed in the total improvement score between the autoantibody‐defined groups. Overall, 62% of patients (n = 96) showed a minimal response, 38% (n = 60) achieved a moderate response, and 19% (n = 30) achieved a major response. Regarding the different levels of response, dermatomyositis‐specific autoantibodies were associated with a moderate response versus the seronegative group (reference), odds ratio 4.12 (95% confidence interval 1.2–16.5). In addition, dysphagia, time from symptom onset to diagnosis, and initial glucocorticoid dose were significant predictors of response after 1 year of follow‐up. Conclusion Patients with DM‐specific autoantibodies achieved better levels of response compared to other autoantibody‐defined groups. Dysphagia, a shorter time span from symptom onset to diagnosis, and intensive initial immunosuppressive treatment were associated with a higher response rate after 1 year of pharmacologic treatment from the index date, regardless of autoantibody status.
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Affiliation(s)
| | - Marie Holmqvist
- Solna, Karolinska Institutet, and Karolinska University HospitalStockholmSweden
| | - Maryam Dastmalchi
- Solna, Karolinska Institutet, and Karolinska University HospitalStockholmSweden
| | - Ingrid E. Lundberg
- Solna, Karolinska Institutet, and Karolinska University HospitalStockholmSweden
| | - Helene Alexanderson
- Solna, Karolinska Institutet, and Karolinska University HospitalStockholmSweden
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Abstract
PURPOSE OF REVIEW To provide an overview of recent discoveries related to myositis-specific autoantibodies (MSAs) and assays used for their measurement. RECENT FINDINGS New autoantibody specificities have been reported including a MSA directed against eukaryotic initiation factor 3 and a myositis-associated autoantibody directed against heat shock factor 1. The association of anti-TIF1γ with cancer-associated dermatomyositis dependent on age has been confirmed in several large cohorts. Despite MSAs being almost entirely mutually exclusive, several myositis autoantigens are overexpressed in regenerating muscle and do not correlate with the corresponding MSA in any one patient. Further mechanisms may determine the final MSA specificity and are likely to include the need for autoantigen processing and presentation with adaptive T-cell help. The presence of CD4-positive T cells specific for histidyl tRNA synthetase protein in bronchial lavage fluid from antisynthetase patients lends support to this view. Finally, it is widely held that MSA do play an important role in clinical practice among some evidence and concern about commercial assay reliability. SUMMARY MSAs continue to provide important tools for clinical diagnosis and management as well as insights into disease mechanisms. Further improvement in the standardization and reliability of routine detection of MSAs is a high priority.
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Tansley SL, McHugh NJ. Comment on: The reliability of immunoassays to detect autoantibodies in patients with myositis is dependent on autoantibody specificity: reply. Rheumatology (Oxford) 2020; 59:2177-2178. [DOI: 10.1093/rheumatology/keaa147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sarah L Tansley
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Neil J McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
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Xu Q, Li QX, Bi FF, Duan HQ, Luo YB, Yang H. The association between myositis-specific autoantibodies and muscle pathologies in idiopathic inflammatory myopathies. Clin Rheumatol 2020; 40:613-624. [PMID: 32671659 DOI: 10.1007/s10067-020-05274-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate specific muscle pathologies of different kinds of myositis-specific autoantibodies (MSAs) in idiopathic inflammatory myopathy (IIM) patients. METHODS One hundred eleven Chinese patients from Xiangya Hospital, Central South University diagnosed with IIMs according to European Neuromuscular Centre (ENMC) criteria were included. Clinical manifestation, myositis-specific autoantibodies, and histologic findings were evaluated to explore the pattern of necrosis, regeneration, and perifascicular atrophy, inflammatory cells in IIM patients with different MSAs. RESULTS Anti-SRP group has the lowest muscle strength scores, the highest creatine kinase levels, the most severe degree of necrosis and regeneration (1.90[0.80-3.95], 1.00[0.30-1.71]), and the lowest positive rate of MHC-I staining (35.71%). The anti-MDA5 group demonstrates the mildest pathological changes, with the fewest necrotic and regenerated muscle fibers (0.00[0.00-0.50], 0.00[0.00-0.00]), and the fewest inflammatory cell infiltration, and the highest muscle strength scores. The anti-NXP2 group has the most frequent inflammatory infiltrates, especially CD4+ T cells (31.14[15.00-39.00]). The patients with anti-NXP2 and the anti-TIF1γ antibodies show higher frequency of punched-out fibers (1.50[0.00-3.70], 0.00[0.00-1.00]) and perifascicular atrophy (71.43%, 55.56%). As for anti-synthetase antibodies (ASAs), the anti-Jo-1 group shows the most frequent rate of perifascicular necrosis (60%), while other ASA groups do not show perifascicular necrosis. CONCLUSIONS Of the MSAs, the anti-SRP antibody leads to the most severe muscle involvement, while the anti-MAD5 antibody the mildest. The anti-NXP2 and anti-TIF1γ groups have the most typical "DM" pathology. Key Points • Anti-SRP group shows severe muscle pathology while anti-MDA5 group shows the mildest. • Anti-NXP2 group has the most frequent inflammatory infiltrates. Pouch-out fibers and perifascicular atrophy are more prevalent in anti-NXP2 and anti-TIF1γ groups. • Anti-Jo-1 group is often accompanied by perifascicular necrosis, while other anti-synthetase antibody groups are not.
