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Paruk F, Dey D, Mosam A, Amira Christina O, Tikly M. Challenges in Diagnosis and Management of SLE in Africa: An Online Survey. ACR Open Rheumatol 2024. [PMID: 39382185 DOI: 10.1002/acr2.11749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 08/03/2024] [Accepted: 09/13/2024] [Indexed: 10/10/2024] Open
Abstract
OBJECTIVE We surveyed African physicians about challenges in diagnosis and management of systemic lupus erythematosus (SLE). METHODS We used a cross-sectional, online questionnaire-based survey of African specialist physicians on availability of laboratory tests, medications, and specialized services for the diagnosis of SLE. RESULTS Our 226 respondents from 31 countries were dermatologists (38%), rheumatologists (28%), and nephrologists (23%), the majority practicing at university/state-funded hospitals (80.8%), but over half of patients (59.6%) were self-funded for laboratory tests and medications. Antinuclear antibody (ANA), antiphospholipid antibody, and complement tests were available to 79.4%, 67.6%, and 62.3% of respondents, respectively, but fewer in the East and West African regions. Median turnaround time for the ANA test was within two weeks but more than four weeks for 5.6% of respondents, and longer in West Africa compared with other regions (P = 0.0002). Availability of urine protein-to-creatinine test, skin and renal histopathology was 82%, 82.5%, and 76.2%, respectively. Median turnaround times were within one to two weeks, but more than four weeks for 13.8% of respondents for skin histology results and usually within four weeks but more than four weeks for 24.5% of respondents for renal histology. Glucocorticoids and antimalarials were readily available across all regions, with variable availability of immunosuppressants from 93.7% for methotrexate to 65% for calcineurin inhibitors and only 58.4% for the biologic rituximab. Intensive care units/high care facilities, hemodialysis, and renal transplantation were available to 69.8%, 91.9%, and 56.5% of respondents, respectively. CONCLUSION Variable availability of laboratory tests, medications, and supportive services coupled with cost constraints are major impediments to early diagnosis and optimal management of SLE in most of Africa and are likely factors contributing to underreporting and poor prognosis of SLE in Africa.
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Affiliation(s)
| | - Dzifa Dey
- University of Ghana, Medical School, Accra, Ghana
| | | | | | - Mohammed Tikly
- Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, South Africa
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Islam SN, Arif Z, Badar A, Moinuddin, Khan MA, Alam K. Glycoxidation of mammalian whole histone generates highly immunogenic aggregates: Sera of SLE patients contain autoantibodies against aggregates. Scand J Immunol 2024; 100:e13389. [PMID: 38816907 DOI: 10.1111/sji.13389] [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: 11/11/2023] [Revised: 04/15/2024] [Accepted: 05/01/2024] [Indexed: 06/01/2024]
Abstract
Non-enzymatic glycation and oxidation of self-proteins, causing formation and accumulation of advanced glycation end products (AGEs), have been reported in an array of pathologies, including systemic lupus erythematosus (SLE). Such modifications may generate neo-epitopes, break immunological tolerance, and induce antibody response. In this study, we have first analysed the structural modifications of whole histone in the presence of deoxyribose followed by oxidation with hydroxyl radicals. Changes in the secondary and tertiary structure of the whole histone were determined by spectroscopic techniques and biochemical assays. Fluorescence spectroscopy and UPLC-MS showed the generation of AGEs such as carboxymethyl lysine and pentosidine, while DLS and TEM indicated the presence of amorphous AGE-aggregates. Moreover, rabbits immunized with these histone-AGEs exhibited enhanced immunogenicity and ELISA and western immunoblot of IgG antibodies from SLE patients' sera showed a significantly higher specificity towards modified histone-AGEs than the native histone.
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Affiliation(s)
- Shireen Naaz Islam
- Department of Biochemistry, Jawaharlal Nehru Medical College, Faculty of Medicine, Aligarh Muslim University, Aligarh, UP, India
| | - Zarina Arif
- Department of Biochemistry, Jawaharlal Nehru Medical College, Faculty of Medicine, Aligarh Muslim University, Aligarh, UP, India
| | - Asim Badar
- Department of Biochemistry, Jawaharlal Nehru Medical College, Faculty of Medicine, Aligarh Muslim University, Aligarh, UP, India
| | - Moinuddin
- Department of Biochemistry, Jawaharlal Nehru Medical College, Faculty of Medicine, Aligarh Muslim University, Aligarh, UP, India
| | - Md Asad Khan
- Department of Biochemistry, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
| | - Khursheed Alam
- Department of Biochemistry, Jawaharlal Nehru Medical College, Faculty of Medicine, Aligarh Muslim University, Aligarh, UP, India
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Lei R, Arain H, Wang D, Arunachalam J, Saxena R, Mohan C. Duplex Vertical-Flow Rapid Tests for Point-of-Care Detection of Anti-dsDNA and Anti-Nuclear Autoantibodies. BIOSENSORS 2024; 14:98. [PMID: 38392017 PMCID: PMC10887294 DOI: 10.3390/bios14020098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024]
Abstract
The goal of this study is to develop a rapid diagnostic test for rheumatic disease and systemic lupus erythematosus (SLE) screening. A novel rapid vertical flow assay (VFA) was engineered and used to assay anti-nuclear (ANA) and anti-dsDNA (αDNA) autoantibodies from systemic lupus erythematosus (SLE) patients and healthy controls (HCs). Observer scores and absolute signal intensities from the VFA were validated via ELISA. The rapid point-of-care VFA test that was engineered demonstrated a limit of detection of 0.5 IU/mL for ANA and αDNA autoantibodies in human plasma with an inter-operator CV of 19% for ANA and 12% for αDNA. Storage stability was verified over a three-month period. When testing anti-dsDNA and ANA levels in SLE and HC serum samples, the duplex VFA revealed 95% sensitivity, 72% specificity and an 84% ROC AUC value in discriminating disease groups, comparable to the gold standard, ELISA. The rapid αDNA/ANA duplex VFA can potentially be used in primary care clinics for evaluating patients or at-risk subjects for rheumatic diseases and for planning follow-up testing. Given its low cost, ease, and rapid turnaround, it can also be used to assess SLE prevalence estimates.
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Affiliation(s)
- Rongwei Lei
- Department Biomedical Engineering, University of Houston, Houston, TX 77204, USA; (R.L.); (H.A.); (J.A.)
| | - Hufsa Arain
- Department Biomedical Engineering, University of Houston, Houston, TX 77204, USA; (R.L.); (H.A.); (J.A.)
| | - David Wang
- John Sealy School of Medicine, UT Medical Branch, Galveston, TX 77555, USA;
| | - Janani Arunachalam
- Department Biomedical Engineering, University of Houston, Houston, TX 77204, USA; (R.L.); (H.A.); (J.A.)
| | - Ramesh Saxena
- UT Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Chandra Mohan
- Department Biomedical Engineering, University of Houston, Houston, TX 77204, USA; (R.L.); (H.A.); (J.A.)
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Okuda T, Kato K. Serum components influence antibody reactivity to glycan and DNA antigens. Sci Rep 2023; 13:13644. [PMID: 37607950 PMCID: PMC10444758 DOI: 10.1038/s41598-023-40707-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/16/2023] [Indexed: 08/24/2023] Open
Abstract
We previously generated three types of anti-glycan monoclonal IgM antibodies that react with certain structures on the glycans of glycosphingolipids and glycoproteins. As the nucleotide sequences for the variable regions of these IgM antibodies showed homology with those of anti-DNA antibodies deposited in public databases, we analyzed the reactivity of the anti-glycan IgM antibodies to DNA by ELISA. We found that anti-α2,6-sialyl LacNAc IgM in the supernatant of a hybridoma culture cross-reacted with DNA, and after purification of the IgM by zirconia column chromatography, the highly purified IgM showed increased cross-reactivity to DNA. As most of the contaminating bovine serum proteins in the culture supernatant were removed by the purification process, it is likely that a part of the removed components influences antibody reactivity to DNA. Purified anti-DNA antibodies prepared from lupus model NZB/W F1 and MRL/lpr mouse sera and normal human serum were then analyzed, and similar results showing increased reactivity to DNA were obtained. Furthermore, ELISA using these purified antibodies and various carbohydrate antigens showed that the antigen-binding specificity of these antibodies was altered by the purification process from serum-containing antibody preparations. Our results indicate that mammalian serum contains components that strongly influence antibody reactivity to carbohydrate antigens, including DNA.
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Affiliation(s)
- Tetsuya Okuda
- Bioproduction Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Central 6, 1-1-1 Higashi, Tsukuba, 305-8566, Japan.
| | - Katsuya Kato
- Multi-Material Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), 2266-98 Anagahora, Shimoshidami, Moriyama-ku, Nagoya, 463-8560, Japan
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Emerson JS, Gruenewald SM, Gomes L, Lin MW, Swaminathan S. The conundrum of neuropsychiatric systemic lupus erythematosus: Current and novel approaches to diagnosis. Front Neurol 2023; 14:1111769. [PMID: 37025200 PMCID: PMC10070984 DOI: 10.3389/fneur.2023.1111769] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/07/2023] [Indexed: 04/08/2023] Open
Abstract
Recognising neuropsychiatric involvement by systemic lupus erythematosus (SLE) is of growing importance, however many barriers to this exist at multiple levels of our currently available diagnostic algorithms that may ultimately delay its diagnosis and subsequent treatment. The heterogeneous and non-specific clinical syndromes, serological and cerebrospinal fluid (CSF) markers and neuroimaging findings that often do not mirror disease activity, highlight important research gaps in the diagnosis of neuropsychiatric SLE (NPSLE). Formal neuropsychological assessments or the more accessible screening metrics may also help improve objective recognition of cognitive or mood disorders. Novel serum and CSF markers, including autoantibodies, cytokines and chemokines have also shown increasing utility as part of diagnosis and monitoring, as well as in distinguishing NPSLE from SLE patients without SLE-related neuropsychiatric manifestations. Novel neuroimaging studies also expand upon our existing strategy by quantifying parameters that indicate microarchitectural integrity or provide an assessment of neuronal function. Some of these novel markers have shown associations with specific neuropsychiatric syndromes, suggesting that future research move away from considering NPSLE as a single entity but rather into its individually recognized neuropsychiatric manifestations. Nevertheless, it is likely that a composite panel of these investigations will be needed to better address the gaps impeding recognition of neuropsychiatric involvement by SLE.
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Affiliation(s)
- Jonathan S. Emerson
- Department of Clinical Immunology and Immunopathology, Westmead Hospital, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Centre for Immunology and Allergy Research, The Westmead Institute for Medical Research, Sydney, NSW, Australia
- *Correspondence: Jonathan S. Emerson,
| | - Simon M. Gruenewald
- Department of Nuclear Medicine, PET and Ultrasound, Westmead Hospital, Sydney, NSW, Australia
| | - Lavier Gomes
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Department of Radiology, Westmead Hospital, Sydney, NSW, Australia
| | - Ming-Wei Lin
- Department of Clinical Immunology and Immunopathology, Westmead Hospital, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Sanjay Swaminathan
- Department of Clinical Immunology and Immunopathology, Westmead Hospital, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Department of Clinical Immunology, Blacktown Hospital, Sydney, NSW, Australia
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
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A Controlled Community Study of Distress and Resilience in Women Diagnosed with Fibromyalgia and Systemic Lupus Erythematosus. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09903-7. [PMID: 35995960 DOI: 10.1007/s10880-022-09903-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 10/15/2022]
Abstract
This study examines psychological and physical influences on the distress and well-being of patients with chronic rheumatic diseases. The study aims were to (1) evaluate the relative contribution of objective disease activity and psychological factors on the wellbeing of patients with systemic lupus erythematosus (SLE); (2) to compare the psychological distress of SLE patients to fibromyalgia (FM) patients and healthy controls, and to (3) characterize subgroups of patients by performing cluster analysis using psychological variables. Participants were ascertained from closed forums and social media channels resulting in 41 women with a diagnosis of SLE, 47 with a diagnosis of FM, and 77 healthy controls (HC). Hierarchical linear regression for well-being of SLE patients found that most of the variance was accounted for by social support. Cluster analysis performed on the entire sample identified two clusters, a distressed group tending to Type D personality, anxiety and depression, low in well-being and social support, and a resilient group; the proportion of resilient individuals was highest in the HC intermediate in the SLE group and lowest in the FM group. The importance of psychological variables vs disease severity in these two rheumatic diseases for wellbeing is demonstrated by these results. The results suggest that psychological interventions that enhance the experience of social support in medical settings, might benefit patients with both diseases, and be of particular importance to the well-being of patients who are more distressed.
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Cheng H, Zhang XY, Yang HD, Yu Z, Yan CL, Gao C, Wen HY. Efficacy and safety of belimumab/low-dose cyclophosphamide therapy in moderate-to-severe systemic lupus erythematosus. Front Immunol 2022; 13:911730. [PMID: 35979351 PMCID: PMC9376229 DOI: 10.3389/fimmu.2022.911730] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/13/2022] [Indexed: 11/14/2022] Open
Abstract
Objectives We have reported previously that Belimumab, a human monoclonal antibody that inhibits B-cell activating factor(BAFF) could be an effective and safe option to treat Neuropsychiatric manifestations of SLE (NPSLE). To avoid inadequate efficacy of Belimumab and significant adverse events of often-used dose of cyclophosphamide (CYC) for SLE, we evaluated the efficacy, safety, and possible immune mechanisms of Belimumab treatment in combination with intermittent low-dose intravenous CYC for moderate-to-severe SLE. Methods In this non blinded and parallel-group trial, we collected 82 cases of moderate-to-severe SLE patients, 40 received Belimumab treatment and 42 received conventional treatments as historical controls for 24 weeks. The demographic features, clinical manifestations, and laboratory indicators including peripheral blood lymphocyte subgroups or subsets were compared before and after the treatments. Results Compared with the baseline, 6 months post Belimumab group treatment, disease activity score SLEDAI (13.78 to 3.82, P<0.05) and BILAG scores (16.40 to 5.48, P<0.05) were reduced; C3 (0.19 to 1.14, P<0.05) and C4 (0.04 to 0.22, P<0.05) increased; the absolute numbers of B and T cells were the first decreased and then significantly increased, tended to balance. Moreover, Belimumab group treatment significantly reduced the serum levels of IL-6, the ratio of B and T cells, and the proportion of infections and menstrual disorders. Conclusion Compared with conventional treatment, Belimumab with low-dose intravenous CYC significantly reduced disease activity scores and maintained the B/T cell balance for SLE patients at 24 weeks. It was more efficacy and safe (adverse events such as infection were significantly lower). It should be the mechanism that Belimumab combined with low-dose intravenous CYC therapy restores the balance of T and B cells, which proposes a potential treatment strategyfor SLE.
