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Deane KD, Van Hoovels L, Joy VE, Olschowka N, Bossuyt X. From autoantibody test results to decision making: Incorporating likelihood ratios within medical practice. Autoimmun Rev 2024; 23:103537. [PMID: 38565401 DOI: 10.1016/j.autrev.2024.103537] [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: 03/05/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/04/2024]
Abstract
Autoantibodies are important laboratory markers to support diagnosis of autoimmune diseases. Interpretation of autoantibodies is classically done in a dichotomous way (positive versus negative). Yet, interpretation of autoantibody test results can be improved by reporting likelihood ratios. Likelihood ratios convey information on how much more/less likely a test result is in individuals with the disease compared to individuals without the disease. It incorporates information on the antibody level (the higher the antibody level, the higher the association with the disease), which is helpful for (differential) diagnosis. Likelihood ratios are unit-independent and allow users to harmonize test result interpretation. When the likelihood ratio is combined with information on the pre-test probability, post-test probability can be appraised. In this review, the applicability of likelihood ratio in autoimmune diagnostics will be reviewed from the perspective of the clinician, the laboratory professional and the in vitro diagnostic industry.
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Affiliation(s)
- Kevin D Deane
- University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
| | - Lieve Van Hoovels
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium; Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium.
| | | | | | - Xavier Bossuyt
- Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium; Department of Laboratory Medicine, UZ Leuven, Leuven, Belgium.
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Bossuyt X. DFS70 Autoantibodies: Clinical Utility in Antinuclear Antibody Testing. Clin Chem 2024; 70:374-381. [PMID: 38084885 DOI: 10.1093/clinchem/hvad181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/20/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Screening for antinuclear antibodies (ANA) by indirect immunofluorescence (IIF) on HEp-2 cells is helpful for the diagnosis and classification of ANA-associated rheumatic diseases, including systemic lupus erythematosus, Sjögren syndrome, mixed connective tissue disease, systemic sclerosis, and inflammatory myopathies. The dense fine speckled (DFS) pattern is a special HEp-2 IIF pattern (produced by anti-DFS70 antibodies) because it is not associated with a specific medical condition and therefore can obfuscate interpretation. CONTENT In this paper, detection methods for and clinical associations of anti-DFS70 antibodies are reviewed. SUMMARY The target antigen of the antibodies that cause the DFS pattern is a 70 kDa protein (DFS70). Commercial methods that detect antibodies to full-length or truncated DFS70 are available for use in clinical laboratories (ELISA, chemiluminescence, dot/line blot). Anti-DFS70 can be found in (apparently) healthy individuals (with a higher frequency in young individuals and in females), in several (inflammatory) conditions and in malignancy. There is no clinical association that is well-established. Special attention (and critical reflection) is given to the observation that monospecific anti-DFS70 (i.e., in the absence of antibodies that are linked to ANA-associated rheumatic diseases) is rarely found in ANA-associated rheumatic diseases.
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Affiliation(s)
- Xavier Bossuyt
- Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Clinical and Diagnostic Immunology Research Group, KU Leuven, Leuven, Belgium
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Bonroy C, Vercammen M, Fierz W, Andrade LEC, Van Hoovels L, Infantino M, Fritzler MJ, Bogdanos D, Kozmar A, Nespola B, Broeders S, Patel D, Herold M, Zheng B, Chan EYT, Uibo R, Haapala AM, Musset L, Sack U, Nagy G, Sundic T, Fischer K, Rego de Sousa MJ, Vargas ML, Eriksson C, Heijnen I, García-De La Torre I, Carballo OG, Satoh M, Kim KH, Chan EKL, Damoiseaux J, Lopez-Hoyos M, Bossuyt X. Detection of antinuclear antibodies: recommendations from EFLM, EASI and ICAP. Clin Chem Lab Med 2023; 61:1167-1198. [PMID: 36989417 DOI: 10.1515/cclm-2023-0209] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVES Antinuclear antibodies (ANA) are important for the diagnosis of various autoimmune diseases. ANA are usually detected by indirect immunofluorescence assay (IFA) using HEp-2 cells (HEp-2 IFA). There are many variables influencing HEp-2 IFA results, such as subjective visual reading, serum screening dilution, substrate manufacturing, microscope components and conjugate. Newer developments on ANA testing that offer novel features adopted by some clinical laboratories include automated computer-assisted diagnosis (CAD) systems and solid phase assays (SPA). METHODS A group of experts reviewed current literature and established recommendations on methodological aspects of ANA testing. This process was supported by a two round Delphi exercise. International expert groups that participated in this initiative included (i) the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group "Autoimmunity Testing"; (ii) the European Autoimmune Standardization Initiative (EASI); and (iii) the International Consensus on ANA Patterns (ICAP). RESULTS In total, 35 recommendations/statements related to (i) ANA testing and reporting by HEp-2 IFA; (ii) HEp-2 IFA methodological aspects including substrate/conjugate selection and the application of CAD systems; (iii) quality assurance; (iv) HEp-2 IFA validation/verification approaches and (v) SPA were formulated. Globally, 95% of all submitted scores in the final Delphi round were above 6 (moderately agree, agree or strongly agree) and 85% above 7 (agree and strongly agree), indicating strong international support for the proposed recommendations. CONCLUSIONS These recommendations are an important step to achieve high quality ANA testing.
