Auto-Antibodies to Cell Nuclei

The laboratory identification of serum antinuclear antibody in the dog

An indirect immunofluorescence test with sections of rat liver as a substrate, proved useful in detecting antinuclear antibodies (ANA) in the dog. A specific anti-canine IgG reagent conjugated with fluorescein isothiocyanate was used. A proportion of normal dogs gave positive reactions at low titres. The presence of ANA was one of the criteria used to diagnose canine systemic lupus erythematosus. Some dogs within a general hospital population were also positive for the auto-antibody. The indirect immunofluorescence test with Trypanosoma brucei as a substrate was insensitive. The LE-cell test was laborious and insensitive. A commercial latex slide agglutination test used for detecting ANA in man gave false positive and false negative results in the dog. A commercial radioimmunoassay used in man gave many false positive results. A similar assay with synthetic DNA gave encouraging results and is worthy of further study.

Diagnosis of systemic lupus erythematosus in Jamaica by Crithidia luciliae indirect immunofluorescence test

The Crithidia luciliae indirect immunofluorescence test (CL-IFT) was compared with the DNA-binding assay for confirmation of the presence of double-stranded DNA (dsDNA) antibodies in cases of systemic lupus erythematosus (SLE). The study involved 142 patients whose sera had anti-nuclear antibodies (ANA). In 62 patients with clinical or suspected SLE, 66% gave positive CL-IFT results as against 69% by DNA-binding. Two patients who had negative CL-IFT results but positive DNA-binding were only marginally positive (31% and 36%). Anti-dsDNA antibody was not found in any ANA negative sera. C. luciliae is easily maintained in culture and the test is relatively easy to perform in any laboratory with facilities for doing fluorescence microscopy; we recommend it for confirmation of the diagnosis of SLE, especially in laboratories with limited resources.

The clinical significance of the antinuclear antibody test as a screening procedure for DNA antibodies in SLE

During the two-year period (1st October 1974-30th September 1976), 2979 sera were tested for DNA antibodies by the Farr test. One thousand six hundred and ninety-five of these were tested because they had high ANA titres (1/256 or greater). In this group 285 sera were found to have raised DNA binding capacities (DNA-bc), 86 of which were found in patients having diagnoses other than SLE. When the diagnoses were reviewed following the finding of a raised DNA-bc, 55 of these patients were found to be suffering from SLE. Of the 1284 sera tested for DNA antibodies without the prior ANA screening procedures, 288 were positive, 36 of which came from patients not considered to have SLE; 30 of these patients were subsequently shown to have SLE. Thus the DNA-bc test is an important tool in the diagnosis of SLE, and the ANA test appears to be a valuable screening procedure. The level of DNA-bc was not of any diagnostic value.

Clinical and laboratory features of canine lupus syndromes

Determination of the specificities of antinuclear antibodies in the sera of 20 dogs presenting with symptoms of a lupus-like syndrome permitted their separation into 2 groups. The first group of 14 dogs all had antibody activity to DNA-histone antigen(s), and 4 of them also had antibodies to native DNA (nDNA). The Farr test with standard buffer was found to be unsatisfactory for the measurement of anti-nDNA antibodies in dog sera due to a high incidence of false positive reactions; these could be eliminated by the inclusion of sodium dodecyl sulfate in the buffer system. The second group of 6 dogs was characterized by the presence of antibodies to extractable nuclear antigen. In every serum tested diseased dogs had a diminished level of circulating thymic factor as compared to controls of the same age, suggesting that a diminution of suppressor T cells may be an etiologic factor.

Thiamphenicol as an immunosuppressant in active systemic lupus erythematosus with nephritis

Thirteen patients with active systemic lupus erythematosus (SLE) and biopsy proven nephropathy were treated with thiamphenicol for two weeks. Laboratory indices of SLE disease activity (antinuclear factor, complement activity and ESR) were improved after the course of treatment in half of the patients and did not change significantly in the rest. Thiamphenicol may have value as an alternative to currently popular immunosuppressive drugs in the management of systemic lupus erythematosus.