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Affiliation(s)
- Hao Cheng
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, China
| | - Xiao-ying Zhang
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, China
| | - Hui-dan Yang
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, China
| | - Zhen Yu
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, China
| | - Cheng-lan Yan
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, China
| | - Chong Gao
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Hong-yan Wen
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, China
- *Correspondence: Hong-yan Wen, ;
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Cao L, Zhang H, Bai J, Wu T, Wang Y, Wang N, Huang C. HERC6 is upregulated in peripheral blood mononuclear cells of patients with systemic lupus erythematosus and promotes the disease progression. Autoimmunity 2022; 55:506-514. [PMID: 35880641 DOI: 10.1080/08916934.2022.2103800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease. Peripheral blood mononuclear cells (PBMCs) are any peripheral blood cell with round nuclei, including lymphocytes (T cells, B cells) and monocytes, whose physicochemical properties are randomized by obvious immune changes, and are a potentially effective source of SLE blood test samples and therapeutic targets. This study aimed to explore the upregulation molecules of PBMCs in patients with SLE and to explore their biological role. Homologous to the E6-AP carboxyl terminus (HECT) and regulator of chromosome condensation 1 (RCC1)-like domain (RLD) containing E3 ubiquitin protein ligase family member 6 (HERC6) expression was found significantly upregulated in four Gene Expression Omnibus gene sets. Moreover, HERC6 expression was upregulated in PBMCs from SLE patients compared with that in PBMCs from normal donors. HERC6 was significantly associated with SLE clinical phenotypes such as complement C3 content, erythrocyte sedimentation rate, and SLE disease activity index. In vitro, knockdown of HERC6 inhibited PBMC apoptosis, inflammatory response, and janus kinase (JAK)/signal transducer and activator of transcription (STAT) signalling pathway, while overexpression of HERC6 led to the opposite results. In addition, AG490, a JAK/STAT pathway inhibitor, reversed the promoting effect of HERC6 overexpression on PBMC apoptosis and inflammation. In conclusion, the level of HERC6 in PBMCs in patients with SLE was upregulated. Overexpression of HERC6 promoted PBMC apoptosis and inflammatory response, which was involved in the JAK/STAT pathway.
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Affiliation(s)
- Ling Cao
- Pediatric Department, The First Hospital of Yulin, Yulin, PR China
| | - Hui Zhang
- Cardiology Department, The First Hospital of Yulin, Yulin, PR China
| | - Jin Bai
- Pediatric Department, The First Hospital of Yulin, Yulin, PR China
| | - Tingting Wu
- Pediatric Department, The First Hospital of Yulin, Yulin, PR China
| | - Yingjuan Wang
- Pediatric Department, The First Hospital of Yulin, Yulin, PR China
| | - Ning Wang
- Pediatric Department, Xi'an International Medical Center Hospital, Xi'an, PR China
| | - Caihong Huang
- Pediatric Department, The First Hospital of Yulin, Yulin, PR China
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Ujiie H, Rosmarin D, Schön MP, Ständer S, Boch K, Metz M, Maurer M, Thaci D, Schmidt E, Cole C, Amber KT, Didona D, Hertl M, Recke A, Graßhoff H, Hackel A, Schumann A, Riemekasten G, Bieber K, Sprow G, Dan J, Zillikens D, Sezin T, Christiano AM, Wolk K, Sabat R, Kridin K, Werth VP, Ludwig RJ. Unmet Medical Needs in Chronic, Non-communicable Inflammatory Skin Diseases. Front Med (Lausanne) 2022; 9:875492. [PMID: 35755063 PMCID: PMC9218547 DOI: 10.3389/fmed.2022.875492] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/09/2022] [Indexed: 12/15/2022] Open
Abstract
An estimated 20-25% of the population is affected by chronic, non-communicable inflammatory skin diseases. Chronic skin inflammation has many causes. Among the most frequent chronic inflammatory skin diseases are atopic dermatitis, psoriasis, urticaria, lichen planus, and hidradenitis suppurativa, driven by a complex interplay of genetics and environmental factors. Autoimmunity is another important cause of chronic skin inflammation. The autoimmune response may be mainly T cell driven, such as in alopecia areata or vitiligo, or B cell driven in chronic spontaneous urticaria, pemphigus and pemphigoid diseases. Rare causes of chronic skin inflammation are autoinflammatory diseases, or rheumatic diseases, such as cutaneous lupus erythematosus or dermatomyositis. Whilst we have seen a significant improvement in diagnosis and treatment, several challenges remain. Especially for rarer causes of chronic skin inflammation, early diagnosis is often missed because of low awareness and lack of diagnostics. Systemic immunosuppression is the treatment of choice for almost all of these diseases. Adverse events due to immunosuppression, insufficient therapeutic responses and relapses remain a challenge. For atopic dermatitis and psoriasis, a broad spectrum of innovative treatments has been developed. However, treatment responses cannot be predicted so far. Hence, development of (bio)markers allowing selection of specific medications for individual patients is needed. Given the encouraging developments during the past years, we envision that many of these challenges in the diagnosis and treatment of chronic inflammatory skin diseases will be thoroughly addressed in the future.
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Affiliation(s)
- Hideyuki Ujiie
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - David Rosmarin
- Department of Dermatology, Tufts Medical Center, Boston, MA, United States
| | - Michael P. Schön
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
- Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Göttingen, Germany
| | - Sonja Ständer
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Muenster, Muenster, Germany
| | - Katharina Boch
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Martin Metz
- Institute for Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Marcus Maurer
- Institute for Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Diamant Thaci
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Connor Cole
- Division of Dermatology, Rush University Medical Center, Chicago, IL, United States
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Kyle T. Amber
- Division of Dermatology, Rush University Medical Center, Chicago, IL, United States
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Dario Didona
- Department of Dermatology and Allergology, Philipps-Universität, Marburg, Germany
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps-Universität, Marburg, Germany
| | - Andreas Recke
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Hanna Graßhoff
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Alexander Hackel
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Anja Schumann
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Gabriela Riemekasten
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Gant Sprow
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Joshua Dan
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Tanya Sezin
- Department of Dermatology, Columbia University Medical Center, New York, NY, United States
| | - Angela M. Christiano
- Department of Dermatology, Columbia University Medical Center, New York, NY, United States
| | - Kerstin Wolk
- Psoriasis Research and Treatment Centre, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Interdisciplinary Group Molecular Immunopathology, Dermatology/Medical Immunology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Sabat
- Psoriasis Research and Treatment Centre, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Interdisciplinary Group Molecular Immunopathology, Dermatology/Medical Immunology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Khalaf Kridin
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Victoria P. Werth
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Ralf J. Ludwig
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
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Anti-double stranded DNA antibodies: A rational diagnostic approach in limited resource settings. Pract Lab Med 2022; 31:e00285. [PMID: 35711387 PMCID: PMC9192786 DOI: 10.1016/j.plabm.2022.e00285] [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: 12/30/2021] [Accepted: 05/31/2022] [Indexed: 11/22/2022] Open
Abstract
Context Anti-double-stranded deoxyribonucleic acid antibodies (dsDNA Abs) are highly specific markers of systemic lupus erythematosus (SLE). Multiple methods are employed for their detection in routine diagnostics. Objectives The aim of this study was to evaluate a diagnostic approach for anti-dsDNA Abs using DNA-ELISA and Crithidia luciliae fluorescence test (CLIFT), in combination with antinuclear antibody (ANA) screening. Methods We enrolled 113 patients—53 with SLE, 50 with other systemic autoimmune rheumatic diseases (OSARD), and 10 with non-autoimmune clinical conditions (NAICC). Patients’ samples were tested for anti-dsDNA Abs using an enzyme-linked immunosorbent assay (ELISA) and CLIFT, combined to ANA screening by indirect immunofluorescence assay (ANA-IIFA). Results The mean age of patients was 39.94 ± 15 years (ranges: 11–85 years). Overall, specimens from 77.3%, 11.7%, and 20% of patients with SLE, OSARD and NAICC respectively were ELISA-positive; and those from 54.7% to 4% of patients with SLE and OSARD, respectively, were CLIFT-positive. CLIFT positivity was significantly associated with high ELISA titers (p = 0.002) and homogeneous ANA-IIF pattern (p = 0.0002). Conclusion For better clinical relevance of anti-dsDNA antibodies, we suggest a combined detection strategy based on ELISA, CLIFT and ANA-IIFA, considering the clinical criteria of SLE. Anti-dsDNA Abs represent an excellent indicator of systemic lupus erythematosus (SLE) activity and valuable diagnostic biomarker. We tested 103 autoimmune disease cases and 10 non-autoimmune condition cases for anti-dsDNA Abs using DNA and CLIFT, in combination with ANA-IIF screening. CLIFT positivity was significantly associated with high DNA-ELISA titers (p = 0.002) and homogeneous ANA-IIF pattern (p = 0.0002). High DNA-ELISA titers with a positive CLIFT are clinically relevant for the diagnosis of SLE, especially in the presence of a homogeneous ANA-IIF pattern.
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Matza MA, Rincon SP, Yucel E, Jorge AM, Singhal AB, Coleman CA, Uljon SN. Case 12-2022: A 41-Year-Old Woman with Transient Ischemic Attack and Mitral Valve Masses. N Engl J Med 2022; 386:1560-1570. [PMID: 35443111 DOI: 10.1056/nejmcpc2115855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Mark A Matza
- From the Departments of Medicine (M.A.M., E.Y., A.M.J.), Radiology (S.P.R.), Neurology (A.B.S.), Obstetrics and Gynecology (C.A.C.), and Pathology (S.N.U.), Massachusetts General Hospital, and the Departments of Medicine (M.A.M., E.Y., A.M.J.), Radiology (S.P.R.), Neurology (A.B.S.), Obstetrics and Gynecology (C.A.C.), and Pathology (S.N.U.), Harvard Medical School - both in Boston
| | - Sandra P Rincon
- From the Departments of Medicine (M.A.M., E.Y., A.M.J.), Radiology (S.P.R.), Neurology (A.B.S.), Obstetrics and Gynecology (C.A.C.), and Pathology (S.N.U.), Massachusetts General Hospital, and the Departments of Medicine (M.A.M., E.Y., A.M.J.), Radiology (S.P.R.), Neurology (A.B.S.), Obstetrics and Gynecology (C.A.C.), and Pathology (S.N.U.), Harvard Medical School - both in Boston
| | - Evin Yucel
- From the Departments of Medicine (M.A.M., E.Y., A.M.J.), Radiology (S.P.R.), Neurology (A.B.S.), Obstetrics and Gynecology (C.A.C.), and Pathology (S.N.U.), Massachusetts General Hospital, and the Departments of Medicine (M.A.M., E.Y., A.M.J.), Radiology (S.P.R.), Neurology (A.B.S.), Obstetrics and Gynecology (C.A.C.), and Pathology (S.N.U.), Harvard Medical School - both in Boston
| | - April M Jorge
- From the Departments of Medicine (M.A.M., E.Y., A.M.J.), Radiology (S.P.R.), Neurology (A.B.S.), Obstetrics and Gynecology (C.A.C.), and Pathology (S.N.U.), Massachusetts General Hospital, and the Departments of Medicine (M.A.M., E.Y., A.M.J.), Radiology (S.P.R.), Neurology (A.B.S.), Obstetrics and Gynecology (C.A.C.), and Pathology (S.N.U.), Harvard Medical School - both in Boston
| | - Aneesh B Singhal
- From the Departments of Medicine (M.A.M., E.Y., A.M.J.), Radiology (S.P.R.), Neurology (A.B.S.), Obstetrics and Gynecology (C.A.C.), and Pathology (S.N.U.), Massachusetts General Hospital, and the Departments of Medicine (M.A.M., E.Y., A.M.J.), Radiology (S.P.R.), Neurology (A.B.S.), Obstetrics and Gynecology (C.A.C.), and Pathology (S.N.U.), Harvard Medical School - both in Boston
| | - Carrie A Coleman
- From the Departments of Medicine (M.A.M., E.Y., A.M.J.), Radiology (S.P.R.), Neurology (A.B.S.), Obstetrics and Gynecology (C.A.C.), and Pathology (S.N.U.), Massachusetts General Hospital, and the Departments of Medicine (M.A.M., E.Y., A.M.J.), Radiology (S.P.R.), Neurology (A.B.S.), Obstetrics and Gynecology (C.A.C.), and Pathology (S.N.U.), Harvard Medical School - both in Boston
| | - Sacha N Uljon
- From the Departments of Medicine (M.A.M., E.Y., A.M.J.), Radiology (S.P.R.), Neurology (A.B.S.), Obstetrics and Gynecology (C.A.C.), and Pathology (S.N.U.), Massachusetts General Hospital, and the Departments of Medicine (M.A.M., E.Y., A.M.J.), Radiology (S.P.R.), Neurology (A.B.S.), Obstetrics and Gynecology (C.A.C.), and Pathology (S.N.U.), Harvard Medical School - both in Boston
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12
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Infantino M, Nagy E, Bizzaro N, Fischer K, Bossuyt X, Damoiseaux J. Anti-dsDNA antibodies in the classification criteria of systemic lupus erythematosus. J Transl Autoimmun 2022; 5:100139. [PMID: 35028552 PMCID: PMC8741517 DOI: 10.1016/j.jtauto.2021.100139] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/23/2021] [Accepted: 12/23/2021] [Indexed: 11/30/2022] Open
Abstract
Anti-double stranded DNA (dsDNA) antibodies play an important role in the diagnosis, classification and management of systemic lupus erythematosus (SLE), an autoimmune disease characterized by heterogeneous clinical manifestations and a wide range of autoantibodies, which makes the diagnosis quite challenging. In the absence of diagnostic criteria, classification criteria have been used for many decades. The first classification criteria for SLE were formulated in 1971 by the American College of Rheumatology (ACR), followed by two revisions in 1982 and 1997. In order to improve their clinical performance and to reflect new knowledge on autoantibodies, new classification criteria for SLE were issued in 2012 by the Systemic Lupus International Collaborating Clinics (SLICC). These criteria proposed to classify only patients that have at least one immunologic criterion, overcoming SLE classification based solely on clinical manifestations. In 2019, the European League Against Rheumatism (EULAR)/ACR proposed new criteria that aimed to maintain the high specificity of the ACR criteria with a sensitivity close to the SLICC 2012 criteria. These 2019 criteria reinforced the importance of autoantibodies in SLE diagnosis, assigning the highest score (6 points) to anti-dsDNA antibodies in the fully weighted scoring of the disease. The current criteria require the use of an anti-dsDNA assay with at least 90% specificity, such as the Crithidia luciliae immunofluorescence test (CLIFT) or FARR assay. However, the criteria do not comment on all the tests currently widely used in clinical laboratories. Neither do they consider the technological evolutions, nor standardization issues. Since strict adherence to any of the classification criteria, including the serological items, could lead to possible misclassification of SLE and/or delayed diagnosis, test characteristics of the distinct immunoassays should be taken into consideration.