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Affiliation(s)
- Carolien Bonroy
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
- Department of Laboratory Medicine, University Hospital Ghent, Ghent, Belgium
| | - Martine Vercammen
- Department of Laboratory Medicine, AZ Sint-Jan, Brugge, Belgium
- Research Group REIM, Vrije Universiteit Brussel, Brussels, Belgium
| | - Walter Fierz
- Schweizerischer Verband der Diagnostikindustrie (SVDI-ASID), Bern, Switzerland
| | - Luis E C Andrade
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
- Immunology Division, Fleury Medicine and Health Laboratories, Sao Paulo, Brazil
| | - Lieve Van Hoovels
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Maria Infantino
- Immunology and Allergology Laboratory, S. Giovanni di Dio Hospital, Florence, Italy
| | - Marvin J Fritzler
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Dimitrios Bogdanos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University General Hospital of Larissa, Larissa, Greece
| | - Ana Kozmar
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Benoit Nespola
- Laboratory of Immunology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Dina Patel
- UK NEQAS Immunology, Immunochemistry & Allergy, Sheffield Teaching Hospitals, Sheffield, UK
| | - Manfred Herold
- Department of Internal Medicine II, Rheumatology Laboratory, Medical University of Innsbruck, Innsbruck, Austria
| | - Bing Zheng
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Eric Y T Chan
- Department of Pathology, Queen Mary Hospital, Hong Kong, P.R. China
| | - Raivo Uibo
- Department of Immunology, Medical Faculty, University of Tartu, Tartu, Estonia
| | | | - Lucile Musset
- Department of Immunology, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Ulrich Sack
- Medical Faculty, Leipzig University, Leipzig, Germany
| | - Gabor Nagy
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tatjana Sundic
- Department of Immunology and Transfusion Medicine, Haugesund Hospital, Helse Fonna, Haugesund, Norway
| | - Katarzyna Fischer
- Individual Laboratory for Rheumatologic Diagnostics, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Maria-José Rego de Sousa
- Immunopathology and Autoimmunity Department, Centro de Medicina Laboratorial Germano de Sousa, Lisbon, Portugal
| | | | - Catharina Eriksson
- Department of Clinical Microbiology Section of Infection and Immunology, Umeå University, Umeå, Sweden
| | - Ingmar Heijnen
- Immunology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland
| | - Ignacio García-De La Torre
- Department of Immunology and Rheumatology, Hospital General de Occidente, Universidad de Guadalajara, Guadalajara, Mexico
| | - Orlando Gabriel Carballo
- Laboratory of Immunology, Hospital Carlos G. Durand, Buenos Aires, Argentina
- Department of Microbiology and Immunology, Instituto Universitario, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Minoru Satoh
- Department of Human, Information and Life Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
- Department of Medicine, Kitakyushu Yahata-Higashi Hospital, Kitakyushu, Japan
| | - Kyeong-Hee Kim
- Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Edward K L Chan
- Department of Oral Biology, University of Florida, Gainesville, FL, USA
| | - Jan Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marcos Lopez-Hoyos
- Immunology Service, University Hospital Marques de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | - Xavier Bossuyt
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
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Dinse GE, Zheng B, Co CA, Parks CG, Weinberg CR, Miller FW, Chan EKL. Anti-dense fine speckled 70 (DFS70) autoantibodies: correlates and increasing prevalence in the United States. Front Immunol 2023; 14:1186439. [PMID: 37426660 PMCID: PMC10326272 DOI: 10.3389/fimmu.2023.1186439] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/22/2023] [Indexed: 07/11/2023] Open
Abstract
Objective Recent studies report high-titer anti-dense fine speckled 70 (DFS70) autoantibodies in persons with inflammatory conditions, but the clinical significance remains unclear. Our goals were to estimate anti-DFS70 autoantibody prevalence, identify correlates, and assess time trends. Methods Serum antinuclear antibodies (ANA) were measured by indirect immunofluorescence assay on HEp-2 cells in 13,519 participants ≥12 years old from three time periods (1988-1991, 1999-2004, 2011-2012) of the National Health and Nutrition Examination Survey. ANA-positive participants with dense fine speckled staining were evaluated for anti-DFS70 antibodies by enzyme-linked immunosorbent assay. We used logistic models adjusted for survey-design variables to estimate period-specific anti-DFS70 antibody prevalence in the US, and we further adjusted for sex, age, and race/ethnicity to identify correlates and assess time trends. Results Women were more likely than men (odds ratio (OR)=2.97), black persons were less likely than white persons (OR=0.60), and active smokers were less likely than nonsmokers (OR=0.28) to have anti-DFS70 antibodies. The prevalence of anti-DFS70 antibodies increased from 1.6% in 1988-1991 to 2.5% in 1999-2004 to 4.0% in 2011-2012, which corresponds to 3.2 million, 5.8 million, and 10.4 million seropositive individuals, respectively. This increasing time trend in the US population (P<0.0001) was modified in some subgroups and was not explained by concurrent changes in tobacco smoke exposure. Some, but not all, anti-DFS70 antibody correlates and time trends resembled those reported for total ANA. Conclusion More research is needed to elucidate anti-DFS70 antibody triggers, their pathologic or potentially protective influences on disease, and their possible clinical implications.