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Affiliation(s)
- Qiu Xu
- Department of Neurology, Xiangya Hospital Central South University, Xiangya Road, Changsha, 410008, China
| | - Qiu-Xiang Li
- Department of Neurology, Xiangya Hospital Central South University, Xiangya Road, Changsha, 410008, China
| | - Fang-Fang Bi
- Department of Neurology, Xiangya Hospital Central South University, Xiangya Road, Changsha, 410008, China
| | - Hui-Qian Duan
- Department of Neurology, Xiangya Hospital Central South University, Xiangya Road, Changsha, 410008, China
| | - Yue-Bei Luo
- Department of Neurology, Xiangya Hospital Central South University, Xiangya Road, Changsha, 410008, China.
| | - Huan Yang
- Department of Neurology, Xiangya Hospital Central South University, Xiangya Road, Changsha, 410008, China.
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Leurs A, Dubucquoi S, Machuron F, Balden M, Renaud F, Rogeau S, Lopez B, Lambert M, Morell-Dubois S, Maillard H, Béhal H, Hachulla E, Launay D, Sobanski V. Extended myositis-specific and -associated antibodies profile in systemic sclerosis: A cross-sectional study. Joint Bone Spine 2020; 88:105048. [PMID: 32653653 DOI: 10.1016/j.jbspin.2020.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/22/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE In systemic sclerosis (SSc) and idiopathic inflammatory myopathies (IIM), auto-antibodies are used in daily practice as potent biomarkers of clinical phenotypes. This study aimed at estimating the prevalence of myositis-specific (MSA) and myositis-associated (MAA) auto-antibodies in a well-characterised SSc patients cohort using two different immunoblot assays, and studying their clinical associations. METHODS In this cross-sectional study, the sera of 300 consecutive patients were tested at the same time with myositis antibodies Euroimmun® and D-tek® immunoblot assays. RESULTS Prevalence of MSA/MAA, MSA and MAA were 17.0%, 8.0% and 9.7%, respectively. When combining results of both tests, anti-PM/Scl 100 were found in 5.0% (95% confidence interval 2.8; 8.1); anti-PM/Scl 75 and anti-TIF1γ in 3.7% (1.8; 6.5); anti-Ku 3.0% (1.4; 5.6); anti-MDA5 in 1.3% (0.4; 3.4); anti-Mi-2 β, anti-NXP2, anti-PL-7 and anti-SRP in 0.7% (0.08; 2.4); anti-EJ and anti-PL-12 in 0.3% (0.01; 1.8) of patients. No reactivity against SAE1, Jo-1 or OJ was observed. Anti-PM/Scl 75 antibodies were associated with interstitial lung disease (80% vs. 42%) and myositis (27% vs. 3%); anti-Ku antibodies were associated with myositis (33% vs. 3%). CONCLUSION In this cross-sectional study of 300 SSc patients, the prevalence of MSA/MAA, MSA and MAA using immunoblot assays were 17.0%, 8.0% and 9.7%, respectively. MAA positivity was associated with ILD and myositis, but this study did not highlight any clinical associations with MSA positivity.
