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Vandevelde A, Gris JC, Moore GW, Musiał J, Zuily S, Wahl D, Devreese KMJ. Toward harmonized interpretation of anticardiolipin and anti-β2-glycoprotein I antibody detection for diagnosis of antiphospholipid syndrome using defined level intervals and likelihood ratios: communication from the ISTH SSC Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibodies. J Thromb Haemost 2024; 22:2345-2362. [PMID: 38704123 DOI: 10.1016/j.jtha.2024.04.016] [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: 12/22/2023] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Improving harmonization of the clinical interpretation of anticardiolipin (aCL) and anti-β2-glycoprotein I (aβ2GPI) antibodies immunoglobulin G (IgG)/immunoglobulin M (IgM) in the diagnosis of antiphospholipid syndrome (APS) is desirable. Likelihood ratios (LRs) with corresponding test-result intervals can identify the power of a test to discriminate between a diseased and nondiseased patient and may be useful for the semiquantitative interpretation of aCL/aβ2GPI results. OBJECTIVES To determine moderate and high thresholds for aCL and aβ2GPI IgG/IgM measured with chemiluminescent immunoassay, enzyme-linked immunosorbent assay, fluorescence enzyme immunoassay, and multiplex flow immunoassay. METHODS aCL and aβ2GPI antibodies IgG/IgM were determined with 4 solid-phase systems in a case-control study population including 381 APS patients and 727 controls. Interval-specific LRs (IS-LR) were calculated for ranges determined by prespecified specificity and sensitivity levels. Three methods were used for determining thresholds that separated low, moderate, and high positive antibody levels. Interassay agreement was checked with Cohen's kappa statistics. RESULTS Assay- and antibody-specific thresholds demonstrated increasing IS-LR, reflecting different clinical significance for low, moderate, and high levels, especially for IgG aCL and aβ2GPI and in thrombotic APS. IS-LRs per antibody and unit range were comparable across solid-phase platforms resulting in enhanced harmonization of result interpretation. Agreement between assays for identifying high levels was improved by semiquantitative interpretation compared with that by quantitative reporting. CONCLUSION aCL and aβ2GPI IgG/IgM moderate and high thresholds were determined for 4 analytical platforms. Thresholds improve harmonized interpretation of aCL/aβ2GPI levels across platforms. The proposed thresholds should be verified in an independent case-control study to check interlaboratory transferability.
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Affiliation(s)
- Arne Vandevelde
- Coagulation Laboratory, Ghent University Hospital, Ghent, Belgium; Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Jean-Christophe Gris
- Department of Hematology, CHU Nîmes, Univ Montpellier, Nîmes, France; Department of Hematology, Faculty of Pharmaceutical and Biological Sciences, Montpellier University, Montpellier, France; UMR UA11 Institut national de la santé et de la recherche médicale (INSERM) - Desbrest Institute of Epidemiology and Public Health (IDESP), Montpellier University, Montpellier, France; Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Gary W Moore
- Specialist Haemostasis Unit, Addenbrooke's Hospital, Cambridge, United Kingdom; Department of Natural Sciences, Middlesex University, London, United Kingdom
| | - Jacek Musiał
- Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Stéphane Zuily
- Université de Lorraine, Institut national de la santé et de la recherche médicale (INSERM), DCAC and Centre Hospitalier Regional Universitaire de Nancy, Vascular Medicine Division and Reference Center for Rare Vascular and Systemic Autoimmune Diseases, Nancy, France
| | - Denis Wahl
- Université de Lorraine, Institut national de la santé et de la recherche médicale (INSERM), DCAC and Centre Hospitalier Regional Universitaire de Nancy, Vascular Medicine Division and Reference Center for Rare Vascular and Systemic Autoimmune Diseases, Nancy, France
| | - Katrien M J Devreese
- Coagulation Laboratory, Ghent University Hospital, Ghent, Belgium; Department of Diagnostic Sciences, Ghent University, Ghent, Belgium.
