Evaluation of five commercial assays for the detection of anti-dsDNA antibodies: three Crithidia luciliae indirect immunofluorescence test kits and two enzyme immunoassay kits

OBJECTIVE

There are various methods for anti-dsDNA detection. Crithidia luciliae indirect immunofluorescence test (CLIFT) and enzyme immunoassay (EIA) are the most commonly used at present. A number of CLIFT and EIA kits are commercially available. The objective of the present study was to evaluate the diagnostic performance of three commercial CLIFT kits, two commercial EIA kits, and their combinations for anti-dsDNA detection.

MATERIAL AND METHOD

One hundred thirty nine sera sent for anti-dsDNA testing were investigated. Three commercial CLIFT kits (kit C1, C2, and C3) and two commercial EIA kits (kit E1 and E2) were evaluated. Sensitivities and specificities were calculated. The gold standard methods were the consensus results of all five kits, together with the clinical diagnosis when the results of five kits were discrepant.

RESULTS

Of 139 sera investigated, 94 (67.6%) sera showed concordant results for all five kits and 45 (32.4%) sera showed discordant results. Thirty-five of those 45 patients (77.7%) were diagnosed as SLE. Sensitivities and specificities of the kits were as follows, Cl 82.1% and 94%, C2 46.4% and 100%, C3 78.6% and 98.8%, E1 71.4% and 94%, and E2 75% and 93.8%, respectively. Kit C3 yielded the maximum sum of sensitivity and specificity (177.4%). Sensitivities and specificities of the combinations of CLIFT and EIA kits were as follows, C1 + E1 89.3% and 90.4%, C1 + E2 98.2% and 87.9%, C2 + E1 73.2% and 94%, C2 + E2 82.1% and 92.8%, C3 + E1 85.7% and 94%, and C3 + E2 94.6% and 91.6%, respectively. The combination of kit C3 and E2 yielded the maximum sum of sensitivity and specificity (186.2%).

CONCLUSION

Kit C3 was the assay of choice for anti-dsDNA detection. EIA kits yielded lower sensitivities and specificities than two of three CLIFT kits. Therefore, they should not be used as the first assay for anti-dsDNA screening. When CLIFT and EIA assays were combined, sensitivities were increased Kit E2 helped CLIFT kits to detect more SLE cases than E1.

Antimicrobial peptides play a functional role in bumblebee anti-trypanosome defense

Bumblebees, amongst the most important of pollinators, are under enormous population pressures. One of these is disease. The bumblebee and its gut trypanosome Crithidia bombi are one of the fundamental models of ecological immunology. Although there is previous evidence of increased immune gene expression upon Crithidia infection, recent work has focussed on the bumblebee's gut microbiota. Here, by knocking down gene expression using RNAi, we show for the first time that antimicrobial peptides (AMPs) have a functional role in anti-Crithidia defense.

Immune gene expression in Bombus terrestris: signatures of infection despite strong variation among populations, colonies, and sister workers

Ecological immunology relies on variation in resistance to parasites. Colonies of the bumblebee Bombus terrestris vary in their susceptibility to the trypanosome gut parasite Crithidia bombi, which reduces colony fitness. To understand the possible origin of this variation in resistance we assayed the expression of 28 immunologically important genes in foraging workers. We deliberately included natural variation of the host "environment" by using bees from colonies collected in two locations and sampling active foraging workers that were not age controlled. Immune gene expression patterns in response to C. bombi showed remarkable variability even among genetically similar sisters. Nevertheless, expression varied with parasite exposure, among colonies and, perhaps surprisingly, strongly among populations (collection sites). While only the antimicrobial peptide abaecin is universally up regulated upon exposure, linear discriminant analysis suggests that the overall exposure effect is driven by a combination of several immune pathways and further immune functions such as ROS regulation. Also, the differences among colonies in their immune gene expression profiles provide clues to the mechanistic basis of well-known inter-colony variation in susceptibility to this parasite. Our results show that transcriptional responses to parasite exposure can be detected in ecologically heterogeneous groups despite strong background noise.

Single and mixed-species trypanosome and microsporidia infections elicit distinct, ephemeral cellular and humoral immune responses in honey bees

Frequently encountered parasite species impart strong selective pressures on host immune system evolution and are more apt to concurrently infect the same host, yet molecular impacts in light of this are often overlooked. We have contrasted immune responses in honey bees to two common eukaryotic endoparasites by establishing single and mixed-species infections using the long-associated parasite Crithidia mellificae and the emergent parasite Nosema ceranae. Quantitative polymerase chain reaction was used to screen host immune gene expression at 9 time points post inoculation. Systemic responses in abdomens during early stages of parasite establishment revealed conserved receptor (Down syndrome cell adhesion molecule, Dscam and nimrod C1, nimC1), signaling (MyD88 and Imd) and antimicrobial peptide (AMP) effector (Defensin 2) responses. Late, established infections were distinct with a refined 2 AMP response to C. mellificae that contrasted starkly with a 5 AMP response to N. ceranae. Mixed species infections induced a moderate 3 AMPs. Transcription in gut tissues highlighted important local roles for Dscam toward both parasites and Imd signaling toward N. ceranae. At both systemic and local levels Dscam, MyD88 and Imd transcription was consistently correlated based on clustering analysis. Significant gene suppression occurred in two cases from midgut to ileum tissue: Dscam was lowered during mixed infections compared to N. ceranae infections and both C. mellificae and mixed infections had reduced nimC1 transcription compared to uninfected controls. We show that honey bees rapidly mount complex immune responses to both Nosema and Crithidia that are dynamic over time and that mixed-species infections significantly alter local and systemic immune gene transcription.