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Affiliation(s)
- Maria Infantino
- Immunology and Allergy Laboratory, San Giovanni di Dio Hospital, Florence, Italy
| | - Eszter Nagy
- National Institute of Locomotor Diseases and Disabilities, Budapest, Hungary.,Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Nicola Bizzaro
- Laboratory of Clinical Pathology, San Antonio Hospital, Tolmezzo, Italy
| | - Katarzyna Fischer
- Individual Laboratory for Rheumatologic Diagnostics, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Xavier Bossuyt
- Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium.,Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Jan Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
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13
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Cockx M, Van Hoovels L, De Langhe E, Lenaerts J, Thevissen K, Persy B, Bonroy C, Vercammen M, Bossuyt X. Laboratory evaluation of anti-dsDNA antibodies. Clin Chim Acta 2022; 528:34-43. [PMID: 35016875 DOI: 10.1016/j.cca.2021.12.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 11/19/2022]
Abstract
Antibodies to dsDNA are an important laboratory parameter for diagnosis, monitoring and classification of systemic lupus erythematosus (SLE). In clinical laboratories, several techniques are used to detect and quantify anti-dsDNA antibodies. Each technique has its advantages and disadvantages regarding sensitivity, specificity, avidity and assay procedure. Assays differ with respect to the antigen source (native versus synthetic versus molecular biological) used and the way the antigen is presented (e.g. in solution, covalently linked to a solid phase,…). Consequently, correlation between assays can be poor and standardization of anti-dsDNA antibody tests is challenging. We here provide an overview of the currently available anti-dsDNA tests frequently used in clinical laboratories [Crithidiae luciliae immunofluorescence test (CLIFT), Enzyme linked immune sorbent assay (ELISA), fluoroenzyme immunoassay (FEIA), chemiluminescence (CIA), multiplexed bead-based assays and Farr-RIA] and their performance characteristics. From this literature study, we concluded that performance characteristics differ between assays. Often, a combination of techniques is necessary for the best result interpretation.
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Affiliation(s)
- Maaike Cockx
- Department of Microbiology, Immunology and Transplantation, University of Leuven, Leuven, Belgium
| | - Lieve Van Hoovels
- Department of Microbiology, Immunology and Transplantation, University of Leuven, Leuven, Belgium; Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium
| | - Ellen De Langhe
- Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - Jan Lenaerts
- Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium; Reumainstituut and Jessa Hospital, Hasselt, Belgium
| | | | - Ben Persy
- Department of Laboratory Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Carolien Bonroy
- Department of Diagnostic Sciences, Ghent University Hospitals, Ghent, Belgium; Department of Laboratory Medicine, Ghent University Hospitals, Ghent, Belgium
| | | | - Xavier Bossuyt
- Department of Microbiology, Immunology and Transplantation, University of Leuven, Leuven, Belgium; Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium.
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14
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Urbanski G, Gury A, Jeannin P, Chevailler A, Lozac’h P, Reynier P, Lavigne C, Lacout C, Vinatier E. Discordant Predictions of Extraglandular Involvement in Primary Sjögren's Syndrome According to the Anti-SSA/Ro60 Antibodies Detection Assay in a Cohort Study. J Clin Med 2022; 11:jcm11010242. [PMID: 35011983 PMCID: PMC8745780 DOI: 10.3390/jcm11010242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/24/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022] Open
Abstract
Electrophoresis-derived techniques for anti-SSA/Ro60 KDa (anti-SSA) antibodies detection have been progressively replaced by methods using non-native antigens. We aimed to compare the patients’ phenotypes and the occurrence of extraglandular manifestations in primary Sjögren’s syndrome according to the method used to detect anti-SSA antibodies. Sera from patients with a diagnosis of pSS according to ACR/EULAR 2016 criteria between 2008 and 2017 were tested for anti-SSA antibodies using methods with non-native antigens (magnetic bead multiplex assay; line immunoassays) and one with native antigens (counterimmunoelectrophoresis (CIE)). The population was split into three groups according to anti-SSA antibodies status: absence (SSA−), presence in any method except for CIE (SSA+CIE−), and presence in CIE (SSA+CIE+). The patients in the SSA+CIE+ group (n = 70, 42.7%) were ten years younger and presented more immunological activity compared with both the SSA− (n = 80, 48.8%) and SSA+CIE− groups (n = 14, 8.5%). The SSA− and SSA+CIE− groups were poorly distinct. The presence of anti-SSA antibodies solely in CIE was significantly associated with the occurrence of extraglandular manifestations of pSS (HR = 4.45 (2.35–8.42)). Contrary to CIE, methods using non-native antigens to detect anti-SSA antibodies were unable to predict the occurrence of systemic expression of pSS.
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Affiliation(s)
- Geoffrey Urbanski
- Department of Internal Medicine and Clinical Immunology, University Hospital, 49000 Angers, France; (A.G.); (P.L.); (C.L.); (C.L.)
- Mitolab, MitoVasc Institute, CNRS 6015, INSERM U1083, University of Angers, 49000 Angers, France;
- Correspondence: ; Tel.: +33-(0)2-4135-4003
| | - Aline Gury
- Department of Internal Medicine and Clinical Immunology, University Hospital, 49000 Angers, France; (A.G.); (P.L.); (C.L.); (C.L.)
| | - Pascale Jeannin
- Laboratory of Immunology, University Hospital, 49000 Angers, France; (P.J.); (A.C.); (E.V.)
- INSERM, CRCINA, Angers University, 49000 Angers, France
| | - Alain Chevailler
- Laboratory of Immunology, University Hospital, 49000 Angers, France; (P.J.); (A.C.); (E.V.)
| | - Pierre Lozac’h
- Department of Internal Medicine and Clinical Immunology, University Hospital, 49000 Angers, France; (A.G.); (P.L.); (C.L.); (C.L.)
- Department of Internal Medicine, General Hospital, 72000 Le Mans, France
| | - Pascal Reynier
- Mitolab, MitoVasc Institute, CNRS 6015, INSERM U1083, University of Angers, 49000 Angers, France;
| | - Christian Lavigne
- Department of Internal Medicine and Clinical Immunology, University Hospital, 49000 Angers, France; (A.G.); (P.L.); (C.L.); (C.L.)
| | - Carole Lacout
- Department of Internal Medicine and Clinical Immunology, University Hospital, 49000 Angers, France; (A.G.); (P.L.); (C.L.); (C.L.)
| | - Emeline Vinatier
- Laboratory of Immunology, University Hospital, 49000 Angers, France; (P.J.); (A.C.); (E.V.)
- INSERM, CRCINA, Angers University, 49000 Angers, France
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15
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Yoon S, Moon HW, Kim H, Hur M, Yun YM. Clinical Performance of Two Automated Immunoassays, EliA CTD Screen and QUANTA Flash CTD Screen Plus, for Antinuclear Antibody Screening. Ann Lab Med 2022; 42:63-70. [PMID: 34374350 PMCID: PMC8368234 DOI: 10.3343/alm.2022.42.1.63] [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: 12/09/2020] [Revised: 02/26/2021] [Accepted: 07/06/2021] [Indexed: 12/31/2022] Open
Abstract
Background Recently, two fully automated immunoassays for antinuclear antibody (ANA) screening were introduced EliA CTD Screen (Thermo Fisher Scientific, Freiburg, Germany) and QUANTA Flash CTD Screen Plus (Inova Diagnostics, San Diego, USA). We evaluated their clinical performance in comparison with the indirect immunofluorescence assay (IIFA) and analyzed samples with discrepant results. Methods In total, 406 serum samples (206 from patients undergoing routine checkups and 200 from rheumatology clinic patients) were assayed using EliA, QUANTA Flash, and IIFA. We evaluated assay concordance and agreement and confirmed the presence of anti-extractable nuclear antigen (ENA) antibodies in samples with discrepant automated immunoassay and IIFA results. Additionally, we compared the clinical performance of each assay in diagnosing ANA-associated rheumatic disease (AARD) and adjusted the cut-off values. Results In rheumatology clinic samples, the concordance and agreement were 91.5% and strong between EliA and QUANTA Flash, 79.0% and weak between EliA and IIFA, and 80.5% and moderate between QUANTA Flash and IIFA, respectively. In automated immunoassay-positive, IIFA-negative samples (N=15), all anti-ENA antibodies detected (6/15) were anti-Sjögren’s syndrome antigen A/Ro (Ro60) antibodies. The automated immunoassays and IIFA showed high accuracy for diagnosing AARD, and adjusted cut-off values improved their sensitivities (EliA with 0.56 ratio, 82.9% sensitivity; QUANTA Flash with 9.7 chemiluminescent units, 87.8% sensitivity). Conclusions The two automated immunoassays showed reliable performance compared with IIFA and can be efficiently used with the IIFA in clinical immunology laboratories. Clinical cut-off values can be adjusted according to the workflow in each laboratory.
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Affiliation(s)
- Sumi Yoon
- Department of Laboratory Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hee-Won Moon
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hanah Kim
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Mina Hur
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Yeo-Min Yun
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
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16
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Du AX, Gniadecki R, Osman M. Biomarkers of B cell activation in autoimmune connective tissue diseases: More than markers of disease activity. Clin Biochem 2021; 100:1-12. [PMID: 34822848 DOI: 10.1016/j.clinbiochem.2021.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/25/2022]
Abstract
B cells play a central role in the pathogenesis of many autoimmune diseases, acting as antigen-presenting cells, producing inflammatory cytokines, and acting as a source of autoantibodies after differentiating into plasma cells. In this review, we aim to summarize and synthesize the literature for the utility of biomarkers of B cell activation (plasma immunoglobulins (Ig), free light chains (FLCs), and beta-2 microglobulin (β2M)) in monitoring inflammatory rheumatic connective tissue diseases, such as Sjogren's syndrome (SS), systemic lupus erythematosus (SLE), dermatomyositis (DM), and systemic sclerosis (SSc). Clinically, it is quite difficult to gauge prognosis in these conditions as there, historically, have not been many quantitative markers of disease activity available. From our extensive literature review, Ig, FLC, and β2M may function as invaluable prognostic markers of ongoing disease activity, and potentially as biomarkers for response to therapy or disease relapse. They are inexpensive and unsophisticated tests that are vastly underused in the setting of autoimmune disease. However, clinicians still need to be aware of the potential of false positives in times of infection or plasma cell dyscrasia, as these disease states can artificially increase these biomarkers. Ultimately, the utility of serum Ig, FLCs, and β2M is clearly delineated in SS and SLE, and least investigated in DM, and additional prospective studies utilizing these biomarkers, and specific B cell targeted therapies are still needed.
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Affiliation(s)
- Amy X Du
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Robert Gniadecki
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Mohamed Osman
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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17
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Alesaeidi S, Daraei M, Salami Khanshan A, Zainaldain H. A multisystem syndrome compatible with systemic lupus erythematosus: Case report and review of literature. CASPIAN JOURNAL OF INTERNAL MEDICINE 2021; 12:S482-S486. [PMID: 34760111 PMCID: PMC8559634 DOI: 10.22088/cjim.12.0.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/03/2020] [Accepted: 08/15/2020] [Indexed: 11/12/2022]
Abstract
Background: Abdominal pain is a routine symptom. Mesenteric arteritis, intestinal vasculitis, enteric vasculitis, mesenteric vasculitis, lupus peritonitis, and abdominal serositis are the possible differential diagnoses. Therefore, lupus enteritis has an uncertain outbreak. Case Presentation: A 27-year-old woman presented with clinical presentation of peritonitis suggestive of acute abdominal crisis with three days history of fever, bloody diarrhea, nausea, vomiting and seizure. Further work up revealed microangiopathic hemolytic anemia, thrombocytopenia, proteinuria, polyserositis and her initial autoimmune panel all were negative. Since SLE was at the top of our diagnosis, we considered glucocorticoid and cyclophosphamide pulse therapy. After approximately two months of her initial presentation, when all of her symptoms subsided by initial therapy, her antinuclear antibody became positive at 1:320 titers and renal biopsy was compatible with lupus nephritis (stage III). Conclusion: It is crucial to take the diagnosis of lupus into consideration, in case of any young female with multiorgan involvement even without positive antibody tests. As in this case, it took more than two months after initial presentation to confirm the diagnosis via renal biopsy and only after then, serum autoantibodies became seropositive.
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Affiliation(s)
- Samira Alesaeidi
- Department of Internal Medicine, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Amir-Alam Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Daraei
- Department of Internal Medicine, Imam khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Salami Khanshan
- Student Research Committee, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hamed Zainaldain
- Amir-Alam Research Center, Tehran University of Medical Sciences, Tehran, Iran.,School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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18
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Mahmood Z, Barr JA. Diabetic nephropathy and end-stage renal disease in a 28-year-old woman, or is it? BMJ Case Rep 2021; 14:14/4/e240089. [PMID: 33910792 PMCID: PMC8094368 DOI: 10.1136/bcr-2020-240089] [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: 11/04/2022] Open
Abstract
A 28-year-old Hispanic woman presented to the emergency department with pneumonia and bilateral pulmonary oedema, requiring admission to the intensive care unit. Additional history included type 1 diabetes mellitus, End Stage Renal Disease on haemodialysis and Hashimoto's disease. On further diagnostic evaluation, she was found to have systemic lupus erythematosus (SLE) with overlap syndrome. The goal of this case report was twofold: to share our holistic investigative processes and to explore how racial identity and experiences play a role in health disparities present in SLE. The diagnostic process was difficult because of language and socioeconomic barriers our patient experienced. Additionally, SLE in the Hispanic population has only recently been researched, limiting specifics about presentation and disease course. In the Hispanic population, SLE has increased morbidity and mortality when compared with the Caucasian population. Thus, our patient's case highlights the need for holistic practices when diagnosing patients, particularly in historically and presently marginalised identities.