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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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3
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Dekeyser C, De Kesel P, Cambron M, Vanopdenbosch L, Van Hijfte L, Vercammen M, Laureys G. Inter-assay diagnostic accuracy of cerebrospinal fluid kappa free light chains for the diagnosis of multiple sclerosis. Front Immunol 2024; 15:1385231. [PMID: 38745673 PMCID: PMC11091388 DOI: 10.3389/fimmu.2024.1385231] [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: 02/12/2024] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
Background Cerebrospinal fluid (CSF) kappa free light chain (κFLC) measures gained increasing interest as diagnostic markers in multiple sclerosis (MS). However, the lack of studies comparing assay-dependent diagnostic cutoff values hinders their use in clinical practice. Additionally, the optimal κFLC parameter for identifying MS remains a subject of ongoing debate. Objectives The aim of this study was to compare same-sample diagnostic accuracies of the κFLC index, κIgG index, CSF κFLC/IgG ratio, and isolated CSF κFLC (iCSF-κFLC) between two reference centers using different methods. Methods Paired serum and CSF samples were analyzed for κFLC and albumin concentrations by Freelite®-Optilite (Sint-Jan Bruges hospital) and N Latex®-BNII (Ghent University hospital). Diagnostic performance to differentiate MS from controls was assessed using ROC curve analysis. Results A total of 263 participants were included (MS, n = 80). Optimal diagnostic cutoff values for the κFLC index (Freelite®-Optilite: 7.7; N Latex®-BNII: 4.71), κIgG index (Freelite®-Optilite: 14.15, N Latex®-BNII: 12.19), and CSF κFLC/IgG ratio (Freelite®-Optilite: 2.27; N Latex®-BNII: 1.44) differed between the two methods. Sensitivities related to optimal cutoff values were 89.9% (Freelite®-Optilite) versus 94.6% (N Latex®-BNII) for the κFLC index, 91% (Freelite®-Optilite) versus 92.2% (N Latex®-BNII) for the κIgG index, and 81.3% (Freelite®-Optilite) versus 91.4% (N Latex®-BNII) for the CSF κFLC/IgG ratio. However, for iCSF-κFLC, optimal diagnostic cutoff values (0.36 mg/L) and related specificities (81.8%) were identical with a related diagnostic sensitivity of 89.9% for Freelite®-Optilite and 90.5% for N Latex®-BNII. The diagnostic performance of the κFLC index [area under the curve (AUC) Freelite®-Optilite: 0.924; N Latex®-BNII: 0.962] and κIgG index (AUC Freelite®-Optilite: 0.929; N Latex®-BNII: 0.961) was superior compared to CSF oligoclonal bands (AUC: 0.898, sensitivity: 83.8%, specificity: 95.9%). Conclusions The κFLC index and the κIgG index seem to be excellent markers for identifying MS, irrespective of the method used for κFLC quantification. Based on the AUC, they appear to be the measures of choice. For all measures, optimal cutoff values differed between methods except for iCSF-κFLC. iCSF-κFLC might therefore serve as a method-independent, more cost-efficient, initial screening measure for MS. These findings are particularly relevant for clinical practice given the potential future implementation of intrathecal κFLC synthesis in MS diagnostic criteria and for future multicentre studies pooling data on κFLC measures.
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Affiliation(s)
| | - Pieter De Kesel
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Melissa Cambron
- Department of Neurology, AZ Sint-Jan Brugge, Bruges, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | | | - Martine Vercammen
- Department of Laboratory Medicine, Algemeen Ziekenhuis (AZ) Sint-Jan Brugge, Bruges, Belgium
- Basic Biomedical Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Guy Laureys
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
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Ogrič M, Švec T, Poljšak KM, Žigon P, Hočevar A, Čučnik S. Verification, implementation and harmonization of automated chemiluminescent immunoassays for MPO- and PR3-ANCA detection. Clin Chem Lab Med 2024; 62:682-689. [PMID: 37870064 DOI: 10.1515/cclm-2023-0764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVES Antineutrophil cytoplasmic antibody (ANCA) testing assists clinicians diagnose ANCA-associated vasculitis (AAV). We aimed to verify and harmonize chemiluminescent immunoassays for the detection of myeloperoxidase (MPO)- and proteinase 3 (PR3)-ANCA. METHODS An in-house ELISA, a capture ELISA, and a chemiluminescent assay QUANTA Flash on a BIO-FLASH analyzer were used to detect MPO- and PR3-ANCA in sera from 39 patients with AAV, 55 patients with various non-AAV, and 66 patients with connective tissue diseases. The results of the assays were evaluated, and their clinical performance was assessed. The precision and linearity of the QUANTA Flash assays were determined, and likelihood ratios (LRs) for AAV at diagnosis were calculated. RESULTS The precision and linearity of the QUANTA Flash assays were confirmed. Overall agreement between 97.5 and 98.8 % and Cohen's kappa coefficients between 0.861 and 0.947 were observed for the results of the QUANTA Flash assays and ELISAs. The diagnostic sensitivity, specificity, and ROC analysis of the assays for AAV were statistically similar (in-house ELISA 89.7 %, 95.0 %, and 0.937; capture ELISA 92.3 %, 98.3 %, and 0.939; and QUANTA Flash 89.7 %, 95.9 %, and 0.972). For the QUANTA Flash assay results, the interval-specific LRs for AAV at diagnosis were: 0-8 CU had LR 0.08, 8-29 CU had LR 1.03, 29-121 CU had LR 7.76, 121-191 CU had LR 12.4, and >191 CU had LR ∞. CONCLUSIONS The QUANTA Flash MPO and PR3 assays provide precise and consistent results and have comparable clinical utility for AAV. The calculated LRs were consistent with published LRs, confirming the utility of LRs for harmonization of ANCA results.