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Affiliation(s)
- Gregg E. Dinse
- Public Health and Scientific Research, Social and Scientific Systems, Inc., a DLH Holdings Corp. Company, Durham, NC, United States
| | - Bing Zheng
- Department of Oral Biology, University of Florida, Gainesville, FL, United States
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Caroll A. Co
- Public Health and Scientific Research, Social and Scientific Systems, Inc., a DLH Holdings Corp. Company, Durham, NC, United States
| | - Christine G. Parks
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, United States
| | - Clarice R. Weinberg
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, United States
| | - Frederick W. Miller
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, United States
| | - Edward K. L. Chan
- Department of Oral Biology, University of Florida, Gainesville, FL, United States
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Onarer P, Mutlu E, Öngüt G, Gültekin M. Investigation of dense fine speckled pattern and anti-dense fine speckled 70 antibody by a single step assay. J Microbiol Methods 2022; 203:106606. [PMID: 36343769 DOI: 10.1016/j.mimet.2022.106606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
The indirect immunofluorescence (IIF) method is the gold standard for identifying anti-nuclear antibodies (ANAs). It is recommended that ANA, including the dense fine speckled (DFS) pattern, should be verified with a highly specific confirmatory test after a sensitive screening test. Although methods such as ELISA and LIA are often used to confirm the presence of anti-DFS70 antibodies, new IIF methods have been developed in recent years to prevent the difficulties in the recognition of the DFS pattern and to carry out the confirmatory test in a single step. In this study, we evaluated CytoBead (Generic Assays, Germany) test, which contained both HEp-2 cell substrate and beads coated with DFS70 antigen in one well, in comparison to the routine two-step test strategy. Five hundred forty-one samples were studied by conventional IIF assay, LIA, and CytoBead assay; 264 samples were studied by ELISA. The Bead component of the CytoBead test was found to be reliable as a confirmational test when compared with ELISA and LIA (total agreement values were 85.6% and 87.6%, respectively). The CytoBead ANA DFS70 might be a promising test in the future, allowing both screening and confirmation in a single step, saving time and being easier than two-step testing.
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Affiliation(s)
- Pelin Onarer
- Akdeniz University Faculty of Medicine, Department of Medical Microbiology, Antalya, Turkey
| | - Esvet Mutlu
- Akdeniz University Faculty of Medicine, Department of Medical Microbiology, Antalya, Turkey.
| | - Gözde Öngüt
- Akdeniz University Faculty of Medicine, Department of Medical Microbiology, Antalya, Turkey.
| | - Meral Gültekin
- Akdeniz University Faculty of Medicine, Department of Medical Microbiology, Antalya, Turkey
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Dai Y, Li E, Chen D, Niu X, Wang Z, Lu L, Zheng B. Anti-DFS70 antibodies in systemic lupus erythematosus: Prevalence in a large Chinese cohort and an unexpected association with anti-dsDNA antibodies by a long-term follow-up. Front Immunol 2022; 13:913714. [PMID: 36189276 PMCID: PMC9515321 DOI: 10.3389/fimmu.2022.913714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/19/2022] [Indexed: 11/24/2022] Open
Abstract
Objective Monospecific autoantibodies to dense fine speckles 70 (DFS70) antigen are purported to aid in excluding systemic autoimmune rheumatic diseases (SARD) such as systemic lupus erythematosus (SLE). However, the non-isolated anti-DFS70 still has a certain prevalence in SLE patients, and the clinical significance remains unclear. We aimed to investigate the prevalence, clinical relevance, and value of long-term monitoring of anti-DFS70 antibodies in SLE patients. Methods Anti-DFS70 antibodies were measured by enzyme-linked immunosorbent assay (ELISA) in 851 SLE patients, 211 healthy individuals, and 194 patients with other SARD (except SLE). Demographic, serological, and clinical associations of anti-DFS70 antibodies were analyzed by a stepwise multivariable logistic regression model. The correlation of anti-DFS70 with anti-dsDNA, anti-C1q, and SLE Disease Activity Index 2000 (SLEDAI-2K) was analyzed. Sixty-one SLE patients with follow-up time ranging from 2 to 57 months were measured anti-DFS70 antibodies using both ELISA and line immunoassay. The dynamic variations of anti-DFS70 antibodies were evaluated with anti-dsDNA, anti-C1q, and SLEDAI-2K during the follow-up. Results The prevalence of anti-DFS70 was significantly higher in SLE (20.7% (176/851)) than in healthy individuals (9.5% (20/211), p = 0.0002) and other SARD (10.8% (21/194), p = 0.002). Multivariable analysis revealed that anti-DFS70-positive SLE patients were associated with younger age (odds ratio (OR) = 0.982; 95% confidence interval (CI) = 0.969, 0.995), higher frequencies of anti-dsDNA (OR 1.598; 95% CI 1.107, 2.306) and anti-PCNA (OR 6.101; 95% CI 2.534, 14.688), and higher levels of serum IgG (OR 1.097; 95% CI 1.067, 1.129) and were more likely to be accompanied by mucosal ulcers (OR 5.921; 95% CI 1.652, 21.215). The O.D. value of anti-DFS70 positively correlated with levels of anti-dsDNA (r = 0.183, p < 0.0001) and anti-C1q (r = 0.181, p < 0.0001), respectively, but not with SLEDAI-2K (p = 0.920). During the follow-up, 49 (42 negative and 7 positive) patients remained stable with anti-DFS70 levels. The other 12 patients experienced significant changes in anti-DFS70, and 83.3% (10/12) of them showed similar trends between anti-DFS70 and anti-dsDNA by evaluation of dynamic variations. Conclusion Anti-DFS70 antibodies seem to be prevalent in Chinese SLE patients. The positive association of anti-DFS70 with anti-dsDNA and consistent dynamic variation between anti-DFS70 and anti-dsDNA during the follow-up suggested a potential relationship between anti-DFS70 and anti-dsDNA in patients with SLE.