Infection with the trypanosome Crithidia bombi and expression of immune-related genes in the bumblebee Bombus terrestris

Social bees and other insects are frequently parasitized by a large range of different microorganisms. Among these is Crithidia bombi (Kinetoplastida: Trypanosomatidae), a common gut parasite of bumblebees, Bombus spp. (Insecta: Apidae). Bumblebees are important pollinators in commercial and natural environments. There are clear detrimental effects of C. bombi infections on the fitness of bumblebees. However, little has been known about how the bee's immune system responds to infections with trypanosome parasites. Here, we study the immune response of Bombus terrestris on infection by C. bombi. We measured the expression of four immune-related genes (Hemomucin, MyD88, Relish, and TEP7) using RT-qPCR in adult B. terrestris workers that were either healthy or infected with the trypanosome parasite C. bombi. The potential recognition gene Hemomucin was significantly upregulated in the infected bees. Further, there was substantial and significant variation in all four genes among different bumblebee colonies irrespective of infection status.

Clinical significance of ELISA positive and immunofluorescence negative anti-dsDNA antibody

BACKGROUND

Positivity for anti-dsDNA antibody is a diagnostic criterion of systemic lupus erythematosus (SLE). In the present study, the significance of ELISA positive and Crithidia luciliae immunofluorescence test (CLIFT) negative anti-dsDNA sera was evaluated.

METHODS

There were 371 consecutive serum samples submitted to for anti-dsDNA testing that were assayed using anti-dsDNA ELISA and CLIFT. Sera showing discrepant results were collected and then examined using 3 commercial anti-dsDNA and anti-ssDNA ELISA kits and by Farr assay. Medical records were reviewed for those patients who were ELISA positive and CLIFT negative for anti-dsDNA.

RESULTS

Fifty-two patients of 100 anti-dsDNA ELISA positive patients were negative by CLIFT. For ELISA positive and CLIFT negative sera, Farr assays showed the highest positive rate (72.7%) for the 4 different anti-dsDNA assays (3 commercial kits and the Farr assay). Nearly 80% of 44 ELISA positive and CLIFT negative patients met >or=3 of the SLE classification criteria (excluding the anti-dsDNA criterion).

CONCLUSION

Some anti-dsDNA ELISA kits have diagnostic efficiencies that are similar to that of the Farr assay. Moreover, the study identifies a group of patients that are ELISA positive but CLIFT negative for anti-dsDNA, and indicates that the majority of these patients have clinically relevant SLE.

[Immunofluorescence assay with Crithidia luciliae for the detection of anti-DNA antibodies. Atypical images and their relationship with Chagas' disease and leishmaniasis]

Anti-native DNA antibodies can be detected by indirect immunofluorescence assay with Crithidia luciliae, displaying an annular image due to a kinetoplast containing double stranded DNA. Other structures such as membrane, flagellum and basal corpuscle can be stained as well, showing what is called atypical fluorescent images. As C. luciliae belongs to the Trypanosomatidae family, which include the human pathogens Trypanosoma cruzi and Leishmania spp., it was considered that these atypical images could be caused by cross-reactions. Serological studies for Chagas' disease were performed in 105 serum samples displaying atypical images. Sixty four percent of the samples from non endemic and 78.3% from endemic areas for Chagas' disease showed fluorescence in both, membrane and flagellum (joint image). Fifty samples from normal blood donors and 57 samples from patients with conective tissue diseases were tested with C. luciliae. None of them presented the joint image except for two patients with lupus who were also chagasic. In addition, 54 samples from chagasic patients were studied and all of them presented the joint image. We also studied 46 samples from patients with leishmaniasis from whom 28 were coinfected with T. cruzi. The joint image was observed in 88.0% of the samples with leishmaniasis and in 89.3% of the co-infected samples. The results suggest that C. luciliae could be used as an economical, and of low risk, alternative substrate for the serological diagnosis of Chagas' disease, even though it does not discriminate for Leishmania spp. infection. This study also suggests that whenever atypical images are observed in C. luciliae during the search for anti-DNA antibodies, it would be convenient to submit the patient to clinical and serological tests for the diagnosis of leishmaniosis and Chagas' disease.