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Affiliation(s)
- Manca Ogrič
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tinka Švec
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Katjuša Mrak Poljšak
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Polona Žigon
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- University of Primorska, FAMNIT, Koper, Slovenia
| | - Alojzija Hočevar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Saša Čučnik
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
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Bossuyt X, Van Hoovels L. Reporting Likelihood Ratio in Autoimmune Serology: Just a Theory or Feasible in Practice? Clin Chem 2024; 70:482-485. [PMID: 38300842 DOI: 10.1093/clinchem/hvad222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/28/2023] [Indexed: 02/03/2024]
Affiliation(s)
- Xavier Bossuyt
- Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Clinical and Diagnostic Immunology, KU Leuven, Leuven, Belgium
| | - Lieve Van Hoovels
- Department of Microbiology, Immunology and Transplantation, Clinical and Diagnostic Immunology, KU Leuven, Leuven, Belgium
- Laboratory Medicine, OLV Hospital, Aalst, Belgium
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Damoiseaux J, van Beers J. Correspondence on "ACR/EULAR antiphospholipid syndrome classification criteria". Ann Rheum Dis 2024; 83:e6. [PMID: 37989546 DOI: 10.1136/ard-2023-225067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/11/2023] [Indexed: 11/23/2023]
Affiliation(s)
- Jan Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joyce van Beers
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
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Renuncio-García M, Calvo-Río V, Benavides-Villanueva F, Al Fazazi S, Rodríguez-Vidriales M, Escagedo-Cagigas C, Martín-Penagos L, Irure-Ventura J, López-Hoyos M, Blanco R. ANCA detection with solid phase chemiluminescence assay: diagnostic and severity association in vasculitis. Immunol Res 2024; 72:128-133. [PMID: 37676628 PMCID: PMC10810966 DOI: 10.1007/s12026-023-09422-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/31/2023] [Indexed: 09/08/2023]
Abstract
ANCA-associated vasculitis (AAV) comprises a group of necrotizing vasculitis that mainly affects small- and medium-sized vessels. Serum anti-neutrophil cytoplasmic antibodies (ANCA), mainly anti-myeloperoxidase (anti-MPO) and anti-proteinase 3 (anti-PR3), levels may correlate to severity, prognosis, and recurrence of the disease. A retrospective analysis of 101 patients with MPO-positive and 54 PR3-positive vasculitis was performed, using laboratory established cut-off value, measured by chemiluminescence. Furthermore, data of renal disease and pulmonary involvement were collected at vasculitis diagnosis, as well as the progress, requiring dialysis, transplant, or mortality. For anti-MPO antibodies with a diagnosis of vasculitis (n = 77), an area under the curve (AUC) was calculated (AUC = 0.8084), and a cut-off point of 41.5 IU/ml was determined. There were significant differences in anti-MPO levels between patients with renal or pulmonary dysfunction (n = 65) versus those without them (n = 36) (p = 0.0003), and a cut-off threshold of 60 IU/ml was established. For anti-PR3 antibodies with a diagnosis of vasculitis (n = 44), an area under the curve (AUC) was calculated (AUC = 0.7318), and a cut-off point of 20.5 IU/ml was determined. Significant differences in anti-PR3 levels were observed between those patients with renal or pulmonary dysfunction (n = 30) and those without them (n = 24) (p = 0.0048), and a cut-off threshold of 41.5 IU/ml was established. No significant differences between those patients who had a worse disease progression and those who did not were found for anti-MPO and anti-PR3. Anti-MPO and anti-PR3 levels at the moment of vasculitis diagnosis are related with disease severity but not with disease outcome or vasculitis recurrence.
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Affiliation(s)
- Mónica Renuncio-García
- Department of Immunology, Marqués de Valdecilla University Hospital, Avda. Valdecilla S/N, 39008, Santander, Cantabria, Spain
- Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, 39011, Santander, Spain
| | - Vanesa Calvo-Río
- Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, 39011, Santander, Spain
- Department of Rheumatology, Marqués de Valdecilla University Hospital, 39008, Santander, Cantabria, Spain
| | | | - Salma Al Fazazi
- Department of Rheumatology, Puerta del Mar University Hospital, 11009, Cádiz, Andalucía, Spain
| | - María Rodríguez-Vidriales
- Department of Nephrology, Marqués de Valdecilla University Hospital, 39008, Santander, Cantabria, Spain
| | - Clara Escagedo-Cagigas
- Department of Nephrology, Marqués de Valdecilla University Hospital, 39008, Santander, Cantabria, Spain
| | - Luis Martín-Penagos
- Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, 39011, Santander, Spain
- Department of Nephrology, Marqués de Valdecilla University Hospital, 39008, Santander, Cantabria, Spain
| | - Juan Irure-Ventura
- Department of Immunology, Marqués de Valdecilla University Hospital, Avda. Valdecilla S/N, 39008, Santander, Cantabria, Spain
- Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, 39011, Santander, Spain
| | - Marcos López-Hoyos
- Department of Immunology, Marqués de Valdecilla University Hospital, Avda. Valdecilla S/N, 39008, Santander, Cantabria, Spain.
- Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, 39011, Santander, Spain.
- Molecular Biology Dpt., Universidad Cantabria, Santander, Spain.
| | - Ricardo Blanco
- Immunopathology Group, Marqués de Valdecilla University Hospital-IDIVAL, 39011, Santander, Spain
- Department of Rheumatology, Marqués de Valdecilla University Hospital, 39008, Santander, Cantabria, Spain
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Damoiseaux J, van Beers J. Autoantibodies to dsDNA in the diagnosis, classification and follow-up of patients with systemic lupus erythematosus. J Transl Autoimmun 2023; 6:100191. [PMID: 36718274 PMCID: PMC9883238 DOI: 10.1016/j.jtauto.2023.100191] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/20/2023] [Indexed: 01/23/2023] Open
Abstract
Autoantibodies, in particular anti-dsDNA antibodies, are increasingly used for diagnosis, classification and follow-up of patients with SLE. Since standardization of autoantibody assays is a major challenge, more attention should be paid to harmonization initiatives and better definition of required test characteristics in classification criteria. For diagnosis and follow-up separate multi-center studies are required to establish test characteristics of distinct immuno-assays for both purposes. Finally, such studies should consider not to evaluate SLE as a single disease, but as a disease with distinct subtypes.