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Affiliation(s)
- Yingxin Dai
- Department of Laboratory Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Enling Li
- Department of Laboratory Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dandan Chen
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiangyu Niu
- Department of Laboratory Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiqing Wang
- Department of Laboratory Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liangjing Lu
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Bing Zheng, ; Liangjing Lu,
| | - Bing Zheng
- Department of Laboratory Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Bing Zheng, ; Liangjing Lu,
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Troelnikov A, Hender L, Lester S, Gordon TP, Hughes T, Beroukas D. The choice of anti-LEDGF/DFS70 assay matters: a comparative study of six assays. Pathology 2022; 54:910-916. [DOI: 10.1016/j.pathol.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/01/2022] [Accepted: 07/08/2022] [Indexed: 10/14/2022]
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Wener MH, Fink SL, Morishima C, Chaudhary A, Hutchinson K. Anti-Nuclear Antibody Quantitation: Calibration and Harmonization Adjustment via Population Interrogation. J Appl Lab Med 2022; 7:46-56. [PMID: 34996081 DOI: 10.1093/jalm/jfab142] [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: 09/23/2021] [Accepted: 10/21/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND The 2019 classification criteria for systemic lupus erythematosus (SLE) includes an initial criterion requiring the presence of an antinuclear antibody (ANA), positive at a titer of at least 1:80 on HEp-2 cells, or equivalent. However, results of ANA tests performed on HEp-2 cells vary when tested in different laboratories. Calibration of ANA assays by achieving a common specificity in healthy control populations offers the possibility of achieving harmonization via population interrogation, but the expected specificity in a healthy control population is not known. METHODS The studies used to determine the use of ANAs performed by immunofluorescence microscopy on HEp-2 cells as the entry criterion for classification of SLE were reanalyzed by a meta-analysis to determine the expected frequency of positive ANAs in healthy control populations at serum dilutions of 1:40 and 1:80. RESULTS Our meta-analysis demonstrated that the expected specificity in a healthy control population of ANA performed using serum diluted 1:80 is 91.3% (CI 86.1-94.7%). The expected specificity of ANA performed at 1:40 serum dilution is 79.2% (CI 72.3-84.8%). CONCLUSION One approach to achieving harmonization of ANA assays from different laboratories with each other and with expected performance would involve adjusting assays so that about 10% of a healthy control population has a positive ANA when tested at 1:80 dilution, and about 20% of the healthy control population has a positive ANA when tested at 1:40 dilution. This pragmatic approach to calibration and harmonization adjustment via population interrogation offers an opportunity for individual laboratories to be aligned with each other and with ANA performance expected for consistent categorization of patients with SLE.
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Affiliation(s)
- Mark H Wener
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
- Rheumatology Division, Department of Medicine, University of Washington, Seattle, WA
| | - Susan L Fink
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Chihiro Morishima
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Anu Chaudhary
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Kathleen Hutchinson
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
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Van Hoovels L, Broeders S, Chan EKL, Andrade L, de Melo Cruvinel W, Damoiseaux J, Viander M, Herold M, Coucke W, Heijnen I, Bogdanos D, Calvo-Alén J, Eriksson C, Kozmar A, Kuhi L, Bonroy C, Lauwerys B, Schouwers S, Lutteri L, Vercammen M, Mayer M, Patel D, Egner W, Puolakka K, Tesija-Kuna A, Shoenfeld Y, de Sousa MJR, Hoyos ML, Radice A, Bossuyt X. Current laboratory and clinical practices in reporting and interpreting anti-nuclear antibody indirect immunofluorescence (ANA IIF) patterns: results of an international survey. AUTOIMMUNITY HIGHLIGHTS 2020; 11:17. [PMID: 33228811 PMCID: PMC7684889 DOI: 10.1186/s13317-020-00139-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/29/2020] [Indexed: 12/15/2022]
Abstract
Background The International Consensus on Antinuclear Antibody (ANA) Patterns (ICAP) has recently proposed nomenclature in order to harmonize ANA indirect immunofluorescence (IIF) pattern reporting. ICAP distinguishes competent-level from expert-level patterns. A survey was organized to evaluate reporting, familiarity, and considered clinical value of ANA IIF patterns. Methods Two surveys were distributed by European Autoimmunity Standardization Initiative (EASI) working groups, the International Consensus on ANA Patterns (ICAP) and UK NEQAS to laboratory professionals and clinicians. Results 438 laboratory professionals and 248 clinicians from 67 countries responded. Except for dense fine speckled (DFS), the nuclear competent patterns were reported by > 85% of the laboratories. Except for rods and rings, the cytoplasmic competent patterns were reported by > 72% of laboratories. Cytoplasmic IIF staining was considered ANA positive by 55% of clinicians and 62% of laboratory professionals, with geographical and expertise-related differences. Quantification of fluorescence intensity was considered clinically relevant for nuclear patterns, but less so for cytoplasmic and mitotic patterns. Combining IIF with specific extractable nuclear antigens (ENA)/dsDNA antibody testing was considered most informative. Of the nuclear competent patterns, the centromere and homogeneous pattern obtained the highest scores for clinical relevance and the DFS pattern the lowest. Of the cytoplasmic patterns, the reticular/mitochondria-like pattern obtained the highest scores for clinical relevance and the polar/Golgi-like and rods and rings patterns the lowest. Conclusion This survey confirms that the major nuclear and cytoplasmic ANA IIF patterns are considered clinically important. There is no unanimity on classifying DFS, rods and rings and polar/Golgi-like as a competent pattern and on reporting cytoplasmic patterns as ANA IIF positive.