Antibodies against Leishmania cross-react with Crithidia luciliae: indirect immunofluorescence and Dot-ELISA study in dogs

Leismaniasis is zoonotic parasitic disease distributed in many areas of Mediterranean basin. Because of its pathogenicity and difficulty to grow in vitro, we used Leishmania infantum as primary and Crithidia luciliae as secondary source of antigen. We compared 100 canine sera by indirect immunofluorescence and Dot-ELISA. Both atigens showed same results.

Cross-recognition between histones and La/SSB may account for anti-DNA reactivity in SLE patients

Antibodies to La/SSB are detected in sera of patients with primary Sjogren's syndrome (pSS) and systemic lupus erythematosus (SLE). The vast majority of anti-La/SSB positive sera contain antibodies directed towards a linear B-cell epitope of La/SSB spanning the sequence 349-364aa (pep349-364). The aim of this study was to evaluate the fluctuation of antibody levels to major B-cell epitopes of La/SSB over time and investigate for their possible crossreactions. Sequential sera from 15 SLE and 15 pSS patients, followed from 3 to 10 years were obtained. All patients with SLE were positive for anti-Ro/SSA, anti-La/SSB and anti-dsDNA antibodies and patients with pSS were positive for anti-Ro/SSA and anti-La/SSB antibodies. Sera from 30 patients with SLE without anti-La/SSB antibodies and 30 healthy individuals served as disease and negative control respectivelly. All sera tested for the presence of anti-pep349-364 antibodies, using a specific ELISA. Specific anti-pep349-364 IgG was purified from sera of SLE patients and evaluated for cross reactivity against dsDNA and histones. In all SLE sera the levels of anti-pep349-364 antibodies varied in time and fluctuated in parallel with anti dsDNA antibodies. Anti-pep349-364 IgG purified from 7 SLE patients. Five out of 7 were found to react with calf thymus DNA in ELISA. All purified (7/7) anti-pep349-364 IgG preparations reacted with histone H1 and failed to produce a positive immunofluorescence pattern in Crithidia luciliae anti-dsDNA assay which lacks histones. Competative inhibition experiments demonstrated that histone H1 could inhibit completely the binding of anti-pep349-364 IgG to pep349-364 while pep349-364 inhibited by 70% the binding of anti-pep349-364 IgG to histone H1. These findings indicate that a subgroup of SLE patients possess cross-reacting anti-histone H1 antibodies and anti-pep349-364 antibodies, which can be faulty considered as anti-dsDNA reactivity in regular ELISA techniques.

Antinuclear Antibodies in Domestic Animals

Antinuclear antibodies in domestic animal species have been commonly detected for many years, with the greatest frequency occurring in dogs as well as horses and cats. Most commonly, the assay used in diagnostic laboratories is indirect immunofluorescence on HEP-2 cells, similar to that used in human medicine, but with the exception that species-specific antiglobulin reagents are used instead of antihuman immunoglobulin. To a lesser extent, the Crithidia luciliae test for antibodies to double-stranded DNA has been used. Several research groups have used other assays.

Gene immunization may induce secondary antibodies reacting with DNA

The fear of autoimmunity in DNA-vaccine recipients initiated screening for anti-DNA antibodies in rabbits immunized with genes of viral nucleic acid-binding and adapter proteins. Of 11 DNA/protein-immunized rabbits, seven had developed secondary antibodies against DNA detected at weeks 11-50 from the on-start of immunization. Two rabbits immunized with HIV-1 reverse transcriptase gene developed transient anti-double-stranded DNA antibodies of high avidity that recognized DNA in the kinetoplasts of Crithidia luciliae. Others developed antibodies reacting with DNA in ELISA and targeting nuclear-associated antigens in the immunofluoresence test. No anti-DNA antibodies were detected at these time-points in any of the controls (P=0.036). Induction of anti-DNA antibodies by epitope spreading from protein domains involved in nucleic acid-binding versus maturation of anti-protein antibodies to dual protein-DNA specificity is discussed. (126 words).

Anti-dsDNA antibodies and disease classification in antinuclear antibody positive patients: the role of analytical diversity

BACKGROUND

The presence of "anti-DNA antibodies in abnormal titres" is a well established criterion for SLE classification, but there is no agreement on the performance of this test.

OBJECTIVE

To study the correlation between clinical findings and five different solid and solution phase anti-DNA antibody assays.

METHODS

158 consecutively collected ANA positive sera were studied in a double blind fashion. Anti-DNA antibodies were determined by different solid phase assays (ssDNA-, dsDNA- specific ELISA, EliA anti-dsDNA assay, Crithidia luciliae assay), and by an experimental solution phase anti-DNA assay using biotinylated pUC18 plasmid, human, calf thymus, and E coli DNA. Antibody affinity was determined by surface plasmon resonance. Clinical data were obtained independently of the laboratory analyses and later related to the anti-dsDNA findings.

RESULTS

Anti-dsDNA antibodies were most frequently detected by ELISA, but were not specific for SLE as they were present in up to 30% of other disease groups. Those detected by the Crithidia luciliae assay were predictive for SLE, while antibodies binding in solution phase ELISA using the pUC18 correlated strongly with the Crithidia luciliae assay. Surface plasmon resonance analysis showed that antibody binding to pUC18 was not due to higher relative affinity for dsDNA in general, but apparently to specificity for that plasmid DNA. Serum samples from three patients with lupus nephritis were positive in both pUC18 solution phase and Crithidia luciliae assays.