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Affiliation(s)
- Jan Damoiseaux
- Corresponding author. Central Diagnostic Laboratory, Maastricht University Medical Center, P. Debyelaan 25, 6229HX, Maastricht, the Netherlands.
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Zaninotto M, Graziani MS, Plebani M. The harmonization issue in laboratory medicine: the commitment of CCLM. Clin Chem Lab Med 2022; 61:721-731. [PMID: 36383396 DOI: 10.1515/cclm-2022-1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022]
Abstract
Abstract
The analytical quality of the clinical laboratory results has shown a significant improvement over the past decades, thanks to the joint efforts of different stakeholders, while the comparability among the results produced by different laboratories and methods still presents some critical issues. During these years, Clinical Chemistry and Laboratory Medicine (CCLM) published several papers on the harmonization issue over all steps in the Total Testing Process, training an important number of laboratory professionals in evaluating and monitoring all the criticisms inherent to the pre-analytical, as well as analytical and post analytical phases: from the consensus statement on the most informative testing in emergency setting, to the prevention and detection of hemolysis or to patients identification and tube labeling procedures, as far as to different approaches to harmonize hormones measurements or to describe new reference methods or to harmonize the laboratory report. During these years the commitment of the journal, devoted to the harmonization processes has allowed to improve the awareness on the topic and to provide specific instruments to monitor the rate of errors and to improve patients safety.
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Damoiseaux J, Mammen AL, Piette Y, Benveniste O, Allenbach Y. 256 th ENMC international workshop: Myositis specific and associated autoantibodies (MSA-ab): Amsterdam, The Netherlands, 8-10 October 2021. Neuromuscul Disord 2022; 32:594-608. [PMID: 35644723 DOI: 10.1016/j.nmd.2022.05.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/12/2022] [Accepted: 05/17/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Jan Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Andrew L Mammen
- Muscle Disease Unit. Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, United States
| | - Yves Piette
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, INSERM, UMR974, Pitié-Salpêtrière University Hospital, Paris, France
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, INSERM, UMR974, Pitié-Salpêtrière University Hospital, Paris, France
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11
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Dragon-Durey MA, Bizzaro N, Senant M, Andreeva H, Bogdanos DP, Bonroy C, Bossuyt X, Eriksson C, Fabien N, Heijnen I, Herold M, Musset L, Kuhi L, Lopez-Hoyos M, Berki T, Roozendaal C, Sack U, Sundic T, Taylor L, Kuna AT, Damoiseaux J. Repository of intra- and inter-run variations of quantitative autoantibody assays: a European multicenter study. Clin Chem Lab Med 2022; 60:1373-1383. [PMID: 35749077 DOI: 10.1515/cclm-2022-0411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/14/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES No reference data are available on repositories to measure precision of autoantibody assays. The scope of this study was to document inter- and intra-run variations of quantitative autoantibody assays based on a real-world large international data set. METHODS Members of the European Autoimmunity Standardisation Initiative (EASI) group collected the data of intra- and inter-run variability obtained with assays quantifying 15 different autoantibodies in voluntary participating laboratories from their country. We analyzed the impact on the assay performances of the type of immunoassay, the number of measurements used to calculate the coefficient of variation (CVs), the nature and the autoantibody level of the internal quality control (IQC). RESULTS Data were obtained from 64 laboratories from 15 European countries between February and October 2021. We analyzed 686 and 1,331 values of intra- and inter-run CVs, respectively. Both CVs were significantly dependent on: the method of immunoassay, the level of IQC with higher imprecision observed when the antibody levels were lower than 2-fold the threshold for positivity, and the nature of the IQC with commercial IQCs having lower CVs than patients-derived IQCs. Our analyses also show that the type of autoantibody has low impact on the assay' performances and that 15 measurements are sufficient to establish reliable intra- and inter-run variations. CONCLUSIONS This study provides for the first time an international repository yielding values of intra- and inter-run variation for quantitative autoantibody assays. These data could be useful for ISO 15189 accreditation requirements and will allow clinical diagnostic laboratories to assure quality of patient results.