Antinuclear antibodies (ANA): immunologic and clinical significance

The methods currently used for the detection of ANA have been analyzed, with emphasis on their practical application to the diagnosis of the CTD. The use of the indirect IF-ANA test was recommended as a screening procedure to detect ANA. The need to standardize the technique using a single substrate and fluorescent conjugates with uniform F/P ratios was stressed. Most importantly, the value of titrating ANA for the diagnosis of the CTD was discussed. ANA titers higher than 1/500 are usually very significant clinically, often found in spontaneous or drug-induced SLE and few other CTD. The immunologic aspects of ANA and their potential value as aids in the diagnosis and management of the CTD were discussed. Anti-nDNA antibodies have been found to have a high degree of specificity for SLE and high titers of these antibodies correlate well with low levels of serum complement and severity of kidney involvement. The spectrum of ANA in the sera from patients with SLE has been expanded with the finding of anti-Sm antibodies which, when detected by gel precipitation with prototype serum, have been found so far only in SLE. Some of these antibodies have been found to have prognostic significance. Patients with MCTD and a group of patients with SLE have high titers of serum ANA with specificity for an RNase-sensitive component of ENA. The group of SLE patients defined by the presence of these antibodies (anti-Mo) have a better prognosis and in general develop only mild nephritis or have no kidney involvement at all. High titers of pure antinucleolar antibodies probably are found almost exclusively in the sera of patients with scleroderma. Some ANA have organ specificity, and GS-ANA have been found in all patients with Felty's syndrome and in a large proportion of patients with RA. One of the great advances in the field has been the recognition that ANA can be induced in the human and in experimental animals by the use of a number of therapeutic agents. Some of these agents can also induce a clinical picture resembling spontaneous SLE, though kidney involvement does not occur or is extremely mild. It is interesting that the whole spectrum of ANA can be found in drug-induced LE except anti-nDNA antibodies which have been associated to the pathogenesis of immune complex nephritis in spontaneous SLE. There is no doubt that research on ANA has contributed a great deal to the understanding of the CTD and will continue to be a valuable tool for the clinician and the investigator.

Anticonnective tissue and other antitissue 'antibodies' in the sera of patients with coeliac disease compared with the findings in a mixed hospital population

Serum IgG specificities directed against various components of basement membrane and reticulin have been described, and their incidence in 138 patients with coeliac disease has been compared with that in 110 hospital inpatients, 100 normal blood donors, and 1441 other patients. A wide variety of antitissue specificities were observed but only a few appeared to be of any significance. The 'antireticulin' specificities have been subdivided into different groups according to their distinctive histological staining patterns. Specificity directed primarily against endothelial basement membrane was found most frequently in the sera of patients with hiatus hernia (35%) or coeliac disease (22%). The same specificity was also observed in patients with myasthenia gravis and to a lesser extent in Crohn's disease and in a mixed group of patients with unspecified organic gastrointestinal disease. An epithelial basement membrane reactivity was found in patients with rheumatoid arthritis but only rarely in other conditions. Staining of perivascular connective tissue represented a third type of 'antireticulin' specificity. It was found only rarely, although in coeliac disease this reactivity was found more frequently in combination with other connective tissue specificities.

Autoantibodies in patients with chronic bronchitis

Antinuclear antibody (ANA) was found in low titre in 28% of a group of 50 patients with chronic bronchitis by MRC criteria and defined as "severe", that is having at least six infective episodes a year, a vital capacity of less than 70% of predicted and less than 30% reversibility of their airways obstruction after inhalation of isoprenaline. By contrast ANA was found in only 4% of age and sex matched non-bronchitic controls and in none of 28 patients with "less severe" chronic bronchitis in whom these three criteria of severity were not fulfilled. The presence of antinuclear antibody was unrelated to the duration of the disease, sputum volume or the presence of purulent sputum at the time of the study. Neither was it related to blood eosinophilia, respiratory function, smoking or the presence of bacterial precipitins in the patient's serum. These findings are important because they suggest that incidental chronic bronchitis, unless it is extremely severe, is unlikely to contribute substantially to the prevalence of antinuclear antibody found in certain other lung diseases. There was no significant increase in smooth muscle or "reticulin" antibodies in this series of patients.