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Affiliation(s)
- Zainab Mahmood
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Jayne A Barr
- Internal Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
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19
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Tebo AE, Schmidt RL, Kadkhoda K, Peterson LK, Chan EKL, Fritzler MJ, Wener MH. The antinuclear antibody HEp-2 indirect immunofluorescence assay: a survey of laboratory performance, pattern recognition and interpretation. AUTOIMMUNITY HIGHLIGHTS 2021; 12:4. [PMID: 33640027 PMCID: PMC7916270 DOI: 10.1186/s13317-020-00146-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/12/2020] [Indexed: 12/15/2022]
Abstract
Background To evaluate the interpretation and reporting of antinuclear antibodies (ANA) by indirect immunofluorescence assay (IFA) using HEp-2 substrates based on common practice and guidance by the International Consensus on ANA patterns (ICAP). Method Participants included two groups [16 clinical laboratories (CL) and 8 in vitro diagnostic manufacturers (IVD)] recruited via an email sent to the Association of Medical Laboratory Immunologists (AMLI) membership. Twelve (n = 12) pre-qualified specimens were distributed to participants for testing, interpretation and reporting HEp-2 IFA. Results obtained were analyzed for accuracy with the intended and consensus response for three main categorical patterns (nuclear, cytoplasmic and mitotic), common patterns and ICAP report nomenclatures. The distributions of antibody titers of specimens were also compared. Results Laboratories differed in the categorical patterns reported; 8 reporting all patterns, 3 reporting only nuclear patterns and 5 reporting nuclear patterns with various combinations of other patterns. For all participants, accuracy with the intended response for the categorical nuclear pattern was excellent at 99% [95% confidence interval (CI): 97–100%] compared to 78% [95% CI 67–88%] for the cytoplasmic, and 93% [95% CI 86%–100%] for mitotic patterns. The accuracy was 13% greater for the common nomenclature [87%, 95% CI 82–90%] compared to the ICAP nomenclature [74%, 95% CI 68–79%] for all participants. Participants reporting all three main categories demonstrated better performances compared to those reporting 2 or less categorical patterns. The average accuracies varied between participant groups, however, with the lowest and most variable performances for cytoplasmic pattern specimens. The reported titers for all specimens varied, with the least variability for nuclear patterns and most titer variability associated with cytoplasmic patterns. Conclusions Our study demonstrated significant accuracy for all participants in identifying the categorical nuclear staining as well as traditional pattern assignments for nuclear patterns. However, there was less consistency in reporting cytoplasmic and mitotic patterns, with implications for assigning competencies and training for clinical laboratory personnel.
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Affiliation(s)
- Anne E Tebo
- Department of Pathology, University of Utah, Salt Lake City, UT, USA. .,ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA.
| | - Robert L Schmidt
- Department of Pathology, University of Utah, Salt Lake City, UT, USA.,ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
| | - Kamran Kadkhoda
- Immunopathology Laboratory, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lisa K Peterson
- Department of Pathology, University of Utah, Salt Lake City, UT, USA.,ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
| | - Edward K L Chan
- Department of Oral Biology, University of Florida, Gainesville, FL, USA
| | - Marvin J Fritzler
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mark H Wener
- Department of Laboratory Medicine and Pathology & Department of Medicine, University of Washington, Seattle, WA, USA
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20
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Fan R, Zhang Y, Xu Y, Tong J, Chen Z, Gu M, Fan W, Chen Y, Peng F, Jiang Y. Serum antinuclear antibodies associate with worse prognosis in AQP4-positive neuromyelitis optica spectrum disorder. Brain Behav 2021; 11:e01865. [PMID: 33319460 PMCID: PMC7821584 DOI: 10.1002/brb3.1865] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 08/31/2020] [Accepted: 09/14/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Studies have demonstrated that antinuclear antibodies (ANAs) may be correlated with neuromyelitis optica spectrum disorder (NMOSD). However, the conflicting results of studies about the value of ANAs in AQP4 antibody-positive NMOSD patients need to be further investigated. MATERIAL Case data were collected from 143 patients with AQP4 antibody-positive NMOSD. Patients were divided into two groups based on the ANA test results. The analysis of clinical characteristics, laboratory tests, and MRI examination results were compared between two groups: the NMOSD patients with ANA (+) and with ANA (-). RESULTS Disease duration of NMOSD is shorter in the ANA (+) patients with EDSS < 4 than in the ANA (-) patients (12.05 ± 16.73 versus 29.43 ± 41.03, p-value = .013). The median time from disease onset to an EDSS score of 4.0 is significantly longer in the ANA (-) NMOSD patients than in the ANA (+) patients (48.2 months versus 24 months, p = .04). In addition, ANA (RR, 2.234; 95% CI, 1.078-4.629; p-value = .031) can predict the severity of NMOSD. CONCLUSIONS Antinuclear antibodies seem to be associated with more severe disease activity in NMOSD patients.
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Affiliation(s)
- Rong Fan
- Department of Neurology and Multiple Sclerosis Research Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuefeng Zhang
- Department of Neurology, Guangzhou Brain Hospital, Guangzhou, China
| | - Yunqi Xu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jiayi Tong
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Zhigang Chen
- Department of Neurology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Meifeng Gu
- Department of Neurology and Multiple Sclerosis Research Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenkui Fan
- Department of Nephrology, The Second People's Hospital of Foshan, Foshan, China
| | - Yong Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Fuhua Peng
- Department of Neurology and Multiple Sclerosis Research Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ying Jiang
- Department of Neurology and Multiple Sclerosis Research Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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21
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Zhang B, Liu L, Zhou T, Shi X, Wu H, Xiang Z, Zhao M, Lu Q. A simple and highly efficient method of IFI44L methylation detection for the diagnosis of systemic lupus erythematosus. Clin Immunol 2020; 221:108612. [PMID: 33069854 DOI: 10.1016/j.clim.2020.108612] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/10/2020] [Accepted: 10/11/2020] [Indexed: 01/17/2023]
Abstract
Systemic lupus erythematosus (SLE) is a complex heterogenous autoimmune disease that can be challenging to diagnose. We previously identified the IFN-induced protein 44-like (IFI44L) methylation marker for SLE diagnosis, which can be detected by pyrosequencing. Although the previous technique has high sensitivity and specificity, it requires special equipment and high cost for detection. Here, we established a high-resolution melting-quantitative polymerase chain reaction (HRM-qPCR) assay to detect the methylation of IFI44L promoter for the diagnosis of SLE. The result was determined according to the standard melting curve of the methylation level of the IFI44L promoter region. The sensitivity was 88.571% and the specificity was 97.087%. The HRM-qPCR and pyrosequencing results presented good consistency when both methods were used to detect the methylation of the IFI44L promoter for SLE diagnosis. Furthermore, the HRM-qPCR method can be used to distinguish SLE from other autoimmune diseases, infectious diseases and virus-related cancers.
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Affiliation(s)
- Bo Zhang
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, Hunan, China; Research Unit of Key Technologies of Diagnosis and Treatment for Immune-related Skin Diseases, Chinese Academy of Medical Sciences (2019RU027), Changsha, Hunan, China
| | - Limin Liu
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, Hunan, China; Research Unit of Key Technologies of Diagnosis and Treatment for Immune-related Skin Diseases, Chinese Academy of Medical Sciences (2019RU027), Changsha, Hunan, China
| | - Tian Zhou
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, Hunan, China; Research Unit of Key Technologies of Diagnosis and Treatment for Immune-related Skin Diseases, Chinese Academy of Medical Sciences (2019RU027), Changsha, Hunan, China
| | - Xiaoli Shi
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, Hunan, China; Research Unit of Key Technologies of Diagnosis and Treatment for Immune-related Skin Diseases, Chinese Academy of Medical Sciences (2019RU027), Changsha, Hunan, China
| | - Haijing Wu
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, Hunan, China; Research Unit of Key Technologies of Diagnosis and Treatment for Immune-related Skin Diseases, Chinese Academy of Medical Sciences (2019RU027), Changsha, Hunan, China
| | - Zhongyuan Xiang
- Department of Clinical Laboratory, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ming Zhao
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, Hunan, China; Research Unit of Key Technologies of Diagnosis and Treatment for Immune-related Skin Diseases, Chinese Academy of Medical Sciences (2019RU027), Changsha, Hunan, China.
| | - Qianjin Lu
- Department of Dermatology, Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, Hunan, China; Research Unit of Key Technologies of Diagnosis and Treatment for Immune-related Skin Diseases, Chinese Academy of Medical Sciences (2019RU027), Changsha, Hunan, China.
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22
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Yan R, Jiang H, Gu S, Feng N, Zhang N, Lv L, Liu F. Fecal Metabolites Were Altered, Identified as Biomarkers and Correlated With Disease Activity in Patients With Systemic Lupus Erythematosus in a GC-MS-Based Metabolomics Study. Front Immunol 2020; 11:2138. [PMID: 33013903 PMCID: PMC7511511 DOI: 10.3389/fimmu.2020.02138] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/06/2020] [Indexed: 12/11/2022] Open
Abstract
Gut metabolites are products of the crosstalk between microbes and their host and play an important role in the occurrence, development, diagnosis, and treatment of autoimmune diseases. This work profiled the fecal metabolome of patients with systemic lupus erythematosus (SLE) using gas chromatography-mass spectrometry (GC-MS) and analyzed the potential roles of metabolites in the diagnosis and development of SLE. Fecal sample from 29 SLE patients without any other diseases and 30 healthy controls (HCs) were analyzed by metabolomics profiling. All participants took no antibiotics in the month before sampling and clinical data collecting. The metabolome profiles of patients with SLE and HCs were significantly different. Thirty fecal metabolites, such as deoxycholic acid, erucamide, L-tryptophan and putrescine, were significantly enriched, while nine metabolites, such as glyceric acid, γ-tocopherol, (Z)-13-octadecenoic acid and 2,4-di-tert-butylphenol, were depleted in SLE patients vs. HCs. The areas under the curve (AUCs) of L-valine, pyrimidine, erucamide, and L-leucine during ROC analysis were 0.886, 0.833, 0.829, and 0.803, indicating their good diagnostic potential. Moreover, the combination of L-valine, erucamide and 2,4-di-tert-butylphenol gave an AUC of 0.959. SLE-altered metabolites were significantly located in 28 pathways, such as ABC transporters (p = 3.40E-13) and aminoacyl-tRNA biosynthesis (p = 2.11E-12). Furthermore, SLE-altered fecal metabolites were closely correlated with SLE indicators, e.g., L-tryptophan was positively correlated with the SLEDAI-2K (p = 0.007). Our results suggest that the SLE fecal metabolome is closely associated with the occurrence and development of SLE and is of great diagnostic value.
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Affiliation(s)
- Ren Yan
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Huiyong Jiang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Silan Gu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ninghan Feng
- Department of Urology, Affiliated Wuxi No.2 People's Hospital, Nanjing Medical University, Wuxi, China
| | - Nan Zhang
- Department of Urology, Affiliated Wuxi No.2 People's Hospital, Nanjing Medical University, Wuxi, China
| | - Longxian Lv
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Fengping Liu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Wuxi School of Medicine, Jiangnan University, Wuxi, China
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23
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Mihaylova G, Vasilev V, Kosturkova MB, Stoyanov GS, Radanova M. Long Non-Coding RNAs as New Biomarkers in Lupus Nephritis: A Connection Between Present and Future. Cureus 2020; 12:e9003. [PMID: 32775083 PMCID: PMC7402529 DOI: 10.7759/cureus.9003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus (SLE). LN often leads to kidney failure, affecting the quality of a patient's life. There are several classical biomarkers that assist nephrologists’ daily practice. For more than 50 years, anti-double stranded DNA antibodies and complement components C3 and C4 have been used for LN disease activity evaluation. The major obstacle in the usage of conventional biomarkers is that none of them have both high specificity and high sensitivity. Moreover, an invasive kidney biopsy is still the gold standard for renal involvement detection in SLE patients. Therefore, new non-invasive biomarkers are needed for the early and accurate establishment of LN. Among the promising candidates are long non-coding RNAs (lncRNAs). Their dysregulation appears to have predictive and diagnostic potential. Furthermore, these biomarkers like other conventional biomarkers give insight into the pathogenesis of LN. This review aims to summarize the available information on lncRNAs in SLE patients and to present their future opportunities to add to the conventional biomarkers in the diagnosis and monitoring of LN.
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Affiliation(s)
- Galya Mihaylova
- Biochemistry, Molecular Medicine and Nutrigenomics, Medical University of Varna, Varna, BGR
| | - Vasil Vasilev
- Nephrology, "Tsaritsa Yoanna - ISUL" University Hospital, Sofia, BGR
| | | | - George S Stoyanov
- General and Clinical Pathology/Forensic Medicine and Deontology, Medical University of Varna, Varna, BGR
| | - Maria Radanova
- Biochemistry, Molecular Medicine and Nutrigenomics, Medical University of Varna, Varna, BGR
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24
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Oh J, Park Y, Lee KA, Kim HS. Detection of Anti-Extractable Nuclear Antigens in Patients with Systemic Rheumatic Disease via Fluorescence Enzyme Immunoassay and Its Clinical Utility. Yonsei Med J 2020; 61:73-78. [PMID: 31887802 PMCID: PMC6938786 DOI: 10.3349/ymj.2020.61.1.73] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Testing for autoantibodies to extractable nuclear antigens (ENAs) plays an important role in the diagnosis and management of systemic rheumatic disease. Currently, no gold standard tests are available for detecting anti-ENAs. To address this gap, we aimed to identify an assay that exhibits satisfactory diagnostic performance in the detection of five common anti-ENAs by comparing two commonly used assays, an automated fluorescent enzyme immunoassay (FEIA) and a microplate ELISA assay. MATERIALS AND METHODS Sera from 100 patients with systemic rheumatic disease were collected and assayed with FEIA and microplate ELISA to detect anti-ENAs. Statistical analyses were performed to check the agreement rate between the two platforms using kappa coefficients. Analytical sensitivity and specificity for each assay were calculated. RESULTS The concordance rates between ELISA and FEIA ranged from 89% for anti-RNP to 97% for anti-Scl-70, and the kappa coefficients of the two assays were in the range of 0.44 to 0.82. Between the two assays, a significant difference in sensitivity and specificity was seen only for anti-Sm and anti-RNP, respectively. CONCLUSION In this study, FEIA and ELISA showed comparable efficiency for detecting anti-ENAs.