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Affiliation(s)
- Marie-Agnès Dragon-Durey
- Laboratoire d'Immunologie, Hôpital Européen Georges Pompidou, APHP, Université de Paris Cité, Paris, France
| | - Nicola Bizzaro
- Laboratory of Clinical Pathology, San Antonio Hospital, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | | | - Hristina Andreeva
- Section of Protein, Allergy and Immunology, Laboratory Medicine Department, Diagnostic Clinic, University Hospital of North Norway, Tromsø, Norway
| | - Dimitrios P Bogdanos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, University General Hospital of Larissa, Larissa, Greece
| | - Carolien Bonroy
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium; and Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Xavier Bossuyt
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium and Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Catharina Eriksson
- Department of Clinical Microbiology, Division of Infection and Immunology, Umeå University, Umeå, Sweden
| | - Nicole Fabien
- Immunology department, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Ingmar Heijnen
- Medical Immunology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland
| | - Manfred Herold
- Rheumatology Laboratory, Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Lucile Musset
- Département d'Immunologie, UF immunochimie & autoimmunité, CHU Pitié Salpêtrière-Ch Foix, APHP, Paris, France
| | - Liisa Kuhi
- Central Laboratory, Diagnostic Clinic, East Tallinn Central Hospital, Tallinn, Estonia
| | - Marcos Lopez-Hoyos
- Servicio de Inmunología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Tímea Berki
- Department of Immunology and Biotechnology, University of Pécs, Medical School, Pécs, Hungary
| | - Caroline Roozendaal
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ulrich Sack
- Medical Faculty, Institute of Clinical Immunology, University Leipzig, Leipzig, Germany
| | - Tatjana Sundic
- Immunology and Transfusion Medicine, Department of Laboratory Medicine, Haugesund Hospital, Haugesund, Norway
| | - Lorna Taylor
- Department of Immunology, Black Country Pathology Services, Wolverhampton, West Midlands, UK
| | - Andrea Tesija Kuna
- Department of Clinical Chemistry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Jan Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
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Van Hoovels L, Studholme L, Vander Cruyssen B, Sieghart D, Bonroy C, Nagy E, Pullerits R, Čučnik S, Dahle C, Heijnen I, Bernasconi L, Benkhadra F, Bogaert L, Van Den Bremt S, Van Liedekerke A, Vanheule G, Robbrecht J, Wirth C, Müller R, Kyburz D, Sjöwall C, Kastbom A, Ješe R, Jovancevic B, Kiss E, Jacques P, Aletaha D, Steiner G, Verschueren P, Bossuyt X. Standardisation of ACPA tests: evaluation of a new candidate reference preparation. Ann Rheum Dis 2022; 81:annrheumdis-2021-221849. [PMID: 35697487 PMCID: PMC9484372 DOI: 10.1136/annrheumdis-2021-221849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 05/19/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Commercial assays measuring antibodies to citrullinated protein/peptide (ACPA) show poor quantitative agreement. The diagnostic industry has never adopted the International Union of Immunological Societies-Centers for Disease Control and Prevention (IUIS-CDC) ACPA reference standard. Recently, the National Institute for Biological Standards and Control (NIBSC) prepared a new candidate ACPA standard (18/204). We evaluated both reference materials using different commercially available ACPA assays. MATERIALS AND METHODS This is an international study in which the NIBSC candidate ACPA standard and the IUIS-CDC ACPA reference material were analysed together with 398 diagnostic samples from individuals with rheumatoid arthritis (RA) and in 1073 individuals who did not have RA using nine commercial ACPA assays. RESULTS For both reference materials and samples from individuals with RA and individuals who did not have RA, there were large differences in quantitative ACPA results between assays. For most assays, values for the IUIS-CDC standard were lower than values for NIBSC 18/204 and the IUIS-CDC/NIBSC ratio was comparable for several, but not all assays. When NIBSC 18/204 was used as a calibrator, an improvement in alignment of ACPA results across several of the evaluated assays was obtained. Moreover, NIBSC 18/204 could align clinical interpretation for some but not all assays. CONCLUSION Adoption of an international standard for ACPA determination is highly desirable. The candidate NIBSC 18/204 standard improved the standardisation and alignment of most ACPA assays and might therefore be recommended to be used as reference in commercial assays.
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Affiliation(s)
- Lieve Van Hoovels
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Laboratory Medicine, Onze-Lieve-Vrouwziekenhuis Aalst, Aalst, Belgium
| | - Lucy Studholme
- NIBSC, National Institute for Biological Standards and Control, Potters Bar, UK
| | | | - Daniela Sieghart
- Division of Rheumatology, Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Carolien Bonroy
- Department of Internal Medicine, Ghent University, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Eszter Nagy
- Department of Laboratory Medicine, National Institute of Locomotor Diseases and Disabilities, Budapest, Hungary
| | - Rille Pullerits
- Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Rheumatology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Sasa Čučnik
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Charlotte Dahle
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ingmar Heijnen
- Department of Laboratory Medicine, University Hospital Basel, Basel, Switzerland
| | - Luca Bernasconi
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Farid Benkhadra
- Department of Laboratory Medicine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Laura Bogaert
- Department of Laboratory Medicine, Onze-Lieve-Vrouwziekenhuis Aalst, Aalst, Belgium
| | | | - Ann Van Liedekerke
- Department of Laboratory Medicine, AZ Sint-Elisabeth Ziekenhuis Zottegem vzw, Zottegem, Belgium
| | - Geert Vanheule
- Department of Laboratory Medicine, AZ Rivierenland, Bornem, Antwerpen, Belgium
| | - Johan Robbrecht
- Department of Laboratory Medicine, AZ Sint-Lucas Bruges, Bruges, Belgium
| | - Claudine Wirth
- Department of Rheumatology, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | | | - Diego Kyburz
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Christopher Sjöwall
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Alf Kastbom
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Rok Ješe
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Boja Jovancevic
- Department of Rheumatology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Emese Kiss
- Department of Clinical Immunology, Adult and Pediatric Rheumatology, National Institute of Locomotor Diseases and Disabilities, Budapest, Hungary
| | - Peggy Jacques
- Department of Rheumatology and VIB Inflammation Research Center, University Hospital Ghent, Ghent, Belgium
| | - Daniel Aletaha
- Division of Rheumatology, Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Günter Steiner
- Division of Rheumatology, Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Patrick Verschueren
- Division of Rheumatology, University Hospital Leuven, Leuven, Belgium
- Department of Development and Regeneration KU Leuven, Skeletal Biology and Engineering Research Center, University Hospital Leuven, Leuven, Belgium
| | - 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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13
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Bossuyt X, Frans G. The added value of reporting likelihood ratios to laboratory test results in allergy and clinical immunology. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1667. [PMID: 35688503 DOI: 10.1016/j.jaip.2022.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/27/2022] [Accepted: 02/22/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Xavier Bossuyt
- Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium; Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium.