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Affiliation(s)
- Amélie Leurs
- Univ. Lille, U1286 - Infinite - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, U1286, 59000 Lille, France; CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France
| | - Sylvain Dubucquoi
- Univ. Lille, U1286 - Infinite - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, U1286, 59000 Lille, France; CHU Lille, Institut d'Immunologie, Lille, France
| | - François Machuron
- Univ. Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, 59000 Lille, France
| | - Maïté Balden
- Univ. Lille, U1286 - Infinite - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, U1286, 59000 Lille, France; CHU Lille, Institut d'Immunologie, Lille, France
| | - Florence Renaud
- Univ. Lille, CHU Lille, Institute of Pathology, Centre de Biologie Pathologie Lille ; Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer France ; SIRIC OncoLille, 59000 Lille, France
| | | | | | - Marc Lambert
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France
| | - Sandrine Morell-Dubois
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France
| | - Hélène Maillard
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France
| | - Hélène Béhal
- Univ. Lille, CHU Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, 59000 Lille, France
| | - Eric Hachulla
- Univ. Lille, U1286 - Infinite - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, U1286, 59000 Lille, France; CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France
| | - David Launay
- Univ. Lille, U1286 - Infinite - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, U1286, 59000 Lille, France; CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France
| | - Vincent Sobanski
- Univ. Lille, U1286 - Infinite - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, U1286, 59000 Lille, France; CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France.
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Westerdahl S, Hull CM, Clarke JT, Hansen CB, Rhoads JLW. A single-center, retrospective record review of malignancy prevalence in patients with dermatomyositis with anti-transcription intermediary factor 1γ antibodies via line immunoassay versus immunoprecipitation. J Am Acad Dermatol 2020; 84:559-561. [PMID: 32619611 DOI: 10.1016/j.jaad.2020.06.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 06/01/2020] [Accepted: 06/23/2020] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - Jennie T Clarke
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | | | - Jamie L W Rhoads
- Department of Dermatology, University of Utah, Salt Lake City, Utah.
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De Vooght J, Vulsteke JB, De Haes P, Bossuyt X, Lories R, De Langhe E. Anti-TIF1-γ autoantibodies: warning lights of a tumour autoantigen. Rheumatology (Oxford) 2020; 59:469-477. [PMID: 31883334 DOI: 10.1093/rheumatology/kez572] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 10/25/2019] [Indexed: 11/14/2022] Open
Abstract
Anti-transcription intermediary factor 1 (TIF1)-γ autoantibodies are robustly linked with cancer-associated DM in adults. This review aims to give an overview of the physiological context of TIF1-γ and to determine whether there is a pathophysiological link between anti-TIF1-γ autoantibodies and the occurrence of cancer. Detection of anti-TIF1-γ autoantibodies has a high sensitivity and specificity for cancer-associated DM in adults and is therefore useful for both diagnosis and cancer risk stratification. The function of the autoantigen, TIF1-γ, may provide insight into the mechanism behind this association. TIF1-γ is a ubiquitously present protein involved in various biological pathways, including TGF-β signalling. In cancer, it can act either as a tumour suppressor or promoter, depending on the cellular context and cancer stage. Evolving data provide pathophysiological insights, linking anti-TIF1-γ autoantibodies to both the anti-tumour response and to muscle and skin damage. TIF1-γ expression is increased in muscle and skin tissue of patients with DM. Mutations or loss-of-heterozygosity in TIF1-γ alleles in malignant tissue may result in the expression of tumour-specific neo-antigens stimulating autoantibody production. The newly formed autoantibodies are hypothesized to cross-react with antigens in muscle and skin, driving the development of DM. Based on the current evidence, anti-TIF1-γ autoantibodies should be considered warning lights of a potential tumour autoantigen and should alert the physician to the possibility of an underlying cancer.