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Affiliation(s)
- Lieve Van Hoovels
- Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium. .,Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
| | - Sylvia Broeders
- Sciensano (Formerly Scientific Institute of Public Health), Brussels, Belgium
| | - Edward K L Chan
- Department of Oral Biology, University of Florida, Gainesville, FL, USA
| | - Luis Andrade
- Rheumatology Division, Universidade Federal de São Paulo, Escola Paulista de Medicina, Sao Paulo, Brazil
| | | | - Jan Damoiseaux
- Centraal Diagnostisch Laboratorium, MUMC, Maastricht, The Netherlands
| | - Markku Viander
- Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland
| | - Manfred Herold
- Rheumatology Laboratory, Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Wim Coucke
- Sciensano (Formerly Scientific Institute of Public Health), Brussels, Belgium
| | - Ingmar Heijnen
- Medical Immunology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland
| | - Dimitrios Bogdanos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Jaime Calvo-Alén
- Servicio de Reumatología, Hospital Universitario Araba, Vitoria, Spain
| | | | - Ana Kozmar
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Liisa Kuhi
- Central Laboratory, East Tallin Central Hospital, Tallin, Estonia
| | - Carolien Bonroy
- Department of Internal Medicine, Ghent University, Ghent, Belgium.,Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Bernard Lauwerys
- Pôle de Pathologies Rhumatismales Et systémiques, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Sofie Schouwers
- Department of Laboratory Medicine, GZA Hospitals, Antwerp, Belgium
| | - Laurence Lutteri
- Department of Clinical Chemistry, University Hospital Liège, Liège, Belgium
| | - Martine Vercammen
- Department of Laboratory Medicine, AZ Sint-Jan Hospital Bruges-Ostend, Bruges, Belgium.,Research Group Reproductive Immunology and Implantation (REIM), Vrije Universiteit Brussel, Brussels, Belgium
| | - Miroslav Mayer
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Dina Patel
- UK NEQAS Immunology, Northern General Hospital, Immunochemistry & Allergy, Sheffield, UK
| | - William Egner
- UK NEQAS Immunology, Northern General Hospital, Immunochemistry & Allergy, Sheffield, UK
| | - Kari Puolakka
- Department of Medicine, South Karelia Central Hospital, Lappeenranta, Finland
| | - Andrea Tesija-Kuna
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Yehuda Shoenfeld
- Laboratory of the Mosaic of Autoimmunity, Saint Petersburg State University, Saint-Petersburg, Russian Federation.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Affiliated to Tel-Aviv University School of Medicine, Tel-Hashomer, Tel Aviv, Israel
| | | | - Marcos Lopez Hoyos
- Servicio de Inmunología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Antonella Radice
- UOC Microbiologia e Virologia, Presidio Ospedaliero San Carlo Borromeo, Milan, Italy
| | - Xavier Bossuyt
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.,Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
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10
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Zheng B, Wang Z, Mora RA, Liu A, Li C, Liu D, Zhai F, Liu H, Gong H, Zhou J, Liu J, Chen L, Wu L, Yuan L, Ying L, Jie L, He M, Hao M, Xu P, Lu Q, Han S, Chen S, Chen S, Zhu S, Sun W, Guo X, Chen Y, Wang Y, Qu Y, Li Z, Niu Z, Han Z, Chan EKL. Anti-DFS70 Antibodies Among Patient and Healthy Population Cohorts in China: Results From a Multicenter Training Program Showing Spontaneous Abortion and Pediatric Systemic Autoimmune Rheumatic Diseases Are Common in Anti-DFS70 Positive Patients. Front Immunol 2020; 11:562138. [PMID: 33133072 PMCID: PMC7566153 DOI: 10.3389/fimmu.2020.562138] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/14/2020] [Indexed: 11/13/2022] Open
Abstract
Objective Anti-DFS70 antibodies correlating with the nuclear dense fine speckled (DFS) pattern in the HEp-2 indirect immunofluorescence assay (IFA) are less common in patients with systemic autoimmune rheumatic disease (SARD) than in healthy subjects and their clinical associations remain elusive. We hosted a multi-center HEp-2 IFA training program to improve the ability of clinical laboratories to recognize the DFS pattern and to investigate the prevalence and relevance of anti-DFS70 antibodies. Methods DFS pattern sera identified by HEp-2 IFA in 29 centers in China were redirected to a central laboratory for anti-DFS70 testing by line immunoblot assay (LIA), enzyme-linked immunosorbent assay (ELISA), and IFA with HEp-2 ELITE/DFS70-KO substrate. Anti-extractable nuclear antigen antibodies were measured by LIA and the clinical relevance was examined in adult and pediatric patients. Results HEp-2 IFA positive rate and DFS pattern in positive sera were 36.2% (34,417/95,131) and 1.7% (582/34,417) in the patient cohort, and 10.0% (423/4,234) and 7.8% (33/423) in a healthy population, respectively. Anti-DFS70 prevalence among sera presenting the DFS pattern was 96.0, 93.7, and 49.6% by ELISA, LIA, and HEp-2 ELITE, respectively. 15.5% (52/336) of adult and 50.0% (20/40) of pediatric anti-DFS70 positive patients were diagnosed with SARD. Diseases most common in anti-DFS70 positive patients were spontaneous abortion (28.0%) in adults and juvenile idiopathic arthritis (22.5%) in pediatric patients. Conclusion Accurate DFS pattern identification increased the detection rate of anti-DFS70 antibodies by ELISA and LIA. Anti-DFS70 antibodies are remarkably high in cases of spontaneous abortion and in pediatric SARD patients, but not prevalent in adult SARD patients.