| | - Glynis Frans
- Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
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14
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Van Hoovels L, Vander Cruyssen B, Sieghart D, Bonroy C, Nagy E, Pullerits R, Čučnik S, Dahle C, Heijnen I, Bernasconi L, Benkhadra F, Bogaert L, Van Den Bremt S, Van Liedekerke A, Vanheule G, Robbrecht J, Studholme L, Wirth C, Müller R, Kyburz D, Sjöwall C, Kastbom A, Ješe R, Jovancevic B, Kiss E, Jacques P, Aletaha D, Steiner G, Verschueren P, Bossuyt X. Multicentre study to improve clinical interpretation of rheumatoid factor and anti-citrullinated protein/peptide antibodies test results. RMD Open 2022; 8:rmdopen-2021-002099. [PMID: 35321875 PMCID: PMC8943733 DOI: 10.1136/rmdopen-2021-002099] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/21/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Rheumatoid factor (RF) and anti-citrullinated protein/peptide antibodies (ACPA) are important biomarkers for diagnosis of rheumatoid arthritis (RA). However, there is poor harmonisation of RF and ACPA assays. The aim of this study was to refine RF and ACPA interpretation across commercial assays. MATERIALS AND METHODS Six total RF isotype-non-specific assays, 3 RF IgM isotype-specific assays and 9 ACPA immunoglobulin G assays of 13 different companies were evaluated using 398 diagnostic samples from patients with RA and 1073 disease controls. RESULTS Using cut-offs proposed by the manufacturer, there was a large variability in diagnostic sensitivity and specificity between assays. Thresholds of antibody levels were determined based on predefined specificities and used to define test result intervals. Test result interval-specific likelihood ratios (LRs) were concordant across the different RF and ACPA assays. For all assays, the LR for RA increased with increasing antibody level. Higher LRs were found for ACPA than for RF. ACPA levels associated with LRs >80 were found in a substantial fraction (>22%) of patients with RA. CONCLUSION Defining thresholds for antibody levels and assigning test result interval-specific LRs allows alignment of clinical interpretation for all RF and ACPA assays.
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Affiliation(s)
- Lieve Van Hoovels
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium .,Department of Laboratory Medicine, OLV Ziekenhuis, Aalst, Belgium
| | | | - Daniela Sieghart
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Carolien Bonroy
- Department of Internal Medicine, Ghent University, Ghent, Belgium.,Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Eszter Nagy
- Department of Laboratory Medicine, National Institute of Locomotor Diseases and Disabilities, Budapest, Hungary
| | - Rille Pullerits
- Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Gotheburg, Sweden.,Department of Rheumatology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Saša Čučnik
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Charlotte Dahle
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ingmar Heijnen
- Department of Laboratory Medicine, University Hospital Basel, Basel, Switzerland
| | - Luca Bernasconi
- Department of Laboratory Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
| | - Farid Benkhadra
- Department of Laboratory Medicine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Laura Bogaert
- Department of Laboratory Medicine, OLV Ziekenhuis, Aalst, Belgium
| | | | - Ann Van Liedekerke
- Department of Laboratory Medicine, AZ Sint-Elisabeth Ziekenhuis Zottegem, Zottegem, Belgium
| | - Geert Vanheule
- Department of Laboratory Medicine, AZ Rivierenland Campus Bornem, Bornem, Belgium
| | - Johan Robbrecht
- Department of Laboratory Medicine, AZ Sint-Lucas Brugge, Brugge, Belgium
| | - Lucy Studholme
- National Institute for Biological Standards and Control, Hertfordshire, UK
| | - Claudine Wirth
- Department of Rheumatology, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Rüdiger Müller
- Department of Rheumatology, Rheumazentrum Ostschweiz, St. Gallen, Switzerland
| | - Diego Kyburz
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Christopher Sjöwall
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Alf Kastbom
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Rok Ješe
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Boja Jovancevic
- Department of Rheumatology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Emese Kiss
- Department of Clinical Immunology, Adult and Pediatric Rheumatology, National Institute of Locomotor Diseases and Disabilities, Budapest, Hungary
| | - Peggy Jacques
- Department of Rheumatology, University Hospital Ghent and VIB Inflammation Research Center, Ghent, Belgium
| | - Daniel Aletaha
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Guenter Steiner
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Patrick Verschueren
- Department of Rheumatology, KU Leuven University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven Biomedical Sciences Group, Leuven, Belgium
| | - Xavier Bossuyt
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Department of Laboratory Medicine, KU Leuven University Hospitals Leuven, Leuven, Belgium
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15
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Damoiseaux J. Autoantibodies in the criteria of autoimmune diseases: is it sufficient to know that the test is positive? J Transl Autoimmun 2022; 5:100144. [PMID: 35106473 PMCID: PMC8784319 DOI: 10.1016/j.jtauto.2022.100144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Jan Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
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16
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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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17
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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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18