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Affiliation(s)
- Joowon Oh
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Younhee Park
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung A Lee
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyon Suk Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea.
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25
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Karimifar M, Pakzad B, Karimzadeh H, Mousavi M, Kazemi M, Salehi A, Vatandoust N, Amini G, Akbari M, Salehi R. Interferon-induced protein 44-like gene promoter is differentially methylated in peripheral blood mononuclear cells of systemic lupus erythematosus patients. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2019; 24:99. [PMID: 31850088 PMCID: PMC6906918 DOI: 10.4103/jrms.jrms_83_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/12/2019] [Accepted: 08/14/2019] [Indexed: 02/07/2023]
Abstract
Background: The objectives of this study were to compare the interferon-induced protein 44-like (IFI44L) promoter methylation level between systemic lupus erythematosus (SLE) patients and healthy controls and to evaluate its diagnostic value in SLE. Materials and Methods: The IFI44L promoter methylation level was measured in 49 patients with SLE and 50 healthy controls. Quantitative analysis of promoter methylation IFI44L gene in genomic DNA samples extracted from peripheral blood mononuclear cells was examined in SLE patients and healthy controls. The level of DNA methylation was compared between SLE patients and healthy controls as well as within SLE patient groups based on the presence of renal involvement. Moreover, diagnostic values of IFI44L were calculated. Results: The IFI44L promoter methylation level in SLE patients was significantly lower than healthy controls (median, 43.8 vs. 57, respectively; P = 0.008). The level of IFI44L promoter methylation was not significantly different between SLE patients with renal involvement and SLE patients without renal involvement (84.6% vs. 92.7%, respectively; P = 0.774). The IFI44L promoter methylation level ≤94.3% was the best cutoff point with a sensitivity of 91.8% and a specificity of 38% to distinguish patients with SLE from healthy individuals. Conclusion: The level of IFI44L promoter methylation from whole peripheral blood in Iranian SLE patients was significantly lower than healthy controls. Furthermore, the DNA methylation level of IFI44L promoter was not associated with renal damage in patients with SLE.
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Affiliation(s)
- Mansour Karimifar
- Isfahan Metabolic Bone Disorders Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahram Pakzad
- Isfahan Metabolic Bone Disorders Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hadi Karimzadeh
- Isfahan Metabolic Bone Disorders Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Mousavi
- Isfahan Metabolic Bone Disorders Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Kazemi
- Isfahan Metabolic Bone Disorders Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amirhossein Salehi
- Isfahan Metabolic Bone Disorders Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasimeh Vatandoust
- Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Guilda Amini
- Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojtaba Akbari
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rasoul Salehi
- Isfahan Metabolic Bone Disorders Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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26
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Abstract
The presence of antinuclear antibodies (ANAs), which include autoantibodies to extractable nuclear antigens (ENAs), in the sera of patients with connective tissue diseases provides useful immunologic and pathophysiologic insight into the nature of their disease. This article discusses the most commonly used diagnostic modalities for detecting and quantitating the presence of ANA: indirect immunofluorescence assay, enzyme-linked immunosorbent assay, and multiplex bead technology, which serve as useful screening tests. We also review testing for autoantibodies to ENAs, which are often helpful to confirm the diagnosis of a specific connective tissue disease.
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Affiliation(s)
- Morris Ling
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Cox 201, Boston, MA 02114, USA; Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, 55 Fruit Street, Cox 201, Boston, MA 02114, USA; Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, Cox 201, Boston, MA 02114, USA; Department of Medicine, Harvard Medical School, 55 Fruit Street, Cox 201, Boston, MA 02114, USA.
| | - Mandakolathur Murali
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Cox 201, Boston, MA 02114, USA; Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, Cox 201, Boston, MA 02114, USA; Department of Medicine, Harvard Medical School, 55 Fruit Street, Cox 201, Boston, MA 02114, USA
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27
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Garlapati K, Rallabandi M, Shalini S. An update on investigations of autoimmune diseases affecting orofacial region. J Immunoassay Immunochem 2019; 41:1-19. [PMID: 31645179 DOI: 10.1080/15321819.2019.1680387] [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: 01/11/2023]
Abstract
Autoimmune diseases are better diagnosed currently with advances in cellular immunology, molecular biology, and genetics. Clinical diagnosis of systemic and organ specific autoimmune diseases is a challenging task for the Oral physicians and the development of chairside investigation methods has not only saved the time but also cost factor. To understand patient's immune status, the clinical chair side diagnostic aids along with laboratory testing methods are necessary. Laboratory investigations have great importance in detecting, confirming and analyzing the severity, and predicting the prognosis of the autoimmune disease. This article aims to list out the diagnostic methods to diagnose autoimmune conditions and focuses on various diagnostic methods to effectively evaluate autoimmune disease of orofacial region.
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Affiliation(s)
- Komali Garlapati
- Department of Oral Medicine and Radiology, Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre, PMVIDS, Hyderabad, India
| | - Mayuri Rallabandi
- Department of Oral Medicine and Radiology, Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre, Hyderabad, India
| | - Srinivas Shalini
- Department of Oral Medicine and Radiology, Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre, PMVIDS, Hyderabad, India
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28
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Yuan W, Cao H, Wan P, Shi R, Zhou S, Zheng J. Clinical evaluation of total and high-avidity anti-dsDNA antibody assays for the diagnosis of systemic lupus erythematosus. Lupus 2019; 28:1387-1396. [PMID: 31570052 DOI: 10.1177/0961203319877243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background This study evaluated the diagnostic performances of total and high-avidity (HA) anti-dsDNA enzyme immunoassays (EIA) in Chinese systemic lupus erythematosus (SLE) patients. Methods A total of 410 serum samples from 217 SLE patients, 54 patients with other systemic autoimmune diseases, and 139 healthy subjects were tested on total and HA anti-dsDNA EIA, as well as three commercial in vitro diagnostic kits: BioPlex 2200 ANA Screen, Kallestad anti-dsDNA EIA, and Crithidia Lucilae IFA. The disease activities of SLE patients were assessed using the modified SLE Disease Activity Index. The diagnostic performances of each assay were analyzed using Analyse-it software. Results The diagnostic performances of the total and HA anti-dsDNA EIA kits were comparable to other commercially available in vitro diagnostic assays. Receiver operating characteristic curve analysis demonstrated an area under the curve ranging from 0.85 to 0.89, with the total anti-dsDNA kit demonstrating the highest sensitivity and the HA kit showing higher specificity. An overall agreement of >90% was observed between the total and HA anti-dsDNA EIA kits and commercially available quantitative anti-dsDNA kits. The ratio of HA to total anti-dsDNA antibody was significantly higher among SLE patients with active disease status and/or kidney damage. All assays exhibited a significant correlation with disease activity and multiple clinical manifestations. Conclusions While the clinical performances of various anti-dsDNA assays showed adequate agreements, the BioPlex 2200 anti-dsDNA assay demonstrated the highest positive likelihood ratio and odds ratio. The HA anti-dsDNA EIA kit in association with the total anti-dsDNA kit provided superior performance in SLE diagnosis and monitoring disease activity.
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Affiliation(s)
- W Yuan
- Department of Dermatology and Rheumatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - H Cao
- Department of Dermatology and Rheumatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - P Wan
- Department of Dermatology and Rheumatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - R Shi
- Department of Dermatology and Rheumatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - S Zhou
- Bio-Rad Laboratories, Clinical Diagnostic Group, Clinical Immunology Division, Hercules, USA
| | - J Zheng
- Department of Dermatology and Rheumatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
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29
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Bragazzi NL, Watad A, Damiani G, Adawi M, Amital H, Shoenfeld Y. Role of anti-DNA auto-antibodies as biomarkers of response to treatment in systemic lupus erythematosus patients: hypes and hopes. Insights and implications from a comprehensive review of the literature. Expert Rev Mol Diagn 2019; 19:969-978. [PMID: 31516059 DOI: 10.1080/14737159.2019.1665511] [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: 10/26/2022]
Abstract
Introduction: Due to the polymorphic clinical presentations and manifestations of systemic lupus erythematosus (SLE), biomarkers with enough diagnostic and prognostic value are of paramount importance. Recently, anti-double stranded DNA (anti-dsDNA) auto-antibodies have been proposed to monitor the response to different therapies. It has also been suggested that they should be employed as entry markers in trial studies. However, their clinical use remains still debated and, sometimes, controversial, due to conflicting findings reported. Areas covered: Through an extensive literature review, we evaluated changes in anti-dsDNA auto-antibodies levels before and after the administration of the treatment (either biological or non-biological). Expert opinion: Anti-dsDNA auto-antibodies related findings are still difficult to compare mainly because of the different detecting methods employed, even though in most studies included in this review a consistent decreasing pattern after the treatment seems to emerge. Hence, if properly standardized, anti-dsDNA auto-antibody profile may be a reliable biomarker to monitor the effectiveness of biologics as well as of non-biological drugs, especially if grouped in composite outcomes scores, such as the 'Lupus Multivariable Outcome Score' (LUMOS) or measured with other biomarkers, such as anti-nucleosome auto-antibodies. We recommend the assessment of anti-dsDNA auto-antibodies levels in both daily practice and research settings.
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Affiliation(s)
- Nicola Luigi Bragazzi
- Department of Mathematics and Statistics, Laboratory for Industrial and Applied Mathematics (LIAM) , Toronto , Canada
| | - Abdulla Watad
- Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.,Department of Internal Medicine 'B', Sheba Medical Center , Ramat Gan , Israel
| | - Giovanni Damiani
- Centro Studi GISED, Young Dermatologists Italian Network , Bergamo , Italy.,Department of Biomedical, Surgical and Dental Sciences University of Milan , Milan , Italy.,Department of Dermatology, Case Western Reserve University , OH , Cleveland , USA.,Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi , Milan , Italy
| | - Mohammad Adawi
- Padeh and Ziv Hospitals, Azrieli Faculty of Medicine, Bar-Ilan University , Ramat Gan , Israel
| | - Howard Amital
- Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.,Department of Internal Medicine 'B', Sheba Medical Center , Ramat Gan , Israel
| | - Yehuda Shoenfeld
- Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.,Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University) , Moscow , Russia.,Past incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Tel Aviv University , Tel Aviv , Israel
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30
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Dellavance A, Baldo DC, Zheng B, Mora RA, Fritzler MJ, Hiepe F, Rönnelid J, Satoh M, Garcia-De La Torre I, Wener MH, Chan EK, Andrade LE. Establishment of an international autoantibody reference standard for human anti-DFS70 antibodies: proof-of-concept study for a novel Megapool strategy by pooling individual specific sera. ACTA ACUST UNITED AC 2019; 57:1754-1763. [DOI: 10.1515/cclm-2019-0087] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/14/2019] [Indexed: 01/05/2023]
Abstract
Abstract
Background
International autoantibody standards, traditionally based on material obtained from plasmapheresis of single subjects, represent individual immune response and may not comprehend the heterogeneity of the general population. The anti-DFS70 autoantibody yields a characteristic dense fine speckled (DFS) nuclear pattern on indirect immunofluorescence assay on HEp-2 cells (HEp-2 IFA) and speaks against autoimmunity. We propose a novel strategy for developing autoantibody reference standards, based on stepwise pooling of serum samples from hundreds of individuals with anti-DFS70 antibodies.
Methods
Within a 2-year period, serum samples were selected from routine HEp-2 IFA according to the following criteria: DFS HEp-2 IFA pattern at titer ≥1:640; anti-DFS70 reactivity in three analyte-specific tests (Western blot [WB], enzyme-linked immunosorbent assay [ELISA] and chemiluminescent immunoassay [CLIA]). Aliquots of individual samples were combined into progressively larger pools with stepwise validation of intermediary pools as for individual samples. Validated intermediary pools were merged into a final pool for lyophilization.
Results
A total of 741 validated samples yielded a 750 mL final pool that was lyophilized into thousands of 200 μL-aliquots. Reconstituted aliquots yielded the expected anti-DFS70 reactivity in ELISA, CLIA and WB, as well as high-titer DFS HEp-2 IFA pattern. The appropriate anti-DFS70 reactivity of the lyophilized pool was confirmed by seven international expert centers, using HEp-2 IFA, ELISA, WB and immunoprecipitation.
Conclusions
This proof-of-concept study provides an innovative and efficient strategy to build serum reference standards for autoantibody testing. The anti-DFS70 standard will integrate the panel of standards of Autoantibody Standardization Committee (ASC, www.autoab.org), contributing to education for proper assay validation and interpretation of the DFS pattern and other HEp-2 IFA patterns.