CONCLUSIONS

Assay principle selection is decisive for the detection of clinically significant anti-DNA antibodies. Revision of the anti-DNA antibody criterion in the SLE classification may be needed.

Genome scan stratified by the presence of anti-double-stranded DNA (dsDNA) autoantibody in pedigrees multiplex for systemic lupus erythematosus (SLE) establishes linkages at 19p13.2 (SLED1) and 18q21.1 (SLED2)

Anti-double-stranded DNA (anti-dsDNA) is arguably one of the most specific autoantibodies in systemic lupus erythematosus (SLE). This antibody is associated with more severe SLE and with glomerulonephritis. From 196 pedigrees multiplex for SLE, we selected those that had any SLE affected positive for anti-dsDNA by the Crithidia luciliae kinetoplast imunofluorescence assay. This stratification strategy tested the hypothesis that anti-dsDNA would identify a more genetically homogeneous group of pedigrees, in which previously undetected linkage effects could be established. A genome screen data for linkage to SLE was available at 307 microsatellite markers for this selected group of 71 pedigrees: 37 European-American, 29 African-American, and five others. The most significant results were obtained at 19p13.2 (LOD(max) = 4.93), named SLED1, in the 37 European-American pedigrees using a dominant model with mixed penetrances (92% for females and 49% for males) at 100% homogeneity (theta = 0). A second linkage effect, SLED2, was established in the 29 African-American pedigrees at 18q21.1 (LOD(max) = 3.40) using a recessive model with 100% penetrance (theta = 0.1). Parametric and non-parametric multipoint analyses were performed, which provided further evidence and support of susceptibility genes residing in these regions. In conclusion, two powerful linkages have been detected with SLE based on the presence of anti-dsDNA. These findings show SLE to be a richly complicated disease phenotype that is now ripe for important new discovery through a genetic approach.

Titration emulation: a computer-assisted technique that simplifies the quantification of anti-dsDNA antibodies using the Crithidia luciliae assay

Titers of anti-double-stranded (ds) DNA antibodies in sera from patients with systemic lupus erythematosus (SLE) using the Crithidia luciliae assay method were compared by conventional titration vs the titration emulation method (ImageTiter) to evaluate whether the latter assay can replace manual titration. Titers by the two methods were identical or within one dilution in 98% (41/42) of samples. A single sample showed a two-dilution difference. Titration emulation showed a tendency to under-estimate the titer of high titer anti-dsDNA samples, although the difference was small. Titration emulation is a suitable alternative to the conventional titration method, offering an accurate and cost-effective approach to quantification of anti-dsDNA antibodies.

Immune response of Drosophila melanogaster to infection with the flagellate parasite Crithidia spp

Insects are able to recognize invading microorganisms and to mount an immune response to bacterial and fungal infections. Recently, the fruitfly Drosophila melanogaster has emerged as a promising invertebrate model to investigate innate immunity because of its well-characterized genetics. Insects are also vectors of numerous parasites which can trigger an immune response. We have investigated the interaction of Drosophila melanogaster with the flagellate protozoan Crithidia spp. We show that a per os parasitic infection triggers the synthesis of several antimicrobial peptides. By reverse phase HPLC and mass spectrometry, peptides were shown to be present in the hemolymph and not in the gut tissue, suggesting the presence of immune messengers between the site of the infection, namely the gut, and the fat body, the main site of synthesis for antimicrobial peptides. Interestingly, we have identified one molecule which is specifically induced in the hemolymph after infection with Crithidia, but not with bacteria, suggesting that Drosophila can discriminate between pathogens. When flagellates were injected into the hemolymph, a low synthesis of antimicrobial peptides was observed together with phagocytosis of parasites by circulating hemocytes. The data presented here suggest that Drosophila-Crithidia spp. represents an interesting model to study host defense against protozoan parasites.

Systemic lupus erythematosus in mice, spontaneous and induced, is associated with autoimmunity to the C-terminal domain of p53 that recognizes damaged DNA

The tumor suppressor molecule p53 features a regulatory domain at the C terminus that recognizes damaged DNA. Since damaged DNA might be involved in activating anti-DNA autoantibodies, we tested whether autoimmunity to the C terminus of p53 might mark murine systemic lupus erythematosus (SLE). We now report that MRL / MpJ-Fas(lpr) mice, which spontaneously develop SLE, produce antibodies both to the C terminus of p53 and to a monoclonal antibody (PAb-421) that binds the p53 C terminus. Anti-idiotypic antibodies to PAb-421 (sampled as monoclonal antibodies) could also bind DNA. Thus, the PAb-421 antibody mimics DNA, and the anti-idiotypic antibody to PAb-421 mimics the p53 DNA-binding site. This mimicry was functional; immunization of BALB / c mice to PAb-421 induced anti-DNA antibodies and antibodies to the C terminus of p53, and most of the mice developed an SLE-like disease. Immunization of C57BL / 6 mice to PAb-421 induced antibodies to p53, but not to its C-terminal domain. The C57BL / 6 mice also did not develop anti-DNA antibodies or the SLE-like disease. Thus, network autoimmunity to the domain of p53 that recognizes damaged DNA can be a pathogenic feature in SLE in genetically susceptible strains of mice.