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Spitzenberger F, Patel J, Gebuhr I, Kruttwig K, Safi A, Meisel C. Laboratory-Developed Tests: Design of a Regulatory Strategy in Compliance with the International State-of-the-Art and the Regulation (EU) 2017/746 (EU IVDR [In Vitro Diagnostic Medical Device Regulation]). Ther Innov Regul Sci 2022; 56:47-64. [PMID: 34291407 PMCID: PMC8294224 DOI: 10.1007/s43441-021-00323-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/22/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed at the development of a regulatory strategy for compliance of laboratory-developed tests (LDTs) with requirements of the Regulation (EU) 2017/746 ("EU-IVDR") under consideration of international requirements for LDTs as established in major regulatory regions. Furthermore, it was analysed in how far elements of current LDT regulation could qualify for an internationally harmonised concept ensuring quality, safety and performance of LDTs. METHODS A review of regulatory literature including legislation as well as guidance documents was performed. The regulatory strategy was adapted from international guidance concepts used for commercially marketed IVD. It was then applied to the example of a large medical laboratory in the EU. A high-level comparison was conducted to identify gaps and matches between the different international regulatory requirements for LDTs. RESULTS A four-step strategy for compliance of LDTs with the EU IVDR was implemented in an exemplary medical laboratory. On the basis of an internationally used LDT definition, LDTs constitute nearly 50% of the total IVD devices used in the laboratory. While an ISO 15189-compliant QMS is a major component, it should be accompanied by the application of appropriate processes for risk management, performance evaluation and continuous monitoring of LDTs. At least six criteria represent common characteristics of a potential, internationally convergent concept for the regulation/standardization of LDTs. CONCLUSIONS This study confirms the impact of LDTs for individualized and innovative medical laboratory testing. Prerequisites for LDT use as especially given by the IVDR and missing interpretation in the EU with regard to the scope of LDT definition, the application of standards and the extent of documentation for LDTs currently lead to uncertainties for both laboratories and regulatory bodies responsible for LDT oversight. The characteristics identified as common criteria for ensuring quality, safety and performance of LDTs may be considered as central elements of future international consensus guidance.
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Affiliation(s)
- Folker Spitzenberger
- Centre for Regulatory Affairs in Biomedical Sciences, Technische Hochschule Lübeck, Mönkhofer Weg 239, 23562, Lübeck, Germany.
| | - Jaimin Patel
- Centre for Regulatory Affairs in Biomedical Sciences, Technische Hochschule Lübeck, Mönkhofer Weg 239, 23562, Lübeck, Germany
| | - Inga Gebuhr
- Labor Berlin - Charité Vivantes GmbH, Sylter Strasse 2, 13353, Berlin, Germany
| | - Klaus Kruttwig
- Centre for Regulatory Affairs in Biomedical Sciences, Technische Hochschule Lübeck, Mönkhofer Weg 239, 23562, Lübeck, Germany
- Leibniz Institute of Photonic Technology E.V. Jena, Albert-Einstein-Str. 9, 07745, Jena, Germany
| | - Abdulrahim Safi
- Centre for Regulatory Affairs in Biomedical Sciences, Technische Hochschule Lübeck, Mönkhofer Weg 239, 23562, Lübeck, Germany
| | - Christian Meisel
- Labor Berlin - Charité Vivantes GmbH, Sylter Strasse 2, 13353, Berlin, Germany
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Mahroum N, Zoubi M, Lavine N, Ohayon A, Amital H, Shoenfeld Y. The mosaic of autoimmunity - A taste for more. The 12th international congress of autoimmunity 2021 (AUTO12) virtual. Autoimmun Rev 2021; 20:102945. [PMID: 34509655 DOI: 10.1016/j.autrev.2021.102945] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/29/2021] [Indexed: 12/22/2022]
Abstract
Notwithstanding the fact that the 12th international congress of autoimmunity (AUTO12) was held virtual this year, the number of the abstracts submitted and those presented crossed the thousand marks. Leading investigators and researchers from all over the world presented the latest developments of their research in the domain of autoimmunity and its correlation with various diseases. In terms of mechanisms of autoimmunity, an update on the mechanisms behind the association of autoimmunity with systemic diseases focusing on hyperstimulation was presented during AUTO12. In addition, a new mechanism of ASIA syndrome caused by an intrauterine contraceptive device was revealed demonstrating a complete resolution of symptoms following device removal. In regard to the correlation between autoimmunity and neurogenerative diseases, the loss of structural protein integrity as the trigger of immunological response was shown. Schizophrenia as well, and its correlation to pro-inflammatory cytokines was also addressed. Furthermore, and as it was said AUTO12 virtual due to COVID-19 pandemic, various works were dedicated to SARS-CoV-2 infection and COVID-19 in terms of autoimmune mechanisms involved in the pathogenesis, treatment and complications of COVID-19. For instance, the correlation between autoimmunity and the severity of COVID-19 was viewed. Moreover, the presence and association of autoantibodies in COVID-19 was also demonstrated, as well as the clinical outcomes of COVID-19 in patients with rheumatic diseases. Finally, immune-mediated reactions and processes secondary to SARS-CoV-2 vaccination was displayed. Due to the immense importance of all of the topics addressed and while several hundreds of works were presented which cannot be summed up in one paper, we aimed hereby to highlight some of the outstanding abstracts and presentations during AUTO12.