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Affiliation(s)
- Bing Zheng
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhiqing Wang
- 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, United States
| | - Aiping Liu
- Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Chihui Li
- Department of Laboratory Medicine, Jinhua People's Hospital, Jinhua, China
| | - Dengtao Liu
- Department of Clinical Laboratory, Linyi People's Hospital, Linyi, China
| | - Fuying Zhai
- Department of Laboratory Medicine, People's Hospital of Rongcheng, Rongcheng, China
| | - Huiyuan Liu
- Department of Rheumatology Laboratory, Futian District Hospital of Rheumatism, Shenzhen, China
| | - Huiyun Gong
- Department of Laboratory Medicine, Ruijing Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiaye Zhou
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jing Liu
- Department of Laboratory Medicine, General Hospital of Northern Theater Command, Shengyang, China
| | - Li Chen
- Department of Laboratory Medicine, Zhejiang Provincial Hospital of TCM, The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, China
| | - Lijun Wu
- Department of Rheumatology Laboratory, People's Hospital of Xinjiang Ugyur Autonomous Region, Urumqi, China
| | - Lin Yuan
- Department of Laboratory Medicine, Weihai Central Hospital, Weihai, China
| | - Lina Ying
- Department of Clinical Laboratory, Ninbo No.6 Hospital, Ninbo, China
| | - Loujian Jie
- Department of Laboratory Medicine, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Meifang He
- Department of Laboratory Medicine, The Third People's Hospital of Changzhou, Changzhou, China
| | - Meng Hao
- Department of Laboratory Medicine, Jiujiang First People's Hospital, Jiujiang, China
| | - Ping Xu
- Department of Laboratory Medicine, Obstetrics & Gynecology Hospital Affiliated to Fudan University, Shanghai, China
| | - Qiuwei Lu
- Department of Laboratory Medicine, The People's Hospital of Guangxi Zhuang Autonomous Regain, Nanning, China
| | - Shanshan Han
- Department of Laboratory Medicine, People's Hospital of Sanmen, Taizhou, China
| | - Shishi Chen
- Department of Laboratory Medicine, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai, China
| | - Shuimian Chen
- Department of Laboratory Medicine, Zhenggu Hospital, School of Medicine, Fujian University of Traditional Chinese Medicine, Quanzhou, China
| | - Shunfei Zhu
- Department of Laboratory Medicine, Zibo Maternal and Child Health Hospital, Zibo, China
| | - Weihua Sun
- Department of Laboratory Medicine, The 940th Hospital of PLA Joint Logistics Support Force, Lanzhou, China
| | - Xiaoying Guo
- Department of Laboratory Medicine, Daqing Oilfield General Hospital, Daqing, China
| | - Yajuan Chen
- Departments of Microbiological and Immunology, 3201 Hospital, Hanzhong, China
| | - Yan Wang
- Department of Laboratory Medicine, The Red Cross Hospital, Xining, China
| | - Yemin Qu
- Department of Laboratory Medicine, Weihai Municipal Hospital, Shandong University, Weihai, China
| | - Zhen Li
- Department of Laboratory Medicine, Yili Kazak Autonomous Prefecture Hospital of Traditional Chinese Medicine, Yili, China
| | - Zhenzhen Niu
- Department of Laboratory Medicine, Yinzhou People's Hospital, Ningbo, China
| | - Zhongyan Han
- Center of Pathology and Clinical Laboratory, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Edward K L Chan
- Department of Oral Biology, University of Florida, Gainesville, FL, United States
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11
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Zheng B, Mora RA, Fritzler MJ, Satoh M, Bloch DB, Garcia-De La Torre I, Boylan K, Kohl K, Wener MH, Andrade LEC, Chan EKL. Establishment of international autoantibody reference standards for the detection of autoantibodies directed against PML bodies, GW bodies, and NuMA protein. Clin Chem Lab Med 2020; 59:197-207. [PMID: 32776893 PMCID: PMC7855248 DOI: 10.1515/cclm-2020-0981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 07/21/2020] [Indexed: 12/16/2022]
Abstract
Objectives: Reference materials are important in the standardization of autoantibody testing and only a few are freely available for many known autoantibodies. Our goal was to develop three reference materials for antibodies to PML bodies/multiple nuclear dots (MND), antibodies to GW bodies (GWB), and antibodies to the nuclear mitotic apparatus (NuMA). Methods: Reference materials for identifying autoantibodies to MND (MND-REF), GWB (GWB-REF), and NuMA (NuMA-REF) were obtained from three donors and validated independently by seven laboratories. The sera were characterized using indirect immunofluorescence assay (IFA) on HEp-2 cell substrates including two-color immunofluorescence using antigen-specific markers, western blot (WB), immunoprecipitation (IP), line immunoassay (LIA), addressable laser bead immunoassay (ALBIA), enzyme-linked immunosorbent assay (ELISA), and immunoprecipitation–mass spectrometry (IP-MS). Results: MND-REF stained 6–20 discrete nuclear dots that colocalized with PML bodies. Antibodies to Sp100 and PML were detected by LIA and antibodies to Sp100 were also detected by ELISA. GWB-REF stained discrete cytoplasmic dots in interphase cells, which were confirmed to be GWB using two-color immunofluorescence. Anti-Ge-1 antibodies were identified in GWB-REF by ALBIA, IP, and IP-MS. All reference materials produced patterns at dilutions of 1:160 or greater. NuMA-REF produced fine speckled nuclear staining in interphase cells and staining of spindle fibers and spindle poles. The presence of antibodies to NuMA was verified by IP, WB, ALBIA, and IP-MS. Conclusions: MND-REF, GWB-REF, and NuMA-REF are suitable reference materials for the corresponding antinuclear antibodies staining patterns and will be accessible to qualified laboratories.