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Affiliation(s)
- Alessandra Dellavance
- Research and Development Division, Fleury Medicine and Health Laboratory , São Paulo , Brazil
| | - Danielle C. Baldo
- Research and Development Division, Fleury Medicine and Health Laboratory , São Paulo , Brazil
| | - Bing Zheng
- Department of Oral Biology , University of Florida , Gainesville, FL , USA
- Department of Laboratory Medicine, Renji Hospital, School of Medicine , Shanghai Jiao Tong University , Shanghai , China
| | - Rodrigo A. Mora
- Department of Oral Biology , University of Florida , Gainesville, FL , USA
| | - Marvin J. Fritzler
- Department of Medicine, Cumming School of Medicine , University of Calgary , Calgary , Alberta , Canada
| | - Falk Hiepe
- Department of Rheumatology and Clinical Immunology , Charité – Universitätmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany
| | - Johan Rönnelid
- Department of Immunology, Genetics and Pathology , Uppsala University , Uppsala , Sweden
| | - Minoru Satoh
- Department of Clinical Nursing , University of Occupational and Environmental Health , Kitakyushu , Japan
| | - Ignacio Garcia-De La Torre
- Department of Immunology and Rheumatology , Hospital General de Occidente and University of Guadalajara , Guadalajara , Mexico
| | - Mark H. Wener
- Division of Rheumatology and Department of Laboratory Medicine , University of Washington , Seattle, WA , USA
| | - Edward K.L. Chan
- Department of Oral Biology , University of Florida , Gainesville, FL , USA
| | - Luis E.C. Andrade
- Rheumatology Division, Escola Paulista de Medicina , Universidade Federal de São Paulo , Rua Botucatu 740 3° andar , 04023-062 São Paulo , Brazil
- Immunology Division, Fleury Medicine and Health Laboratory , São Paulo , Brazil
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31
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Pisetsky DS, Rovin BH, Lipsky PE. New Perspectives in Rheumatology: Biomarkers as Entry Criteria for Clinical Trials of New Therapies for Systemic Lupus Erythematosus: The Example of Antinuclear Antibodies and Anti-DNA. Arthritis Rheumatol 2019; 69:487-493. [PMID: 27899010 DOI: 10.1002/art.40008] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/22/2016] [Indexed: 12/12/2022]
Affiliation(s)
- David S Pisetsky
- Duke University Medical Center and Medical Research Service, Durham VA Medical Center, Durham, North Carolina
| | - Brad H Rovin
- The Ohio State University, Wexner Medical Center, Columbus
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Carubbi F, Alunno A, Cipriani P, Bistoni O, Scipioni R, Liakouli V, Ruscitti P, Berardicurti O, Di Bartolomeo S, Gerli R, Giacomelli R. Laboratory Assessment of Patients with Suspected Rheumatic Musculoskeletal Diseases: Challenges and Pitfalls. Curr Rheumatol Rev 2019; 15:27-43. [PMID: 29557752 DOI: 10.2174/1573397114666180320113603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 03/14/2018] [Accepted: 03/15/2018] [Indexed: 11/22/2022]
Abstract
Current patient care in rheumatology relies primarily on a combination of traditional clinical assessment and standard laboratory tests. Investigators seek to discover new biomarkers and novel technologies to boost the research in this field. Mechanistic biomarkers such as cytokines, cell types, antibodies, signaling molecules, are rooted in the mechanism underlying the disease and can guide the clinical management of the disease. Conversely, descriptive biomarkers are byproducts of the disease process, depict the state of a disease but are not involved in its pathogenesis. In this article, we reviewed the field of common laboratory biomarkers in rheumatology, highlighting both their descriptive or mechanistic value as well as their role in clinical practice.
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Affiliation(s)
- Francesco Carubbi
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, AQ, Italy.,Department of Medicine, ASL1 Avezzano-Sulmona-L'Aquila, L'Aquila, AQ, Italy
| | - Alessia Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, PG, Italy
| | - Paola Cipriani
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, AQ, Italy
| | - Onelia Bistoni
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, PG, Italy
| | - Rosa Scipioni
- Department of Medicine, ASL1 Avezzano-Sulmona-L'Aquila, L'Aquila, AQ, Italy
| | - Valiki Liakouli
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, AQ, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, AQ, Italy
| | - Onorina Berardicurti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, AQ, Italy
| | - Salvatore Di Bartolomeo
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, AQ, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, PG, Italy
| | - Roberto Giacomelli
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, AQ, Italy
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Trier NH. Detection of SSA and SSB Antibodies Associated with Primary Sjögren's Syndrome Using Enzyme-Linked Immunosorbent Assay. Methods Mol Biol 2019; 1901:229-237. [PMID: 30539582 DOI: 10.1007/978-1-4939-8949-2_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Antibodies to Ro52/Ro60 (SSA) and La (SSB) are strongly associated to the autoimmune disease primary Sjögren's syndrome and are important in the serologic diagnosis of the disease. Several methods for detection of these antibodies exist such as indirect immunofluorescence, commercial western blot kits, in-house assays, and numerous commercial enzyme-linked immunosorbent assays (ELISAs). Dependent on the type of assay, sensitivity and specificity may vary notably. Especially ELISAs, where the antibody reactivity to synthetic peptides, recombinant or native proteins are determined, are often applied. This chapter describes detection of SSA and SSB antibodies by ELISA.
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Affiliation(s)
- Nicole Hartwig Trier
- Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark.
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34
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Pollak TA, Rogers JP, Nagele RG, Peakman M, Stone JM, David AS, McGuire P. Antibodies in the Diagnosis, Prognosis, and Prediction of Psychotic Disorders. Schizophr Bull 2019; 45:233-246. [PMID: 29474698 PMCID: PMC6293207 DOI: 10.1093/schbul/sby021] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Blood-based biomarker discovery for psychotic disorders has yet to impact upon routine clinical practice. In physical disorders antibodies have established roles as diagnostic, prognostic and predictive (theranostic) biomarkers, particularly in disorders thought to have a substantial autoimmune or infective aetiology. Two approaches to antibody biomarker identification are distinguished: a "top-down" approach, in which antibodies to specific antigens are sought based on the known function of the antigen and its putative role in the disorder, and emerging "bottom-up" or "omics" approaches that are agnostic as to the significance of any one antigen, using high-throughput arrays to identify distinctive components of the antibody repertoire. Here we review the evidence for antibodies (to self-antigens as well as infectious organism and dietary antigens) as biomarkers of diagnosis, prognosis, and treatment response in psychotic disorders. Neuronal autoantibodies have current, and increasing, clinical utility in the diagnosis of organic or atypical psychosis syndromes. Antibodies to selected infectious agents show some promise in predicting cognitive impairment and possibly other symptom domains (eg, suicidality) within psychotic disorders. Finally, infectious antibodies and neuronal and other autoantibodies have recently emerged as potential biomarkers of response to anti-infective therapies, immunotherapies, or other novel therapeutic strategies in psychotic disorders, and have a clear role in stratifying patients for future clinical trials. As in nonpsychiatric disorders, combining biomarkers and large-scale use of "bottom-up" approaches to biomarker identification are likely to maximize the eventual clinical utility of antibody biomarkers in psychotic disorders.
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Affiliation(s)
- Thomas A Pollak
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Joint first authors
| | - Jonathan P Rogers
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Joint first authors
| | - Robert G Nagele
- Biomarker Discovery Center, New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford, NJ
| | - Mark Peakman
- Department of Immunobiology, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - James M Stone
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Anthony S David
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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35
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Detection of DNA Autoantibodies by Electrophoretic Mobility Shift Assay. Methods Mol Biol 2018. [PMID: 30539574 DOI: 10.1007/978-1-4939-8949-2_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
Although the presence of antibodies against double-stranded (ds) DNA is considered the serological hallmark of systemic lupus erythematosus (SLE), it is not detected in all SLE patients by routine laboratory tests. Looking at DNA-anti(ds)DNA interaction as one kind of DNA-protein interaction gave us the grounds for a novel type of assay, easy to perform, and providing a direct insight on DNA-anti(ds)DNA IgG interaction. The assay is an application of the electrophoretic mobility shift assay (EMSA) and is based on the observation that the electrophoretic mobility of a DNA-protein complex is typically less than that of free DNA. The EMSA, performed here with purified bacterial DNA and the purified IgG fraction of sera from systemic lupus erythematosus (SLE) or other patients as well as from healthy individuals, revealed itself to be more sensitive than the routinely used assays for the detection of anti-dsDNA in SLE and discoid lupus erythematosus (DLE) patients. In addition, besides providing a direct visualization of DNA-anti(ds)DNA IgG complexes, the assay offers the possibility to study in detail the nature of DNA-IgG interactions. In a further development, we showed that the assay could be performed successfully with sera.
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36
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Spensley KJ, Tam FWK. From Renal Biomarkers to Therapeutic Targets: The Use of Monocyte Chemoattractant Protein 1, Transforming Growth Factor-Beta, and Connective Tissue Growth Factor in Diabetic Nephropathy and Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. EUROPEAN MEDICAL JOURNAL 2018. [DOI: 10.33590/emj/10310232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In an ideal world, every condition would have a sensitive and specific marker that could be measured in a noninvasive or minimally invasive way. Instead, the medical community depends on invasive biomarkers, which carry inherent risks, to make a diagnosis and plan treatment. In this review article, the current state of research into biomarkers for a range of kidney diseases is discussed, beginning with those biomarkers that are already in clinical use and then moving to conditions for which no validated biomarker yet exists. This review focusses on diabetic nephropathy at the proteinuric end of the spectrum and antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis at the nephritic end. An interesting feature is that the same biomarker, monocyte chemoattractant protein-1 (MCP-1, also known as CCL2), has been identified as a potential target in both conditions, which suggests a shared pathogenic process that results in two very distinct clinical presentations. One of the major limiting features of research into this area, particularly for ANCA-associated vasculitis, is the recruitment of a sufficient number of patients to generate strong enough evidence to justify the biomarker’s routine use; this overlap in biomarkers may enable research in one condition to be applied more generally. In addition to their role as biomarkers, these molecules are also therapeutic targets, and some early research has been carried out to investigate this. Overall, this review brings together research from diverse fields to focus attention on the outstanding areas and the future areas that warrant further investigation.
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Affiliation(s)
- Katrina J. Spensley
- Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Frederick W. K. Tam
- Renal and Vascular Inflammation Section, Department of Medicine, Imperial College London, Hammersmith Hospital, London, UK
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Qu C, Zhang J, Zhang X, Du J, Su B, Li H. Value of combined detection of anti-nuclear antibody, anti-double-stranded DNA antibody and C3, C4 complements in the clinical diagnosis of systemic lupus erythematosus. Exp Ther Med 2018; 17:1390-1394. [PMID: 30680018 PMCID: PMC6327606 DOI: 10.3892/etm.2018.7072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 11/19/2018] [Indexed: 01/22/2023] Open
Abstract
Combined detection of antinuclear antibody (ANA), anti-double-stranded DNA (ds-DNA) antibody and complements C3 and C4 in the diagnosis of systemic lupus erythematosus (SLE) was analyzed. One hundred and ninety-four patients with SLE admitted to Yantaishan Hospital of Yantai from January 2012 to December 2017 were selected as SLE group. A total of 106 patients with non-SLE rheumatic disease were selected as disease control group and 120 healthy subjects as healthy control group. The ANA and anti-ds-DNA antibodies were detected by ELISA and complement C3 and C4 were detected by rate nephelometry. The sensitivity and specificity of these four factors were also analyzed for the diagnosis of SLE. The sensitivity and specificity of ANA in diagnosing SLE were 91.75 and 79.65%, respectively; of anti-ds-DNA antibody were 67.01 and 98.23%, respectively; of complement C3 were 87.11 and 82.74%, respectively; and of complement C4 were 88.66 and 77.43%, respectively. The sensitivity and specificity of ANA and anti-ds-DNA antibody in the diagnosis of SLE were 95.36 and 96.90%, respectively; of C3 and C4 were 92.78 and 79.20%, respectively; and the sensitivity and specificity of the combination of all four indicators were 97.42 and 80.97%, respectively. The combined diagnosis of SLE with ANA, anti-ds-DNA antibody, complement C3 and C4 can play a complementary role in the diagnosis and treatment of SLE patients, and it is of great significance to the diagnosis and treatment planning of SLE patients.
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Affiliation(s)
- Changhua Qu
- Department of Clinical Laboratory, Yantaishan Hospital of Yantai, Yantai, Shandong 264000, P.R. China
| | - Juan Zhang
- Outpatient Department, Yantai Yeda Hospital, Yantai, Shandong 264000, P.R. China
| | - Xiumei Zhang
- Department of Internal Medicine, The People's Hospital of Zhangqiu Area, Zhangqiu, Shandong 250200, P.R. China
| | - Jiexin Du
- Department of Neurology, The People's Hospital of Zhangqiu Area, Zhangqiu, Shandong 250200, P.R. China
| | - Baifang Su
- Department of Science and Education, Jinan Zhangqiu District Hospital of TCM, Zhangqiu, Shandong 250200, P.R. China
| | - Hong Li
- Department of Clinical Laboratory, The Fifth People's Hospital of Jinan, Jinan, Shandong 250022, P.R. China
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Zeng L, Wu JL, Liu LM, Jiang JQ, Wu HJ, Zhao M, Lu QJ. Serum miRNA-371b-5p and miRNA-5100 act as biomarkers for systemic lupus erythematosus. Clin Immunol 2018; 196:103-109. [DOI: 10.1016/j.clim.2018.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/11/2018] [Accepted: 10/05/2018] [Indexed: 01/27/2023]
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Sibanda EN, Chase-Topping M, Pfavayi LT, Woolhouse MEJ, Mutapi F. Evidence of a distinct group of Black African patients with systemic lupus erythematosus. BMJ Glob Health 2018; 3:e000697. [PMID: 30245865 PMCID: PMC6144901 DOI: 10.1136/bmjgh-2017-000697] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/23/2018] [Accepted: 04/27/2018] [Indexed: 12/17/2022] Open
Abstract
Background The autoimmune disease systemic lupus erythematosus (SLE) occurs more frequently in patients of African descent with high morbidity and mortality. Current SLE diagnostic criteria including antinuclear antibody (ANA) reactivity are derived largely from non-African populations. This study characterises ANA reactivity patterns and relates them to SLE clinical presentation in Black African patients. Methods Sera from Black participants (61 patients with SLE and 100 controls) aged 1-81 years were analysed for reactivity against the antigens: uridine 1-ribonuclear protein, Smith uridine-1-5 ribonuclear protein antigen, soluble substance-A, recombinant Ro-52, soluble substance-B, Scl-70, cytoplasmic histidyl-tRNA synthetase antigen, proliferating cell nuclear antigen (PCNA), nucleosomes, ribonuclear P-protein, antimitochondrial antibody M2 (AMA-M2), histones, double-stranded DNA (dsDNA), centromere protein B and polymyositis-sclerosis overlap antigen. Findings A significantly higher proportion (97%) of the 61 patients with SLE had detectable autoantibody reactivity compared with 15% of the 100 controls (p<0.001). The highest frequencies of autoantibody reactivity in patients with SLE were against the dsDNA antigen (41%) and PCNA (54%). Anti-PCNA and anti-dsDNA reactivity were mutually exclusive (p<0.001) giving rise to two distinct groups of Black African patients with SLE. The first group (n=25) had reactivity profiles consistent with international standard SLE definitions, including anti-dsDNA reactivity, and was 13 times more likely to present with joint symptoms. The larger, second group (n=34), characterised by anti-PCNA and anti-AMA-M2 reactivity, was nine times more likely to present with only cutaneous symptoms. Interpretation Our study demonstrates a need to extend autoantibody panels to include anti-PCNA in the diagnostic process of Black African patients and further refine the predictive values of the reactivity to different antigens to differentiate SLE syndromes in African populations.