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Affiliation(s)
| | - Jean-Baptiste Vulsteke
- Division of Rheumatology, University Hospitals Leuven, Belgium.,Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven, Belgium
| | - Petra De Haes
- Division of Dermatology, University Hospitals Leuven, Belgium
| | - Xavier Bossuyt
- Clinical and Diagnostic Immunology, Department of Microbiology and Immunology, KU Leuven, Belgium.,Department of Microbiology, Immunology and Transplantation, Clinical and Diagnostic Immunology, KU, Leuven, Leuven, Belgium
| | - Rik Lories
- Division of Rheumatology, University Hospitals Leuven, Belgium.,Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven, Belgium
| | - Ellen De Langhe
- Division of Rheumatology, University Hospitals Leuven, Belgium.,Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven, Belgium
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The promise, perceptions, and pitfalls of immunoassays for autoantibody testing in myositis. Arthritis Res Ther 2020; 22:117. [PMID: 32414409 PMCID: PMC7227250 DOI: 10.1186/s13075-020-02210-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/01/2020] [Indexed: 02/01/2023] Open
Abstract
Background A myositis-specific autoantibody can now be identified in the majority of patients with myositis. They identify homogeneous patient subgroups and are key tools in developing a personalized approach to disease management. There is substantial clinical interest in exploiting myositis autoantibodies as biomarkers, and consequently, a large number of commercial assays have been developed for their detection. These assays are already in widespread clinical use. In order to better understand perceived concerns from the international myositis community in relation to the reliability of these assays and how they are being used, we conducted a survey of international myositis experts, all of whom were members of the International Myositis Assessment and Clinical Studies group. Results We collected data on the types of assay used, manufacturers, and the nature of the report provided by different laboratories and received 111 complete responses. Respondents also provided information on how they used the different assays, their confidence in the results, and how this influenced their clinical practice. Enzyme immunoassay/ELISA was the most popular assay method used worldwide followed by line blot. Line blot was the most popular method used in Europe. Despite concerns from over 80% of respondents regarding false-positive and false-negative results with the assay used by their laboratory, over 80% reported that the identification of a myositis autoantibody influenced their diagnostic confidence, the information they provided to a patient, and their recommended treatment. Conclusions In spite of ongoing concerns from the majority of users regarding the reliability of the results, myositis-specific autoantibody testing, using commercial immunoassays, is being used globally to inform clinical decision-making. These findings highlight the need for urgent guidance on the use of myositis autoantibody testing and on the interpretation of results. Knowledge of the reliability of currently available assays is essential given the importance already placed on myositis-specific autoantibodies as clinical decision-making tools.
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Hamaguchi Y, Kuwana M, Takehara K. Performance evaluation of a commercial line blot assay system for detection of myositis- and systemic sclerosis-related autoantibodies. Clin Rheumatol 2020; 39:3489-3497. [PMID: 32385758 DOI: 10.1007/s10067-020-04973-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 01/16/2020] [Accepted: 02/07/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION/OBJECTIVES A line blot (LB) assay is a multi-analyte platform capable of simultaneously detecting multiple anti-nuclear antibody specificities. Here, we evaluated the performance of a commercial LB assay developed for the identification of myositis- or systemic sclerosis (SSc)-related autoantibodies (autoAbs). METHOD We screened 300 serum samples from patients with various connective tissue diseases using an LB assay and compared the results of myositis- or SSc-related autoAbs with those identified by RNA and protein immunoprecipitation (IP) assays or indirect immunofluorescence (IIF). RESULTS The IP assays revealed anti-Jo-1 Abs in 14 patients, anti-EJ Abs in 12, anti-PL-7 Abs in 8, anti-PL-12 Abs in 4, anti-Mi-2 Abs in 6, anti-SRP Abs in 8, anti-topoisomerase I Abs in 54, anti-RNA polymerase III Abs in 24, anti-U3 RNP Abs in 9, anti-Th/To Abs in 9, anti-Ku Abs in 14 and anti-hUBF Abs in 4, whereas IIF identified anti-centromere in 35. Good agreement between the IP assays and the LB assay was found only for anti-Jo-1 and anti-centromere antibodies. When a cut-off was adjusted to reconcile with the results of IP assays, the detection performance of LB assay was improved for anti-EJ, anti-PL-7, anti-PL-12, anti-SRP, anti-topoisomerase I and anti-RNA polymerase III Abs. However, the results of anti-Mi-2, anti-U3 RNP, anti-Th/To, anti-hUBF and anti-Ku Abs remained discordant between the LB assay and IP assays at all cut-off levels. CONCLUSIONS Detection of myositis- or SSc-related autoAbs using a commercial LB assay requires great caution since it can yield analytically false-positive or false-negative results. Key Points • A line blot (LB) assay is a multi-analyte platform capable of simultaneously detecting multiple antibodies with anti-nuclear specificities. • Detection of myositis- or systemic sclerosis-related autoantibodies using a commercial LB assay requires great caution since it can yield analytically false-positive or false-negative results.