Measurement of anti-dsDNA: a comparative study of two ELISA and the Crithidia assay

We compared the measurement of anti-dsDNA by a commercial ELISA test (DIASTAT), an in-house ELISA and the Crithidia luciliae assay in cross-sectional sera samples of 209 systemic lupus erythematosus (SLE) patients and 64 patients with a variety of rheumatological, autoimmune and non-autoimmune diseases in Hong Kong. The Crithidia assay was found to be the least sensitive (17%) but most specific (95%) method for detection of a positive result in SLE patients. The DIASTAT assay has a higher sensitivity (68%) but lower specificity (80%) than the in-house ELISA test (32% sensitivity and 89% specificity). The positive predictive value of the three assays are comparable at 90-92% while DIASTAT had the highest negative predictive value (44%). There was good linear correlation (r = 0.7) between the two ELISAs. ELISA can serve as a useful screening test for anti-dsDNA in SLE patients and doubtful cases can then be confirmed by another method such as radio-immunoassay.

Serodiagnosis of American trypanosomosis by using nonpathogenic trypanosomatid antigen

Crithidia luciliae, a nonpathogenic trypanosomatid, could provide a good alternative source of antigen for serodiagnosis of Chagas' disease. An enzyme-linked immunosorbent assay showed 100% sensitivity and 83% specificity when 91 human serum samples from Chagas' disease patients and 127 human serum samples from people suffering from toxoplasmosis (21 samples), leishmaniasis (32 samples), systemic rheumatic diseases (33 samples), and heart diseases (41 samples) were tested simultaneously with Trypanosoma cruzi and C. luciliae crude extracts. By Western blotting, an immunodominant band (30 kDa) was recognized by chagasic sera on the C. luciliae crude extract; specificity reached 97% with respect to this protein band. The carbohydrate moieties were not antigenic.

Indirect immunoperoxidase staining of Crithidia luciliae for detecting anti-dsDNA: comparison with other serodiagnostic tests

The indirect immunoperoxidase (IIP) method was modified and improved for detecting anti-dsDNA. Using fetal calf serum to block the non-specific antibodies and staining with chromatic substrate solution at pH 6.2, the performance time is substantially decreased and the patterns of positive and negative staining are easily distinguished. IIP was compared with indirect hemagglutination (IHA), latex agglutination (LA) and the standard method indirect immunofluorescent technique (IFT). The sensitivities and specificities of the three methods were studied in 507 sera from various sources. Using IFT as the gold standard, sensitivities of IIP, IHA, LA were 98.18%, 88.18% and 50.91% respectively, and the corresponding specificities were 99.5%, 98.24% and 100%. There was a good correlation between titers of IFT and IIP (Spearman correlation coefficient = 0.77, p < 0.001) with no significant difference between the titer of both tests (Wilcoxon Matched-Pairs Signed-Rank test, p = 0.143). These results indicate that the modified IIP method is both highly sensitive and specific and only needs a light microscope to perform it.

[Detection of dsDNA antibodies in diagnosis of systemic lupus erythematosus--comparative studies of diagnostic effectiveness of 3 ELISA methods with different antigens and a Crithidia luciliae immunofluorescence test]

Antibodies to double-stranded DNA (anti-dsDNA, dsDNA-Ab) are frequently found in systemic lupus erythematosus (SLE), especially during active disease and differ with respect to immunoglobulin class and avidity. The detection of anti-dsDNA is one of the diagnostic criteria for SLE according to the American College of Rheumatology (ACR). Most of the commercial ELISA test systems have great advantages in routine laboratory testing but often detect dsDNA-Ab which are not specific for SLE and therefore give false positive results for non-SLE patients. The newly developed ELISA presented here, using human recombinant dsDNA (h-Rek) is compared to two commercial ELISA tests with genomic dsDNA from salmon testes (L-dsDNA) or plasmid dsDNA (P-dsDNA) and to the Chrithidia luciliae immunofluorescence test (CLIF) as well. In this study 143 sera were tested, 48 derived from patients with SLE, 40 from rheumatoid arthritis patients, 26 from non-rheumatoid patients whose sera were ANA-negative but L-dsDNA-Ab-positive and 30 from healthy volunteers. All patients were followed and clinically defined by the rheumatology outpatient clinic of our hospital. The prevalence for SLE of all sera was 32%. The sensitivity was 0.73 (h-Rek), 0.83 (L-dsDNA), 0.81 (P-dsDNA) and 0.57 (CLIF); specificity was determined 0.84 (h-Rek), 0.62 (L-dsDNA), 0.63 (P-dsDNA) and 0.98 (CLIF). The diagnostic efficiency of the L-dsDNA- and P-dsDNA-assay was identical, 0.69, and amounted to 0.81 for the h-Rek and 0.84 for the CLIF. Comparing all the ELISA tests and CLIF, the human recombinant dsDNA ELISA is much more sensitive than the CLIF, but considerably more specific than the ELISA assays using genomic or plasmid DNA, whereas the diagnostic efficiency is very close to that of the CLIF. This new generation of anti-dsDNA ELISA using human recombinant dsDNA seems to be a much better diagnostic tool for the detection of highly specific anti-dsDNA antibodies in the diagnosis of SLE than other commercial ELISAs. These results can only be explained by the use of a human recombinant antigen instead of undefined genomic or recombinant plasmid DNA for immobilization.