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Affiliation(s)
- Elopy N Sibanda
- Asthma, Allergy and Immunology Clinic, Twin Palms Medical Centre, Harare, Zimbabwe.,TIBA Partnership, NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Edinburgh, UK
| | - Margo Chase-Topping
- Centre for Immunity, Infection and Evolution, School of Biological Sciences, University of Edinburgh, Edinburgh, UK
| | - Lorraine T Pfavayi
- Asthma, Allergy and Immunology Clinic, Twin Palms Medical Centre, Harare, Zimbabwe
| | - Mark E J Woolhouse
- TIBA Partnership, NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Edinburgh, UK.,Usher Institute of Population Health Sciences and Informatics and Centre for Immunity, Infection and Evolution, School of Biological Sciences, University of Edinburgh, Edinburgh, UK
| | - Francisca Mutapi
- TIBA Partnership, NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Edinburgh, UK.,Institute of Immunology and Infection Research, Centre for Immunity, Infection and Evolution, School of Biological Sciences, Ashworth Laboratories, University of Edinburgh, Edinburgh, UK
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40
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Mummert E, Fritzler MJ, Sjöwall C, Bentow C, Mahler M. The clinical utility of anti-double-stranded DNA antibodies and the challenges of their determination. J Immunol Methods 2018; 459:11-19. [DOI: 10.1016/j.jim.2018.05.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 05/22/2018] [Indexed: 10/16/2022]
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41
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Domljanovic I, Rexen Ulven E, Ulven T, Thomsen RP, Okholm AH, Kjems J, Voss A, Taskova M, Astakhova K. Dihydropyridine Fluorophores Allow for Specific Detection of Human Antibodies in Serum. ACS OMEGA 2018; 3:7580-7586. [PMID: 30087918 PMCID: PMC6068599 DOI: 10.1021/acsomega.8b00424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/26/2018] [Indexed: 05/14/2023]
Abstract
Antigen recognition by antibodies plays an important role in human biology and in the development of diseases. This interaction provides a basis for multiple diagnostic assays and is a guide for treatments. We have developed dihydropyridine-based fluorophores that form stable complexes with double-stranded DNA and upon recognition of the antibodies to DNA (anti-DNA) provide an optical response. The fluorophores described herein have advantageous optical properties compared to those of the currently available dyes making them valuable for research and clinical diagnostics. By studying a series of novel fluorophores, crucial parameters for the design were established, providing the required sensitivity and specificity in the detection of antibodies. Using these DNA-fluorophore complexes in a direct immunofluorescence assay, antibodies to DNA are specifically detected in 80 patients diagnosed with an autoimmune disease, systemic lupus erythematosus. Positivity indicated by emission change of α-(4'-O-methoxyphenyl)-2-furyl dihydropyridine strongly correlates with other disease biomarkers and autoimmune arthritis.
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Affiliation(s)
- Ivana Domljanovic
- Department
of Chemistry, Technical University of Denmark, Kemitorvet 206, 2800 Kongens Lyngby, Denmark
- Department
of Physics, Chemistry and Pharmacy, University
of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Elisabeth Rexen Ulven
- Department
of Physics, Chemistry and Pharmacy, University
of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Trond Ulven
- Department
of Drug Design and Pharmacology, University
of Copenhagen, Universitetsparken
2, 2100 Copenhagen, Denmark
| | - Rasmus P. Thomsen
- Interdisciplinary
Nanoscience Center (iNANO), Aarhus University, Gustav Wieds Vej 14, 8000 Aarhus C, Denmark
| | - Anders H. Okholm
- Interdisciplinary
Nanoscience Center (iNANO), Aarhus University, Gustav Wieds Vej 14, 8000 Aarhus C, Denmark
| | - Jørgen Kjems
- Interdisciplinary
Nanoscience Center (iNANO), Aarhus University, Gustav Wieds Vej 14, 8000 Aarhus C, Denmark
- Department
of Molecular Biology and Genetics, Aarhus
University, C.F. Møllers
Allé 3, 8000 Aarhus C, Denmark
| | - Anne Voss
- Department
of Rheumatology, Odense University Hospital, J. B. Winsløws Vej 19, 2, 5000 Odense C, Denmark
| | - Maria Taskova
- Department
of Chemistry, Technical University of Denmark, Kemitorvet 206, 2800 Kongens Lyngby, Denmark
| | - Kira Astakhova
- Department
of Chemistry, Technical University of Denmark, Kemitorvet 206, 2800 Kongens Lyngby, Denmark
- E-mail:
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Verdelli A, Coi A, Marzano AV, Antiga E, Cozzani E, Quaglino P, La Placa M, Benucci M, De Simone C, Papini M, Parodi A, Bianchi F, Caproni M. Autoantibody profile and clinical patterns in 619 Italian patients with cutaneous lupus erythematosus. J Eur Acad Dermatol Venereol 2018; 33:742-752. [PMID: 29924416 DOI: 10.1111/jdv.15147] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/30/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Anti-nuclear antibodies (ANA), anti-extractable nuclear antigens (ENA) and anti-dsDNA antibodies are often associated with cutaneous lupus erythematosus (CLE), with variable frequency depending on skin subtype. However, specific data based on large case-series on the pathogenetic, diagnostic and prognostic meaning of such autoantibodies are still lacking. OBJECTIVE To characterize the correlations between CLE subtypes as well as LE-non-specific skin lesions and their autoantibody pattern. METHODS Epidemiological, clinical and immunopathological data of 619 Italian patients with CLE and LE-non-specific skin lesions were analysed. Differences in age, sex, clinical features and autoantibody profile were evaluated in each LE subgroup. RESULTS Anti-nuclear antibodies (P < 0.0001), anti-dsDNA (P < 0.0001), ENA (P = 0.001), anti-Sm (P = 0.001), anti-RNP (P = 0.004) and anti-histone (P = 0.005) antibodies were associated with SLE. A strong association between ANA (P < 0.0001) and anti-dsDNA (P < 0.0001) and female gender was also found: positive ANA and positive anti-dsDNA had a higher prevalence among females. Chronic CLE resulted to be negatively associated with ENA (OR = 0.51, P < 0.0001), anti-Ro/SSA (OR = 0.49, P < 0.0001) and anti-dsDNA (OR = 0.37, P < 0.0001). Intermittent CLE resulted to be negatively associated with ENA (OR = 0.50, P = 0.007) and ANA (OR = 0.61, P = 0.025). Subacute CLE resulted to be associated with ENA (OR = 5.19, P < 0.0001), anti-Ro/SSA (OR = 3.83, P < 0.0001), anti-Smith (OR = 2.95, P = 0.004) and anti-RNP (OR = 3.18, P = 0.007). Acute CLE resulted to be strongly associated with anti-dsDNA (OR = 6.0, P < 0.0001) and ANA (OR = 18.1, P < 0.0001). LE-non-specific skin lesions resulted to be significantly associated with systemic involvement. Livedo reticularis was significantly associated with ENA (P = 0.007) and anti-Ro/SSA (P = 0.036). Palpable purpura and periungual telangiectasia were significantly associated with ANA. CONCLUSION According to our findings, some well-known associations between CLE subtypes and autoantibody profile were confirmed; moreover, specific association between autoantibodies and LE-non-specific skin lesions was highlighted. A strict association between anti-ENA and anti-Ro/SSA antibodies and livedo reticularis, ANA and palpable purpura, and ANA and periungual telangiectasia was evidenced.
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Affiliation(s)
- A Verdelli
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy
| | - A Coi
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - A V Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, UOC Dermatologia, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - E Antiga
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy
| | - E Cozzani
- IRCCS-AOU San Martino-IST, Dissal, Section of Dermatology, University of Genoa, Genoa, Italy
| | - P Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - M La Placa
- Dermology Division, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - M Benucci
- Rheumatology Unit, S. Giovanni di Dio Hospital, Florence, Italy
| | - C De Simone
- Dermatology Department, Policlinico Universitario 'A. Gemelli', Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Papini
- Department of Surgical and Biomedical Sciences, Dermatologic Clinic of Terni, University of Perugia, Perugia, Italy
| | - A Parodi
- IRCCS-AOU San Martino-IST, Dissal, Section of Dermatology, University of Genoa, Genoa, Italy
| | - F Bianchi
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - M Caproni
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy
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43
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Obara T, Toyomaki K, Uegaki Y, Kikuchi Y, Arai J, Kuroda K, Suwabe A. Prozone-like phenomenon found in chemiluminescent enzyme immunoassay using magnetic particles for measurement of serum anti-single stranded DNA antibody titers: Definition and management. Clin Chim Acta 2018; 485:88-94. [PMID: 29928865 DOI: 10.1016/j.cca.2018.06.022] [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: 02/19/2018] [Revised: 06/15/2018] [Accepted: 06/18/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Serum anti-single stranded DNA antibody (anti-ssDNAab) is used as a marker for systemic lupus erythematosus. We found a 'prozone-like phenomenon,' which was different from an original prozone phenomenon, in chemiluminescent enzyme immunoassay using magnetic particles for the measurement of serum anti-ssDNAab titers. We investigated mechanisms of the prozone-like phenomenon and countermeasures to prevent it from being overlooked. METHODS This study examined 679 samples from patients tested for anti-ssDNAab titer at our hospital. In addition, the BF photometry OD value 2 (OD2), an index of optical density, was monitored simultaneously. RESULTS The undiluted samples with a prozone-like phenomenon showed extremely lower OD2. Those samples were able to be distinguished from other samples by setting OD2 criteria based on the 95% prediction interval. Significant differences (p < 0.05) were found in the titer ratios (ten-fold diluted against undiluted) between groups with >1.5 and other groups with <1.5 for the ratios of OD2. CONCLUSIONS We proposed two valuable methods to find a prozone-like phenomenon: one by setting OD2 criteria based on the 95% prediction interval and the other by analyzing the ratios both in titers and OD2 between undiluted and 10-fold diluted samples.
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Affiliation(s)
- Takehiro Obara
- Division of Central Clinical Laboratory, Iwate Medical University Hospital, Morioka, Japan.
| | - Kazushi Toyomaki
- Division of Central Clinical Laboratory, Iwate Medical University Hospital, Morioka, Japan
| | - Yurino Uegaki
- Division of Central Clinical Laboratory, Iwate Medical University Hospital, Morioka, Japan
| | - Yoshie Kikuchi
- Division of Central Clinical Laboratory, Iwate Medical University Hospital, Morioka, Japan
| | - Jiro Arai
- Medical & Biological Laboratories Co., Ltd., Nagoya, Japan
| | - Keiko Kuroda
- Medical & Biological Laboratories Co., Ltd., Nagoya, Japan
| | - Akira Suwabe
- Department of Laboratory Medicine, Iwate Medical University School of Medicine, Morioka, Japan
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Bartsch YC, Rahmöller J, Mertes MMM, Eiglmeier S, Lorenz FKM, Stoehr AD, Braumann D, Lorenz AK, Winkler A, Lilienthal GM, Petry J, Hobusch J, Steinhaus M, Hess C, Holecska V, Schoen CT, Oefner CM, Leliavski A, Blanchard V, Ehlers M. Sialylated Autoantigen-Reactive IgG Antibodies Attenuate Disease Development in Autoimmune Mouse Models of Lupus Nephritis and Rheumatoid Arthritis. Front Immunol 2018; 9:1183. [PMID: 29928274 PMCID: PMC5997785 DOI: 10.3389/fimmu.2018.01183] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 05/11/2018] [Indexed: 01/08/2023] Open
Abstract
Pro- and anti-inflammatory effector functions of IgG antibodies (Abs) depend on their subclass and Fc glycosylation pattern. Accumulation of non-galactosylated (agalactosylated; G0) IgG Abs in the serum of rheumatoid arthritis and systemic lupus erythematosus (SLE) patients reflects severity of the diseases. In contrast, sialylated IgG Abs are responsible for anti-inflammatory effects of the intravenous immunoglobulin (pooled human serum IgG from healthy donors), administered in high doses (2 g/kg) to treat autoimmune patients. However, whether low amounts of sialylated autoantigen-reactive IgG Abs can also inhibit autoimmune diseases is hardly investigated. Here, we explore whether sialylated autoantigen-reactive IgG Abs can inhibit autoimmune pathology in different mouse models. We found that sialylated IgG auto-Abs fail to induce inflammation and lupus nephritis in a B cell receptor (BCR) transgenic lupus model, but instead are associated with lower frequencies of pathogenic Th1, Th17 and B cell responses. In accordance, the transfer of small amounts of immune complexes containing sialylated IgG Abs was sufficient to attenuate the development of nephritis. We further showed that administration of sialylated collagen type II (Col II)-specific IgG Abs attenuated the disease symptoms in a model of Col II-induced arthritis and reduced pathogenic Th17 cell and autoantigen-specific IgG Ab responses. We conclude that sialylated autoantigen-specific IgG Abs may represent a promising tool for treating pathogenic T and B cell immune responses in autoimmune diseases.