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Affiliation(s)
- Yasuhito Hamaguchi
- Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Kazuhiko Takehara
- Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
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Mecoli CA, Albayda J, Tiniakou E, Paik JJ, Zahid U, Danoff SK, Casciola-Rosen L, Casal-Dominguez M, Pak K, Pinal-Fernandez I, Mammen AL, Christopher-Stine L. Myositis Autoantibodies: A Comparison of Results From the Oklahoma Medical Research Foundation Myositis Panel to the Euroimmun Research Line Blot. Arthritis Rheumatol 2020; 72:192-194. [PMID: 31430029 DOI: 10.1002/art.41088] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
| | - Jemima Albayda
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eleni Tiniakou
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Julie J Paik
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Umar Zahid
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sonye K Danoff
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Maria Casal-Dominguez
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH Bethesda, MD
| | - Katherine Pak
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH Bethesda, MD
| | - Iago Pinal-Fernandez
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH Bethesda, MD
| | - Andrew L Mammen
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH Bethesda, MD
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Kang EH, Ha YJ, Lee YJ. Autoantibody Biomarkers in Rheumatic Diseases. Int J Mol Sci 2020; 21:ijms21041382. [PMID: 32085664 PMCID: PMC7073052 DOI: 10.3390/ijms21041382] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/04/2020] [Accepted: 02/14/2020] [Indexed: 12/19/2022] Open
Abstract
Autoantibodies encountered in patients with systemic rheumatic diseases bear clinical significance as a biomarker to help or predict diagnosis, clinical phenotypes, prognosis, and treatment decision-making. Furthermore, evidence has accumulated regarding the active involvement of disease-specific or disease-associated autoantibodies in the pathogenic process beyond simple association with the disease, and such knowledge has become essential for us to better understand the clinical value of autoantibodies as a biomarker. This review will focus on the current update on the autoantibodies of four rheumatic diseases (rheumatoid arthritis, myositis, systemic sclerosis, and anti-neutrophil cytoplasmic antibody associated vasculitis) where there has been a tremendous progress in our understanding on their biological effects and clinical use.
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Affiliation(s)
- Eun Ha Kang
- Division of Rheumatology Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (Y.-J.H.); (Y.J.L.)
- Correspondence: ; Tel.: +82-31-787-7048; Fax: +82-31-787-4511
| | - You-Jung Ha
- Division of Rheumatology Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (Y.-J.H.); (Y.J.L.)
| | - Yun Jong Lee
- Division of Rheumatology Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (Y.-J.H.); (Y.J.L.)
- Department of Internal Medicine, Seoul National University, Seoul 03080, Korea
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Gono T, Kuwana M. Current understanding and recent advances in myositis-specific and -associated autoantibodies detected in patients with dermatomyositis. Expert Rev Clin Immunol 2019; 16:79-89. [DOI: 10.1080/1744666x.2019.1699059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Takahisa Gono
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
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Baig S, Mecoli CA. Cancer and Idiopathic Inflammatory Myositis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2019. [DOI: 10.1007/s40674-019-00128-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Mahler M, Satoh M, Fritzler MJ. Anti-Ku antibodies: important points to consider. Ann Rheum Dis 2019; 80:e182. [PMID: 31748234 DOI: 10.1136/annrheumdis-2019-216535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 10/29/2019] [Accepted: 11/01/2019] [Indexed: 11/04/2022]
Affiliation(s)
| | - Minoru Satoh
- Department of Clinical Nursing, University of Occupational and Environmental Health, Kitakyushu, Japan
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