1
|
Mahto M, Rai N, Das PR, Karmakar S, Bhushan D. Interference of anti-nuclear antibodies on determination of anti-neutrophil cytoplasmic antibodies in patients suspected of vasculitis: a case series. Biochem Med (Zagreb) 2023; 33:031001. [PMID: 37545697 PMCID: PMC10373060 DOI: 10.11613/bm.2023.031001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 06/01/2023] [Indexed: 08/08/2023] Open
Abstract
Anti-neutrophil cytoplasmic antibodies (ANCA) are mainly associated with medium and small vessel vasculitis. Two main methodologies currently available for detection of these antibodies are indirect immunofluorescence (IIF) and monospecific proteinase 3 (PR3) and myeloperoxidase (MPO) based immunoassays. However, well-defined guidelines regarding mode of testing for ANCA in laboratories still don't exist, leading to problems in diagnosis and further patient management. Anti-neutrophil cytoplasmic antibodies testing by IIF and enzyme linked immunosorbent assay (ELISA) often pose a significant challenge in diseases other than vasculitis and in overlapping autoimmune conditions. Anti-neutrophil cytoplasmic antibodies reporting by IIF can be challenging in certain circumstances. This case series aims to discuss four cases with probable interference of anti-nuclear antibodies (ANA) during ANCA testing by IIF resulting in ANCA false positivity. All four cases on subsequent reflex testing by line immunoassay (LIA) for PR3, MPO and glomerular basement membrane (GBM) antigens proved otherwise. While analysing for the presence of ANCA by IIF, the possible interference of ANA leading to a false positive ANCA result should be kept in mind and alternative methods of testing like ELISA, extended granulocyte based IIF assays with MPO and PR3 coated beads, etc., should also be advised. Probability of atypical ANCA in diseases other than vasculitis should also be considered in case of ambiguous results.
Collapse
Affiliation(s)
- Mala Mahto
- Department of Biochemistry, AIIMS Patna, Phulwarisharif, Patna, India
| | - Neha Rai
- Department of Biochemistry, AIIMS Patna, Phulwarisharif, Patna, India
| | - Pulak Ranjan Das
- Department of Biochemistry, AIIMS Patna, Phulwarisharif, Patna, India
| | - Saurabh Karmakar
- Department of Pulmonary Medicine, AIIMS Patna, Phulwarisharif, Patna, India
| | - Divendu Bhushan
- Department of General Medicine, AIIMS Patna, Phulwarisharif, Patna, India
| |
Collapse
|
2
|
Ysermans R, Busch MH, Aendekerk JP, Damoiseaux JG, van Paassen P. Adding low dose cyclophosphamide to rituximab for remission-induction may prolong relapse-free survival in patients with ANCA vasculitis: A retrospective study. J Transl Autoimmun 2022; 6:100178. [PMID: 36589266 PMCID: PMC9800337 DOI: 10.1016/j.jtauto.2022.100178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Objective Rituximab (RTX) and cyclophosphamide (CYC) are effective remission-induction therapies in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). However, combining these therapies may favor prognosis in patients with a major disease presentation. We conducted a retrospective study to compare patients treated with a combination of RTX and low dose CYC (RTX-CYC) or with RTX only, both followed by tailored maintenance with RTX, with regard to long-term outcomes. Methods Patients treated in the Maastricht University Medical Center between March 2007 and January 2019, were screened for eligibility. The primary outcome variable was major relapse rate after two and five years. Secondary outcome variables were clinical data and laboratory parameters. Results Of the 246 screened patients, 34 received RTX-CYC and 28 RTX only for remission-induction. All patients were followed for at least two years, with a median follow-up of 48 months (IQR 24-60). At baseline, renal involvement was more prevalent in the RTX-CYC patients (85% vs. 61%, P = 0.028). Major relapse rates within two years, but not after five years, were significantly lower in the RTX-CYC group (3% vs. 24%, P = 0.032). The rate of infections, hypogammaglobulinemia, end-stage renal disease, malignancies, and mortality did not differ after two and five years. Conclusion Adding low dose CYC to RTX is safe and may prevent major relapses in patients with severe AAV in the first two years after remission-induction. Randomized controlled trials that compare the efficacy and safety between RTX and a combination of RTX with CYC are needed.