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Affiliation(s)
- Yannic C Bartsch
- Laboratories of Immunology and Antibody Glycan Analysis, Institute for Nutrition Medicine, University of Lübeck and University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Johann Rahmöller
- Laboratories of Immunology and Antibody Glycan Analysis, Institute for Nutrition Medicine, University of Lübeck and University Medical Center Schleswig-Holstein, Lübeck, Germany.,Department of Anesthesiology and Intensive Care, University of Lübeck and University Medical Center Schleswig Holstein, Lübeck, Germany
| | - Maria M M Mertes
- Laboratory of Tolerance and Autoimmunity, German Rheumatism Research Center, An Institute of the Leibniz Association, Berlin, Germany
| | - Susanne Eiglmeier
- Laboratory of Tolerance and Autoimmunity, German Rheumatism Research Center, An Institute of the Leibniz Association, Berlin, Germany
| | - Felix K M Lorenz
- Laboratory of Tolerance and Autoimmunity, German Rheumatism Research Center, An Institute of the Leibniz Association, Berlin, Germany
| | - Alexander D Stoehr
- Laboratory of Tolerance and Autoimmunity, German Rheumatism Research Center, An Institute of the Leibniz Association, Berlin, Germany
| | - Dominique Braumann
- Laboratories of Immunology and Antibody Glycan Analysis, Institute for Nutrition Medicine, University of Lübeck and University Medical Center Schleswig-Holstein, Lübeck, Germany.,Laboratory of Glycodesign and Glycoanalytics, Institute for Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité - University Medicine Berlin, Berlin, Germany
| | - Alexandra K Lorenz
- Laboratory of Tolerance and Autoimmunity, German Rheumatism Research Center, An Institute of the Leibniz Association, Berlin, Germany
| | - André Winkler
- Laboratory of Tolerance and Autoimmunity, German Rheumatism Research Center, An Institute of the Leibniz Association, Berlin, Germany
| | - Gina-Maria Lilienthal
- Laboratories of Immunology and Antibody Glycan Analysis, Institute for Nutrition Medicine, University of Lübeck and University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Janina Petry
- Laboratories of Immunology and Antibody Glycan Analysis, Institute for Nutrition Medicine, University of Lübeck and University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Juliane Hobusch
- Laboratories of Immunology and Antibody Glycan Analysis, Institute for Nutrition Medicine, University of Lübeck and University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Moritz Steinhaus
- Laboratories of Immunology and Antibody Glycan Analysis, Institute for Nutrition Medicine, University of Lübeck and University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Constanze Hess
- Laboratory of Tolerance and Autoimmunity, German Rheumatism Research Center, An Institute of the Leibniz Association, Berlin, Germany
| | - Vivien Holecska
- Laboratory of Tolerance and Autoimmunity, German Rheumatism Research Center, An Institute of the Leibniz Association, Berlin, Germany
| | - Carolin T Schoen
- Laboratory of Tolerance and Autoimmunity, German Rheumatism Research Center, An Institute of the Leibniz Association, Berlin, Germany
| | - Carolin M Oefner
- Laboratory of Tolerance and Autoimmunity, German Rheumatism Research Center, An Institute of the Leibniz Association, Berlin, Germany
| | - Alexei Leliavski
- Laboratories of Immunology and Antibody Glycan Analysis, Institute for Nutrition Medicine, University of Lübeck and University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Véronique Blanchard
- Laboratory of Glycodesign and Glycoanalytics, Institute for Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité - University Medicine Berlin, Berlin, Germany
| | - Marc Ehlers
- Laboratories of Immunology and Antibody Glycan Analysis, Institute for Nutrition Medicine, University of Lübeck and University Medical Center Schleswig-Holstein, Lübeck, Germany.,Laboratory of Tolerance and Autoimmunity, German Rheumatism Research Center, An Institute of the Leibniz Association, Berlin, Germany.,Airway Research Center North (ARCN), University of Lübeck, German Center for Lung Research (DZL), Lübeck, Germany
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45
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Dima A, Jurcut C, Baicus C. The impact of anti-U1-RNP positivity: systemic lupus erythematosus versus mixed connective tissue disease. Rheumatol Int 2018; 38:1169-1178. [DOI: 10.1007/s00296-018-4059-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 05/17/2018] [Indexed: 12/18/2022]
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46
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Biermann MHC, Boeltz S, Pieterse E, Knopf J, Rech J, Bilyy R, van der Vlag J, Tincani A, Distler JHW, Krönke G, Schett GA, Herrmann M, Muñoz LE. Autoantibodies Recognizing Secondary NEcrotic Cells Promote Neutrophilic Phagocytosis and Identify Patients With Systemic Lupus Erythematosus. Front Immunol 2018; 9:989. [PMID: 29867966 PMCID: PMC5949357 DOI: 10.3389/fimmu.2018.00989] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/20/2018] [Indexed: 12/15/2022] Open
Abstract
Deficient clearance of apoptotic cells reportedly contributes to the etiopathogenesis of the autoimmune disease systemic lupus erythematosus (SLE). Based on this knowledge, we developed a highly specific and sensitive test for the detection of SLE autoantibodies (AAb) utilizing secondary NEcrotic cell (SNEC)-derived material as a substrate. The goal of the present study was to validate the use of SNEC as an appropriate antigen for the diagnosis of SLE in large cohort of patients. We confirmed the presence of apoptotically modified autoantigens on SNEC (dsDNA, high mobility group box 1 protein, apoptosis-associated chromatin modifications, e.g., histones H3-K27-me3; H2A/H4 AcK8,12,16; and H2B-AcK12). Anti-SNEC AAb were measured in the serum of 155 patients with SLE, 89 normal healthy donors (NHD), and 169 patients with other autoimmune connective tissue diseases employing SNEC-based indirect enzyme-linked immunosorbent assay (SNEC ELISA). We compared the test performance of SNEC ELISA with the routine diagnostic tests dsDNA Farr radioimmunoassay (RIA) and nucleosome-based ELISA (anti-dsDNA-NcX-ELISA). SNEC ELISA distinguished patients with SLE with a specificity of 98.9% and a sensitivity of 70.6% from NHD clearly surpassing RIA and anti-dsDNA-NcX-ELISA. In contrast to the other tests, SNEC ELISA significantly discriminated patients with SLE from patients with rheumatoid arthritis, primary anti-phospholipid syndrome, spondyloarthropathy, psoriatic arthritis, and systemic sclerosis. A positive test result in SNEC ELISA significantly correlated with serological variables and reflected the uptake of opsonized SNEC by neutrophils. This stresses the relevance of SNECs in the pathogenesis of SLE. We conclude that SNEC ELISA allows for the sensitive detection of pathologically relevant AAb, enabling its diagnostic usage. A positive SNEC test reflects the opsonization of cell remnants by AAb, the neutrophil recruitment to tissues, and the enhancement of local and systemic inflammatory responses.
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Affiliation(s)
- Mona H C Biermann
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Sebastian Boeltz
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Elmar Pieterse
- Department of Nephrology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Jasmin Knopf
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jürgen Rech
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Rostyslav Bilyy
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany.,Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Johan van der Vlag
- Department of Nephrology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Angela Tincani
- Division of Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, Spedali Civili and University of Brescia, Brescia, Italy
| | - Jörg H W Distler
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Gerhard Krönke
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Georg Andreas Schett
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Martin Herrmann
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Luis E Muñoz
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
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47
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Harry O, Yasin S, Brunner H. Childhood-Onset Systemic Lupus Erythematosus: A Review and Update. J Pediatr 2018; 196:22-30.e2. [PMID: 29703361 DOI: 10.1016/j.jpeds.2018.01.045] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 10/30/2017] [Accepted: 01/12/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Onengiya Harry
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Shima Yasin
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Hermine Brunner
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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48
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Analytical variability in the determination of anti-double-stranded DNA antibodies: the strong need of a better definition of the old and new tests. Immunol Res 2018; 66:340-347. [PMID: 29623613 DOI: 10.1007/s12026-018-8992-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Anti-dsDNA antibodies are a heterogeneous group of antibodies, quite specific for SLE. Their variability is related to the assay used, the immunoglobulin class secondary antibody, and the dsDNA source. The standardization of measuring anti-dsDNA antibodies is still poor and different methods yield different results. Several novel technologies were developed during the last decades that represent viable alternatives to the traditional methods such as the chemiluminescent immunoassay (CIA) and multiplex flow immunoassay (MFI). Additionally, positive results for anti-dsDNA antibodies can be detected in patients with inflammatory arthritis (IA) treated with different biologics reducing its clinical specificity for SLE. Anti-dsDNA antibody levels were evaluated in 246 patient samples: 70 SLE and 176 disease control (including 96 IA during treatment with different biologics), using three enzyme immunoassays (indirect enzyme immunoassay, Bio-Rad Laboratories; chemiluminescent immunoassay, Inova Diagnostics; multiplex flow immunoassay, Bio-Rad Laboratories) and three Crithidia luciliae immunofluorescence tests (CLIFT) (Euroimmun AG, Bio-Rad Laboratories, INOVA Diagnostics). Diagnostic performances were assessed both including and excluding the IA patients. Agreements, measured by the Cohen's Kappa between all methods, ranged from moderate to substantial (0.47-0.68). The clinical sensitivities for the anti-dsDNA antibody tests varied from 5.7% by CLIFT A up to 33.3% provided by EIA while the clinical specificities varied from 89.8% by MFI to 98.9% provided by CLIFT B and C. Newer technologies, such as MFI and CIA, showed great potential as a diagnostic application. Significant variations among anti-dsDNA antibody assays were observed confirming the lack of standardization.
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49
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Jeong S, Yang D, Lee W, Kim GT, Kim HS, Ahn HS, Kim HJ. Diagnostic value of screening enzyme immunoassays compared to indirect immunofluorescence for anti-nuclear antibodies in patients with systemic rheumatic diseases: A systematic review and meta-analysis. Semin Arthritis Rheum 2018; 48:334-342. [PMID: 29609799 DOI: 10.1016/j.semarthrit.2018.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/15/2018] [Accepted: 01/22/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This study aimed to review and compare the diagnostic accuracy of the screening enzyme immunoassay (SEIA) and indirect immunofluorescence (IIF) as anti-nuclear antibody (ANA) screening assays for patients with systemic rheumatic diseases (SRDs), including systemic lupus erythematosus (SLE), Sjögren's syndrome (SS), and systemic sclerosis (SSc). METHODS A systematic literature search was conducted in the Medline, Embase, Cochrane, Web of Science, and Scopus databases for articles published before August 2017. A bivariate random effects model was used to calculate pooled diagnostic values. RESULTS Thirty-three studies including 3976 combined SRDs, 2839 SLE, 610 SS, and 1002 SSc patients and 11,716 non-healthy and 8408 healthy controls were available for the meta-analysis. The summary sensitivities of SEIA vs. IIF were 87.4% vs 88.4% for combined SRDs, 89.4% vs. 95.2% for SLE, 88.7% vs. 88.4% for SS, and 85.4% vs. 93.6% for SSc, respectively. Meanwhile, the summary specificities of SEIA vs. IIF were 79.7% vs.78.9% for combined SRDs, 89.1% vs. 83.3% for SLE, 89.9% vs. 86.8% for SS, and 92.8% vs. 84.2% for SSc, respectively. Although the differences in sensitivity and specificity between SEIA and IIF were not significant in most subgroups, the summary sensitivity of SLE presented statistically significant changes. CONCLUSIONS Our systematic meta-analysis demonstrates that both SEIA and IIF are useful to detect ANAs for SRDs. Between the two assays, IIF is a more sensitive screening assay than SEIA, particularly in patients with SLE. SEIA is comparable to IIF, considering the specificity and standardization.
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Affiliation(s)
- Seri Jeong
- Department of Laboratory Medicine, Cancer Research Institute, Kosin University College of Medicine, Gamcheon-ro 262, Seo-gu, Busan 49267, Republic of Korea
| | - Dahae Yang
- Department of Laboratory Medicine, Cancer Research Institute, Kosin University College of Medicine, Gamcheon-ro 262, Seo-gu, Busan 49267, Republic of Korea
| | - Woonhyoung Lee
- Department of Laboratory Medicine, Cancer Research Institute, Kosin University College of Medicine, Gamcheon-ro 262, Seo-gu, Busan 49267, Republic of Korea
| | - Geun-Tae Kim
- Department of Rheumatology, Kosin University College of Medicine, Gamcheon-ro 262, Seo-gu, Busan 49267, Republic of Korea
| | - Hyon-Suk Kim
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, College of Medicine, Korea University, Anam-ro 145, Seong Buk Gu, Seoul 02841, Republic of Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea University, Anam-ro 145, Seong Buk Gu, Seoul 02841, Republic of Korea.
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50
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Infantino M, Meacci F, Grossi V, Manfredi M, Benucci M, Merone M, Soda P. The burden of the variability introduced by the HEp-2 assay kit and the CAD system in ANA indirect immunofluorescence test. Immunol Res 2018; 65:345-354. [PMID: 27456204 DOI: 10.1007/s12026-016-8845-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
According to the recent recommendations of the American College of Rheumatology, ANA Task Force, IIF technique should be considered the gold standard in antinuclear antibodies (ANAs) testing. To overcome the lack of standardization, biomedical industries have developed several computer-aided diagnosis (CAD) systems. Two hundred and sixty-one consecutive samples with suspected autoimmune diseases were tested for ANA by means of IIF on routinely HEp-2 assay kit (Euroimmun AG). Assignment of result was made if consensus for positive/negative was reached by at least 2 out of 3 expert physicians. ANA-IIF was also carried out using 3 CAD systems: Zenit G-Sight (n = 84), Helios (n = 85) and NOVA View (n = 92); human evaluation was repeated on the same substrate of each CAD system (Immco, Aesku and Inova HEp-2 cells, respectively). To anonymize the results, we randomly named these three systems as A, B and C. We ran a statistical analysis computing several measures of agreement between the ratings, and we also improved the evaluation by using the Wilcoxon's test for nonparametric data. Agreement between the human readings on routinely HEp-2 assay kit and human readings on CAD HEp-2 assay was substantial for A (k = 0.82) and B (k = 0.72), and almost perfect for C (k = 0.89). Such readings were statistically different only in case A. Comparing experts' readings with the readings of CAD systems, when the samples were prepared using CAD HEp-2 assay kits, we found almost perfect agreement for B and C (k = 0.86; k = 0.82) and substantial agreement for A (k = 0.73). Again, human and CAD readings were statistically different only in A. When we compared the readings of medical experts on routinely HEp-2 assay kit with the output of the CAD systems that worked using their own slides, we found substantial agreement for all the systems (A: k = 0.62; B: k = 0.65; C: k = 0.71). Such readings were not statistically different. The change of the assay kit and/or the introduction of a CAD system affect the laboratory reporting, with an evident impact on the autoimmune laboratory workflow. The CAD systems may represent one of the most important novel elements of harmonization in the autoimmunity field, reducing intra- and inter-laboratory variability in a new vision of the diagnostic autoimmune platform.
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Affiliation(s)
- M Infantino
- Immunology and Allergy Laboratory, S.Giovanni di Dio Hospital, Via Torregalli, 3, 50143, Florence, Italy.
| | - F Meacci
- Immunology and Allergy Laboratory, S.Giovanni di Dio Hospital, Via Torregalli, 3, 50143, Florence, Italy
| | - V Grossi
- Immunology and Allergy Laboratory, S.Giovanni di Dio Hospital, Via Torregalli, 3, 50143, Florence, Italy
| | - M Manfredi
- Immunology and Allergy Laboratory, S.Giovanni di Dio Hospital, Via Torregalli, 3, 50143, Florence, Italy
| | - M Benucci
- Rheumatology Unit, S.Giovanni di Dio Hospital, Via Torregalli, 3, 50143, Florence, Italy
| | - M Merone
- Computer Systems & Bioinformatics Laboratory, Department of Engineering, University Campus Bio-Medico, Rome, Italy
| | - P Soda
- Computer Systems & Bioinformatics Laboratory, Department of Engineering, University Campus Bio-Medico, Rome, Italy
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