Induction of cross-reactive anti-dsDNA antibodies in preautoimmune NZB/NZW mice by immunization with bacterial DNA

To investigate the role of antigen drive in anti-double-stranded (ds) DNA production, the antibody response induced in lupus-prone NZB/NZW mice by E. coli (EC) dsDNA was evaluated. Preautoimmune NZB/NZW female mice were immunized with complexes of EC dsDNA with methylated bovine serum albumin (mBSA) in complete Freund's adjuvant; control mice received either mBSA complexes with calf thymus (CT) dsDNA or mBSA alone in adjuvant. IgG antibody responses were assessed by ELISA. Similar to normal mice, immunized NZB/NZW mice produced significant levels of anti-dsDNA when measured with EC dsDNA as antigen. Whereas normal mice produce antibodies which are specific for the immunizing bacterial DNA, NZB/NZW mice produced antibodies that bound crossreactively to CT dsDNA by ELISA. Furthermore, the induced antibodies resembled lupus anti-DNA in their fine specificity for polynucleotide antigens and reactivity with Crithidia luciliae DNA. Despite their response to EC dsDNA, NZB/NZW mice immunized with CT dsDNA failed to generate significant anti-dsDNA responses. These results provide further evidence for the enhanced immunogenicity of bacterial DNA and suggest that immune cell abnormalities in NZB/NZW mice promote the generation of crossreactive autoantibody responses when confronted with a foreign DNA.

Production and analysis of IgG monoclonal anti-DNA antibodies from systemic lupus erythematosus (SLE) patients

This study compares recently devised methods for producing IgG anti-DNA MoAbs from patients with SLE and analyses the antibodies generated from one patient at different phases of disease. Lymphocytes from SLE patients were transformed with Epstein-Barr virus(EBV) and/or fused with a heteromyeloma cell line, CB-F7. Direct fusion with CB-F7 resulted in the highest proportion of IgG-secreting lines, whereas EBV transformation resulted in a high percentage of IgM-secreting lines. Using direct fusion, five IgM anti-DNA antibody-secreting hybridomas were generated using lymphocytes from a patient with relatively inactive SLE. Six months later when the disease was active, only IgG anti-DNA antibodies were produced. The antigen-binding patterns of the MoAbs were analysed. Only one of the IgM anti-DNA antibodies reacted with dsDNA by ELISA and none by Crithidia immunofluorescence, whereas two of the IgG antibodies reacted with dsDNA by ELISA and Crithidia but did not bind to ssDNA. Only the two IgG high affinity anti-dsDNA antibodies bound to histones, and this was enhanced by added DNA, whereas three IgM antibodies bound to cardiolipin. This study supports the notion that MoAbs derived from a patient with SLE represent those found in the serum of SLE patients at different stages of disease activity. The binding to histones by the two IgG anti-dsDNA antibodies supports the recently expressed view that antibodies binding DNA/histone may be important in the pathogenesis of SLE.

The clinical significance of measuring different anti-dsDNA antibodies by using the Farr assay, an enzyme immunoassay and a Crithidia luciliae immunofluorescence test

Anti-double-stranded DNA (dsDNA) antibodies are highly specific for the diagnosis of systemic lupus erythematosus (SLE) but are heterogeneous in respect to, for example, avidity, class and cross-reactivity. Sera from 2061 patients were measured by three methods: an enzyme-linked immunosorbent assay (ELISA), an indirect immunofluorescence test with Crithidia luciliae as substrate (CLIF), and the Farr assay, a radioimmunological method based on the ammonium sulfate precipitation of immune complexes. The different anti-dsDNA antibody determinations were evaluated by analysis of patient records. The reason for a reactive Farr assay in 14 patients was predominantly the measurement of antibodies of the IgM class, which are not detected by the ELISA. The detection of additional antibodies to dsDNA of the IgA class, to single-stranded DNA or to histones plays a minor role. In comparison with the Farr assay, we found more positive results with the ELISA, which additionally detects anti-dsDNA antibodies of low avidity. The ELISA might also yield positive values in conditions such as chronic liver diseases, various infections and connective tissue diseases other than SLE. Avoiding the disadvantages of radioactivity, the ELISA is well suited as a screening test for dsDNA antibodies. However, positive results should be confirmed by the CLIF test or preferably by the Farr assay, thus combining sensitivity with specificity.