Collapse
Affiliation(s)
- Renée Ysermans
- Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center, P. Debyelaan 25, 6202AZ, Maastricht, the Netherlands
| | - Matthias H. Busch
- Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center, P. Debyelaan 25, 6202AZ, Maastricht, the Netherlands
| | - Joop P. Aendekerk
- Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center, P. Debyelaan 25, 6202AZ, Maastricht, the Netherlands
| | - Jan G.M.C. Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, P. Debyelaan 25, 6202AZ, Maastricht, the Netherlands
| | - Pieter van Paassen
- Department of Internal Medicine, Division of Nephrology and Clinical Immunology, Maastricht University Medical Center, P. Debyelaan 25, 6202AZ, Maastricht, the Netherlands,Corresponding author. Dept. Nephrology and Clinical Immunology, Maastricht University Medical Center, P. Debyelaan 25, 6202AZ, Maastricht, the Netherlands.
| |
Collapse
|
3
|
Damoiseaux J, Heijnen I, Van Campenhout C, Eriksson C, Fabien N, Herold M, van der Molen RG, Egner W, Patel D, Plaza-Lopez A, Radice A, de Sousa MJR, Viander M, Shoenfeld Y. An international survey on anti-neutrophil cytoplasmic antibodies (ANCA) testing in daily clinical practice. Clin Chem Lab Med 2019; 56:1759-1770. [PMID: 28710880 DOI: 10.1515/cclm-2017-0306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 05/29/2017] [Indexed: 12/22/2022]
Abstract
Abstract
Background:
Detection of anti-neutrophil cytoplasmic antibodies (ANCA) is important for the diagnosis of the ANCA-associated vasculitides (AAV). For AAV, especially ANCA directed against myeloperoxidase (MPO) and proteinase 3 (PR3) are most relevant. ANCA with less well-defined specificities may, however, also be detected in other inflammatory and non-inflammatory conditions.
Methods:
A questionnaire, initiated by the European Autoimmunity Standardisation Initiative (EASI), was used to gather information on methods and testing algorithms used for ANCA in clinical laboratories of 12 European countries (EASI survey).
Results:
Four hundred and twenty-nine responses were included in the EASI survey analysis which revealed differences within countries and between countries. Laboratories overall were poor in adherence to international consensus on ANCA testing. Substantial variation was observed with respect to the use of ANCA indirect immunofluorescence (IIF) in the algorithm, application of distinct methods for MPO- and PR3-ANCA, the daily availability of new ANCA results, and interpretation of test results.
Conclusions:
Awareness of these differences may stimulate further harmonization and standardization of ANCA testing. This may be promoted by an update of the international ANCA consensus and the introduction of international standards.
Collapse
Affiliation(s)
- Jan Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Ingmar Heijnen
- Medical Immunology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland
| | | | - Catharina Eriksson
- Department of Clinical Immunology/Microbiology, Umeå University, Umeå, Sweden
| | - Nicole Fabien
- Department of Immunology, UF Autoimmunity, Hospices Civils de Lyon, CHLS, Pierre-Benite, France
| | - Manfred Herold
- Department of Internal Medicine/Rheumatology unit, Innsbruck Medical University, Innsbruck, Austria
| | - Renate G van der Molen
- Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - William Egner
- UK NEQAS Immunology, Immunochemistry and Allergy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Dina Patel
- UK NEQAS Immunology, Immunochemistry and Allergy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Aresio Plaza-Lopez
- Department of Immunology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Antonella Radice
- Microbiology Institute, San Carlo Borromeo Hospital, Milan, Italy - on behalf of the Italian Forum on Autoimmune Disease Research (FIRMA)
| | - Marie José Rego de Sousa
- Immunopathology and Autoimmunity Department, Centro de Medicina Laboratorial Germano de Sousa, Lisbon, Portugal
| | - Markku Viander
- Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| |
Collapse
|
4
|
van Beers JJBC, Vanderlocht J, Roozendaal C, Damoiseaux J. Detection of Anti-neutrophil Cytoplasmic Antibodies (ANCA) by Indirect Immunofluorescence. Methods Mol Biol 2019; 1901:47-62. [PMID: 30539567 DOI: 10.1007/978-1-4939-8949-2_4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The eventual presence of anti-neutrophil cytoplasmic antibodies (ANCA) can initially be screened with indirect immunofluorescence (IIF). The majority of laboratories that facilitate ANCA testing use commercial kits. Although in-house assays are not encouraged in routine clinical laboratories, knowledge on the methodological aspects of the assay remains of importance. These aspects include choice of substrate, choice of fixative, staining procedure, and interpretation procedure. In this paper details on the methodology are provided and discussed in the context of the clinical application.