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Affiliation(s)
- 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, PR 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, Canada
| | - Minoru Satoh
- Department of Clinical Nursing, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Donald B Bloch
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ignacio Garcia-De La Torre
- Department of Immunology and Rheumatology, Hospital General de Occidente and University of Guadalajara, Guadalajara, Mexico
| | - Katherine Boylan
- Scientific & Clinical Affairs, Plasma Services Group Inc., Huntingdon Valley, PA, USA
| | - Kathryn Kohl
- Scientific & Clinical Affairs, Plasma Services Group Inc., Huntingdon Valley, PA, USA
| | - Mark H Wener
- Division of Rheumatology and Department of Laboratory Medicine,University of Washington, Seattle, WA, USA
| | - Luis E C Andrade
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.,Immunology Division, Fleury Laboratories, São Paulo, Brazil
| | - Edward K L Chan
- Department of Oral Biology,University of Florida, Gainesville, FL, USA
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12
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Andrade LEC, Damoiseaux J, Chan EK. Response to 'Decision making value of nuclear dense fine speckled pattern in systemic autoimmune rheumatic disease: trick or treat?' by Deng et al. Ann Rheum Dis 2020; 79:e93. [PMID: 31092413 DOI: 10.1136/annrheumdis-2019-215640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 11/04/2022]
Affiliation(s)
| | - Jan Damoiseaux
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Edward K Chan
- Department of Oral Biology, University of Florida, Gainesville, Florida, USA
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13
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Peterson LK, Tebo AE, Wener MH, Copple SS, Fritzler MJ. Assessment of antinuclear antibodies by indirect immunofluorescence assay: report from a survey by the American Association of Medical Laboratory Immunologists. Clin Chem Lab Med 2020; 58:1489-1497. [PMID: 32271157 DOI: 10.1515/cclm-2019-1262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/29/2020] [Indexed: 12/11/2022]
Abstract
Background The indirect immunofluorescence assay (IFA) using HEp-2 cell substrates is the preferred method by some for detecting antinuclear antibodies (ANA) as it demonstrates a number of characteristic staining patterns that reflect the cellular components bound as well as semi-quantitative results. Lack of harmonized nomenclature for HEp-2 IFA patterns, subjectivity in interpretation and variability in the number of patterns reported by different laboratories pose significant harmonization challenges. The main objectives of this study were to assess current practice in laboratory assessment of HEp-2 IFA, identify gaps and define strategies to improve reading, interpretation and reporting. Methods We developed and administered a 24-item survey based on four domains: educational and professional background of participants, current practice of HEp-2 IFA testing and training, gap assessment and the perceived value of International Consensus on Antinuclear Antibody Patterns (ICAP) and other factors in HEp-2 IFA assessment. The Association of Medical Laboratory Immunologists (AMLI) and American Society for Clinical Pathology administered the survey from April 1 to June 30, 2018, to members involved in ANA testing. This report summarizes the survey results and discussion from a dry workshop held during the 2019 AMLI annual meeting. Results One hundred and seventy-nine (n = 179) responses were obtained where a significant number were clinical laboratory scientists (46%), laboratory directors (24%), supervisors (13%) or others (17%). A majority of respondents agreed on the need to standardize nomenclature and reporting of HEp-2 IFA results. About 55% were aware of the ICAP initiative; however, among those aware, a significant majority thought its guidance on HEp-2 IFA nomenclature and reporting is of value to clinical laboratories. To improve ICAP awareness and further enhance HEp-2 IFA assessment, increased collaboration between ICAP and the clinical laboratory community was suggested with emphasis on education and availability of reference materials. Conclusions Based on these suggestions, future efforts to optimize HEp-2 IFA reading, interpretation and reporting would benefit from more hands-on training of laboratory personnel as well as continuous collaboration between professional organizations, in vitro diagnostic manufacturers and clinical laboratories.