Measurement of anti-DNA antibodies by ELISA: a comparative study with Crithidia and a Farr assay

One hundred and twenty six sera from 116 patients with systemic lupus erythematosus (SLE) and from 51 control patients were assayed for the presence of anti-DNA antibodies, using a commercial enzyme linked immunosorbent assay (ELISA). Fifty three sera (42%) from SLE patients were positive and a further 13 sera (10%) fell in the 'equivocal' positive range. Three control sera were positive. In a standard 14C DNA Farr assay, 67 sera (53%) from SLE patients were positive. One control serum was weakly positive. There was a good linear correlation between absorption in the ELISA and the 14C DNA binding result (r = 0.73). Results in the ELISA and Farr assays were concordant in 96 of the 126 SLE sera, and 47 of 51 control sera. Sequential sera from a further 6 patients with fluctuating clinical activity of SLE showed similar patterns of change of anti-DNA antibodies in both assays. The ELISA was more sensitive than the Crithidia luciliae immunofluorescence assay which detected 44 positive sera (35%) in the SLE group. These results suggest that this ELISA assay may be a useful alternative to the Crithidia assay or an effective screen prior to testing in the more technically difficult and time consuming Farr assay for the measurement of anti-DNA antibodies.

Identification of C3 acceptors responsible for complement activation in Crithidia fasciculata

Crithidia fasciculata, an insect trypanosomatid is readily lysed by normal human serum at concentrations as low as 3%. Lysis occurs in the presence of Mg+2-EGTA and is antibody independent, indicating that the alternative pathway of complement activation is involved. Analysis of [131I]C3 deposition on C. fasciculata cells using C8-deficient serum, revealed that about 4 x 10(5) C3 molecules bound to each cell. Most of the C3 was bound to cells as C3b, part of it forming high molecular weight complexes, which could be dissociated by methylamine treatment at alkaline pH. To characterize the C3 acceptors on C. fasciculata, surface-iodinated cells were incubated with C8D or heat-inactivated serum, extracted and immunoprecipitated with anti-C3 or anti-arabinogalactan antisera. Analysis of the immunoprecipitated material on SDS gels showed high-molecular weight components, which disappeared after methylamine treatment, giving rise to a component of 200 kDa molecular size. This 200-kDa component corresponded to a purified arabinogalactan complex, which was immunoprecipitated from labeled cell extracts, without incubation with C8D, using anti-arabinogalactan antibodies. These results suggest that the arabinogalactan glycoconjugate is a C3 acceptor in C. fasciculata during complement activation. Purified arabinogalactan complexes were able to inactivate C3 in vitro. Solubilization in KOH to cleave the peptide moiety rendered it unable to inactivate C3. Apparently, the aggregated state of the purified arabinogalactan component at the cell surface is important for C3 deposition and activation.

Detection of anti-DNA antibodies: a comparison between two Farr assays, Crithidia luciliae and a human chromosomal substrate assay

Four commercially available assays were compared with a 14C DNA Farr assay for their ability to detect anti-DNA antibodies in 119 sera from 109 patients with systemic lupus erythematosus (SLE) and 25 control sera. The 14C DNA Farr assay was the most sensitive and specific assay (SLE, 57% positive, controls, 0%). A commercial 125I DNA Farr assay was significantly less sensitive (SLE, 39% positive). The fluorescence human chromosomal preparation assay was as sensitive as the 14C DNA Farr assay (SLE, 58% positive) but less specific (controls, 8% positive). The immunofluorescence Crithidia luciliae assay was specific, but less sensitive (SLE, 37% positive) than the 14C DNA Farr assay. Adaptation of Crithidia to immunoperoxidase did not alter its sensitivity or performance. These results confirm that the 14C DNA Farr assay, locally refined and performed by experienced hands, is the most sensitive and specific assay for anti-DNA antibodies. The 125I DNA Farr was no more sensitive than the Crithidia assay but considerably more laborious. The human chromosomal preparation may be suitable as a rapid screening test for anti-DNA antibodies.

Evidence for absence of histones in the Crithidia luciliae kinetoplast: a study with anti-H2A and monoclonal anti-H3 antibodies

Recently, the specificity of the Crithidia luciliae immunofluorescent assay for the detection of antibodies to double-stranded deoxyribonucleic acid (dsDNA) has been questioned. It has been proposed that the kinetoplast of this trypanosome-like organism contains antigenic determinants other than dsDNA, presumably histones. Using anti-H2A and monoclonal anti-H3 antihistone antibodies, we have proved that there are no histones present in the Crithidia luciliae kinetoplast. False-positive results from the assay may be due to binding of antibodies to unidentified kinetoplast acid-extractable antigens other than histones.