Collapse
Affiliation(s)
- J J B C van Beers
- Central Diagnostic Laboratory, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J Vanderlocht
- Central Diagnostic Laboratory, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - C Roozendaal
- Department of Laboratory Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Centre, Maastricht, The Netherlands.
| |
Collapse
|
5
|
Savige J, Trevisin M, Pollock W. Testing and reporting antineutrophil cytoplasmic antibodies (ANCA) in treated vasculitis and non-vasculitic disease. J Immunol Methods 2018; 458:1-7. [DOI: 10.1016/j.jim.2018.02.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/22/2018] [Accepted: 02/22/2018] [Indexed: 12/23/2022]
|
6
|
|
7
|
Multiplex autoantibody detection for autoimmune liver diseases and autoimmune gastritis. J Immunol Methods 2017; 448:21-25. [PMID: 28522403 DOI: 10.1016/j.jim.2017.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/05/2017] [Accepted: 05/11/2017] [Indexed: 12/29/2022]
Abstract
Autoantibody detection for autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC) and autoimmune gastritis (AIG) is traditionally performed by IIF on a combination of tissues. Multiplex line/dot blots (LIA/DIA) offer multiple advantages, i.e. automation, objective reading, no interfering reactivities, no coincidental findings. In the current study we evaluated automated DIA (D-Tek) for detecting autoantibodies related to autoimmune diseases of the gastrointestinal tract. We tested samples of the Dutch EQC program and compared the results with the consensus of the participating labs. For the autoimmune liver diseases and AIG, respectively, 64 and 36 samples were tested. For anti-mitochondrial and anti-smooth muscle antibodies a concordance rate of 97% and 88% was observed, respectively. The concordance rate for anti-parietal cell antibodies was 92% when samples without EQC consensus (n=15) were excluded. For antibodies against intrinsic factor a concordance of 96% was observed. For all these antibodies discrepancies were identified that relate to the different test characteristics and the preponderance of IIF utilizing labs in the EQC program. In conclusion, we observed good agreement of the tested DIA blots with the consensus results of the Dutch EQC program. Taken together with the logistic advantages these blots are a good alternative for autoantibody detection in the respective diseases. A large prospective multicenter study is warranted to position these novel tests further in the whole spectrum of assays for the detection of these antibodies in a routine autoimmune laboratory.
Collapse
|
8
|
Damoiseaux J, Csernok E, Rasmussen N, Cohen Tervaert JW, Bossuyt X. Antineutrophil cytoplasmic antibodies: reporting and diagnostic strategies. Ann Rheum Dis 2017; 76:e39. [PMID: 28274911 DOI: 10.1136/annrheumdis-2017-211171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 02/04/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Jan Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Elena Csernok
- Department of Internal Medicine, Rheumatology and Immunology, University Teaching Hospital Kirchheim, Vasculitis-Center Tübingen-Kirchheim, Kirchheim-Teck, Germany
| | - Niels Rasmussen
- Department of Autoimmunology & Biomarkers, Statens Serum Institut, Kobenhavn, Denmark
| | | | - Xavier Bossuyt
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.,Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
9
|
Csernok E, Damoiseaux J, Rasmussen N, Hellmich B, van Paassen P, Vermeersch P, Blockmans D, Cohen Tervaert JW, Bossuyt X. Evaluation of automated multi-parametric indirect immunofluorescence assays to detect anti-neutrophil cytoplasmic antibodies (ANCA) in granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). Autoimmun Rev 2016; 15:736-41. [DOI: 10.1016/j.autrev.2016.03.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 03/03/2016] [Indexed: 01/03/2023]
|