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Affiliation(s)
- Lisa K Peterson
- Department of Pathology, University of Utah, Salt Lake City, UT, USA.,ARUP Laboratories, Salt Lake City, UT, USA
| | - Anne E Tebo
- Department of Pathology, University of Utah, Salt Lake City, UT, USA.,ARUP Laboratories, Salt Lake City, UT, USA
| | - Mark H Wener
- Department of Laboratory Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Marvin J Fritzler
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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14
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Damoiseaux J. The perspective on standardisation and harmonisation: the viewpoint of the EASI president. AUTO- IMMUNITY HIGHLIGHTS 2020; 11:4. [PMID: 32127033 PMCID: PMC7065346 DOI: 10.1186/s13317-020-0127-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/21/2020] [Indexed: 12/16/2022]
Abstract
Standardisation of immuno-assays for autoantibodies is a major challenge. Although multiple organisations participate in the generation of internationally accepted standards, adequate standardisation of assays has not yet been achieved. Harmonisation may offer an alternative approach to better align requesting, testing, reporting and interpretation of autoimmune diagnostics. The European Autoimmunity Standardisation Initiative (EASI) was founded to facilitate both standardisation as well as harmonisation of autoantibody tests, but over the years the focus has drifted away from standardisation in favour of harmonisation. In the current paper the options for harmonisation are highlighted.
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Affiliation(s)
- Jan Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
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15
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Ortiz-Hernandez GL, Sanchez-Hernandez ES, Casiano CA. Twenty years of research on the DFS70/LEDGF autoantibody-autoantigen system: many lessons learned but still many questions. AUTOIMMUNITY HIGHLIGHTS 2020; 11:3. [PMID: 32127038 PMCID: PMC7065333 DOI: 10.1186/s13317-020-0126-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/14/2020] [Indexed: 12/24/2022]
Abstract
The discovery and initial characterization 20 years ago of antinuclear autoantibodies (ANAs) presenting a dense fine speckled (DFS) nuclear pattern with strong staining of mitotic chromosomes, detected by indirect immunofluorescence assay in HEp-2 cells (HEp-2 IIFA test), has transformed our view on ANAs. Traditionally, ANAs have been considered as reporters of abnormal immunological events associated with the onset and progression of systemic autoimmune rheumatic diseases (SARD), also called ANA-associated rheumatic diseases (AARD), as well as clinical biomarkers for the differential diagnosis of these diseases. However, based on our current knowledge, it is not apparent that autoantibodies presenting the DFS IIF pattern fall into these categories. These antibodies invariably target a chromatin-associated protein designated as dense fine speckled protein of 70 kD (DFS70), also known as lens epithelium-derived growth factor protein of 75 kD (LEDGF/p75) and PC4 and SFRS1 Interacting protein 1 (PSIP1). This multi-functional protein, hereafter referred to as DFS70/LEDGF, plays important roles in the formation of transcription complexes in active chromatin, transcriptional activation of specific genes, regulation of mRNA splicing, DNA repair, and cellular survival against stress. Due to its multiple functions, it has emerged as a key protein contributing to several human pathologies, including acquired immunodeficiency syndrome (AIDS), leukemia, cancer, ocular diseases, and Rett syndrome. Unlike other ANAs, "monospecific" anti-DFS70/LEDGF autoantibodies (only detectable ANA in serum) are not associated with SARD and have been detected in healthy individuals and some patients with non-SARD inflammatory conditions. These observations have led to the hypotheses that these antibodies could be considered as negative biomarkers of SARD and might even play a protective or beneficial role. In spite of 20 years of research on this autoantibody-autoantigen system, its biological and clinical significance still remains enigmatic. Here we review the current state of knowledge of this system, focusing on the lessons learned and posing emerging questions that await further scrutiny as we continue our quest to unravel its significance and potential clinical and therapeutic utility.
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Affiliation(s)
- Greisha L Ortiz-Hernandez
- Center for Health Disparities and Molecular Medicine, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA.,Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, USA
| | - Evelyn S Sanchez-Hernandez
- Center for Health Disparities and Molecular Medicine, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA.,Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, USA
| | - Carlos A Casiano
- Center for Health Disparities and Molecular Medicine, Loma Linda University School of Medicine, Loma Linda, CA, 92350, USA. .,Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, USA. .,Department of Medicine/Division of Rheumatology, Loma Linda University School of Medicine, Loma Linda, USA.
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16
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Mahler M, Andrade LE, Casiano CA, Malyavantham K, Fritzler MJ. Implications for redefining the dense fine speckled and related indirect immunofluorescence patterns. Expert Rev Clin Immunol 2019; 15:447-448. [PMID: 30880500 DOI: 10.1080/1744666x.2019.1596802] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Luis E Andrade
- b Rheumatology Division, Department of Medicine, Escola Paulista de Medicina , Universidade Federal de São Paulo , Sau Paulo , Brazil
| | - Carlos A Casiano
- c Center for Health Disparities and Molecular Medicine, Department of Basic Sciences, Department of Medicine, Division of Rheumatology , Loma Linda University School of Medicine , Loma Linda , CA , USA
| | | | - Marvin J Fritzler
- d Cumming School of Medicine , University of Calgary , Calgary , Canada
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