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Affiliation(s)
- Naim Mahroum
- Internal Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; International School of Medicine, Istanbul Medipol University, Istanbul, Turkey.
| | - Magdi Zoubi
- Internal Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat-Gan, Israel
| | - Noy Lavine
- Internal Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat-Gan, Israel; St. George School of Medicine, University of London, London, UK
| | - Aviran Ohayon
- Internal Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat-Gan, Israel; St. George School of Medicine, University of London, London, UK
| | - Howard Amital
- Internal Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yehuda Shoenfeld
- Ariel University, Ariel, Israel; Saint Petersburg State University, Saint-Petersburg, Russia
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20
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Rönnelid J, Turesson C, Kastbom A. Autoantibodies in Rheumatoid Arthritis - Laboratory and Clinical Perspectives. Front Immunol 2021; 12:685312. [PMID: 34054878 PMCID: PMC8161594 DOI: 10.3389/fimmu.2021.685312] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/20/2021] [Indexed: 01/03/2023] Open
Abstract
Measurement of two groups of autoantibodies, rheumatoid factor (RF) and anti-citrullinated protein/peptide antibodies (ACPA) have gained increasing significance in the diagnosis and classification of rheumatoid arthritis (RA) over the last 65 years. Despite this rising importance of autoimmune serology in RA, there is a palpable lack of harmonization between different commercial RF and ACPA tests. While a minimal diagnostic specificity has been defined for RF tests, which almost always are related to an international reference preparation, neither of this applies to ACPA. Especially assays with low diagnostic specificity are associated with very low positive predictive values or post-test probabilities in real world settings. In this review we focus on issues of practical bearing for the clinical physician diagnosing patients who potentially have RA, or treating patients diagnosed with RA. We advocate that all clinically used assays for RF and ACPA should be aligned to a common diagnostic specificity of 98-99% compared to healthy controls. This high and rather narrow interval corresponds to the diagnostic specificity seen for many commercial ACPA tests, and represents a specificity that is higher than what is customary for most RF assays. Data on antibody occurrence harmonized in this way should be accompanied by test result-specific likelihood ratios for the target diagnosis RA on an ordinal or interval scale, which will provide the clinical physician with more granular and richer information than merely relating numerical values to a single cut-off point. As many physicians today are used to evaluate autoantibodies as positive or negative on a nominal scale, the introduction of test result-specific likelihood ratios will require a change in clinical mindset. We also discuss the use of autoantibodies to prognosticate future arthritis development in at-risk patients as well as predict severe disease course and outcome of pharmacological treatment.
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Affiliation(s)
- Johan Rönnelid
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.,Department of Clinical Immunology and Transfusion Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Carl Turesson
- Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| | - Alf Kastbom
- Department of Rheumatology, Linköping University Hospital, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Fierz W, Bossuyt X. Likelihood Ratio Approach and Clinical Interpretation of Laboratory Tests. Front Immunol 2021; 12:655262. [PMID: 33936083 PMCID: PMC8086426 DOI: 10.3389/fimmu.2021.655262] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/23/2021] [Indexed: 12/12/2022] Open
Affiliation(s)
- Walter Fierz
- Schweizerischer Verband der Diagnostikindustrie (SVDI), Bern, Switzerland
| | - Xavier Bossuyt
- Clinical and Diagnostic Immunology, Department of Microbiology, Immunology and Transplantation, KU, Leuven, Belgium.,Immunology Service, Department of Laboratory Medicine, University Hospitals, Leuven, Belgium
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Damoiseaux J. ANCA Testing in Clinical Practice: From Implementation to Quality Control and Harmonization. Front Immunol 2021; 12:656796. [PMID: 33796118 PMCID: PMC8008144 DOI: 10.3389/fimmu.2021.656796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/24/2021] [Indexed: 01/17/2023] Open
Abstract
Analyses for the presence of anti-neutrophil cytoplasmic antibodies (ANCA) are important in the diagnostic work-up of patients with small vessel vasculitis. Since current immuno-assays are predominantly designed for diagnosis of patients with ANCA-associated vasculitis (AAV), implementation in routine clinical practice, internal and external quality control, and harmonization are focused on this particular use. However, ANCA testing may also be relevant for monitoring therapy efficacy and for predicting a clinical relapse in AAV patients, and even for diagnostic purposes in other clinical situations. In the current review, the topics of implementation, quality control, and standardization vs. harmonization are discussed while taking into account the different applications of the ANCA assays in the context of AAV.
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Affiliation(s)
- Jan Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, Netherlands
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