Relationship of phytohaemagglutinin-induced lymphocyte transformation to disease activity in systemic lupus erythematosus

Phytohaemagglutinin-induced lymphocyte transformation was studied in 19 patients with systemic lupus erythematosus (SLE) in relation to disease activity, peripheral blood lymphocyte count, serum iron and folate levels, and corticosteroid treatment. Similar studies were performed on a group of 28 age- and sex-matched controls and on 10 patients with facial palsy who were examined before and after 7 days of high-dose corticosteroid treatment. The patients with SLE were found to have an impairment of lymphocyte transformation which was most marked in active stages of the disease and associated with a lymphopenia. This depressed transformation, which improved with the development of a remission, could not be attributed to the effects of corticosteroid treatment, inhibitory serum factors, iron deficiency, or any numerical reduction in blood lymphocytes, thus indicating along with evidence from other sources that SLE patients have a defect of cell-mediated immunity. The aetiological implications of these findings are discussed.

Autoantibodies in patients with bronchial carcinoma

No overall increase in the incidence of antinuclear, smooth muscle or reticulin antibodies was observed in a group of 105 patients with bronchial carcinoma of various classified histological types. Smooth muscle antibody was, however, demonstrated in 27% of patients with undifferentiated carcinoma compared to 5% of controls (P less than 0-05). A highly significant increase in antinuclear antibodies in patients with adenocarcinoma was found (31% compared with 5% of controls--P less than 0-01). There as no apparent correlation between the presence of these antibodies and age, sex or other clinical features studied. A detailed study of the reproducibility of the antibody results, studied by indirect immunofluorescence in patients with bronchial carcinoma, is reported.

The modifying effect of autologous serum on leukocyte migration inhibition by liver antigens in systemic lupus erythematosus

The leukocyte migration test was used to examine patients with systemic lupus erythematosus (SLE) for evidence of cell-mediated immunity to human liver microsomes and mitochondria. Testing of both these antigens with leukocytes from patients was carried out simultaneously in culture medium enriched by either 20% fetal bovine serum (the standard test) or substituted 20% autologous serum. Normal controls showed little or no reactivity in the standard test whereas the SLE group revealed a high incidence of significant leukocyte migration inhibition to both antigens which, however, was considerably reduced by the substitution of autologous serum. The results suggest that the sera of patients with SLE contain factor(s) capable of blocking the in vitro expression of cell-mediated immunity to human tissue antigens. These factor(s), if active in vivo, might have a role in controlling some of the auto-immune manfestations of the disease.

Combined titre and fluorescent pattern of IgG antinuclear antibodies using cultured cell monolayers in evaluating connective tissue diseases

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Circulating rheumatoid and antinuclear factors in asbestos workers

In an unselected series of 80 patients with asbestos exposure referred to the London Pneumoconiosis Medical Panel, antinuclear and rheumatoid factors were found in 28 and 27% respectively. This probably represents at least a fourfold increase over their incidence in random populations. The presence of these autoantibodies was not related to the duration of exposure, but was related to the extent of radiographic abnormality.

The relation of immunoglobulin class, pattern of anti-nuclear antibody, and complement-fixing antibodies to DNA in sera from patients with systemic lupus erythematosus

Sera from 55 patients with systemic lupus erythematosus were studied to clarify the significance of the patterns of nuclear fluorescence observed. The sera in which the IgG fraction produced a peripheral pattern of nuclear fluorescence were found to contain complement-fixing antibodies to native DNA and to DNA-histone complexes. This correlation did not exist when complement-fixing activity was compared to the IgM nuclear patterns. Sera which contained only complement-fixing antibodies to denatured DNA and which did not react with native DNA or nucleoprotein did not produce the peripheral pattern of nuclear fluorescence. The data suggest that single strands of DNA were not the reactive groups in the nucleus responsible for the peripheral pattern. The results support the conclusion that DNA within a DNA-protein complex may be the nuclear antigen responsible for the peripheral pattern of nuclear fluorescence. Analysis of the clinical data revealed that a close correlation existed between the presence of IgG peripheral pattern, complement-fixing antibodies to DNA and histone-DNA complexes, and clinical manifestation of active disease.