The primary immune response of the green toad (Bufo viridis) to challenge with Crithidia fasciculata

The primary immune response of the green toad (Bufo viridis) following immunization with Crithidia fasciculata choanomastigotes was studied. Lysins, agglutinins, and antibodies detectable by enzyme-linked immunosorbent assay (ELISA) were first detected in the sera of immunized animals one week after injection. The antibody titers increased to significant levels (P less than 0.01) and maximum values were reached seven weeks post-immunization. The stimulated immunoglobulins were antigen-specific, partially heat-labile, sensitive to the reducing agent dithiothreitol, possessed precipitin activity, effectively fixed complement and exhibited an electrophoretic mobility similar to the gamma-globulins of human serum. On this basis, it is probable that the antibody produced during the primary response in green toads is high molecular weight IgM. Increases in serum lysozyme levels paralleled the rise of antibody titers. Overall, the lysozyme concentration increased two-fold compared to the appropriate controls. This is the first report of the immune response in amphibians to experimental injection with protozoan parasites and the use of the ELISA technique to detect antibodies in amphibian sera.

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

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

Monoclonal antibodies against a 60 kDa phenothiazine-binding protein from Trypanosoma brucei can discriminate between different trypanosome species

The dominant structure of the cytoskeleton of the Trypanosomatidae consists of a tight array of singlet pellicular microtubules, which surround the entire cell body. These microtubules are in close and stable contact with the cellular membrane. These contacts can be selectively disrupted by the action of phenothiazine drugs, which are potent trypanocides in vitro. Phenothiazine-affinity chromatography of detergent solubilized proteins from Trypanosoma brucei has resulted in the isolation of a protein of an apparent molecular weight of 60 000. Polyclonal antibodies raised against this protein (p60) have been used to investigate the presence of similar proteins in other protozoa. No such crossreacting proteins have been observed outside the family Trypanosomatidae. Within this family, a strong crossreactivity was observed with Crithidia fasciculata, while only a marginal reaction was seen with two species of Leishmania and, quite unexpectedly, also with the stercorarian trypanosomes T. cruzi and T. rangeli. Different monoclonal antibodies against p60 are able to clearly distinguish different subgenera of salivarian trypanosomes, and most notably to differentiate between various isolates of T. congolense. Therefore, these antibodies may prove valuable for diagnostic and epidemiological applications.

Anti-DNA antibodies of IgA class in patients with systemic lupus erythematosus

Sera obtained from 53 patients with systemic lupus erythematosus (SLE) were investigated for the presence of immunoglobulin class-specific antibodies against native (ds)DNA and denatured (ss)DNA. The methods employed were the Crithidia luciliae test and an enzyme-linked immunosorbent assay (ELISA), respectively. Anti-dsDNA antibodies of IgG class were seen in 42%, IgM-anti-dsDNA antibodies in 43%, and IgA-anti-dsDNA antibodies in 30% of the patients. There was an association between the presence of both IgG- and IgA anti-dsDNA antibodies and the activity of the disease. Patients with active nephritis also had anti-dsDNA antibodies of IgG and IgA class significantly more often than patients with inactive nephritis or without renal disease. IgG-anti-ssDNA antibodies were seen in 89%, IgM-anti-ssDNA antibodies in 51%, and IgA-anti-ssDNA antibodies in 66% of the patients. Patients with nephritis had low levels of antibodies to ssDNA of IgM class. We suggest that immunoglobulin class-specific anti-DNA antibodies should be determined in the diagnosis and monitoring of SLE.

Complement-fixing antibodies to dsDNA detected by the immunofluorescence technique on Crithidia luciliae. A critical appraisal

Studies using an adapted immunofluorescence technique (IFT) on Crithidia luciliae to determine the complement fixing ability of antibodies to dsDNA in relation to disease manifestations, i.e., nephritis, have yielded conflicting results. To establish the relevance of these determinations, we studied sera containing antibodies to dsDNA from 64 patients with systemic lupus erythematosus (SLE), and found that anti-dsDNA of 52% of these sera had the ability to fix complement. SLE patients with nephritis demonstrated a much higher incidence of complement fixing anti-dsDNA (83%) than patients without nephritis (17%, p less than 0.01). On the other hand, patients with nephritis also had higher titers of anti-dsDNA (mean 1:400) than patients without nephritis (mean titer 1:75; p less than 0.01). A clearcut correlation between anti-dsDNA titer and complement fixing anti-dsDNA titer (p less than 0.01) was observed which obviously disturbs the correlation between nephritis and complement fixing anti-dsDNA. Comparing matched sera from patients with nephritis and patients without nephritis with the same antidsDNA titer, we found no difference in complement fixing anti-dsDNA. In the IFT used to measure complement fixing anti-dsDNA, incubation of the Crithidia slides with patients' serum was followed by an incubation with fresh normal serum which served as a source of complement. We observed that this incubation with fresh normal serum resulted in elution of anti-dsDNA antibodies from kinetoplast DNA. This elution was caused by IgG present in normal serum.

Specificity of the Crithidia luciliae method for detecting anti-DNA antibodies. Effect of absorption for lipoproteins

Using the immunofluorescent (IF) assay with Crithidia luciliae smears, anti-native (n) DNA antibodies were detected in the sera of 12 of 20 systemic lupus erythematosus (SLE) patients, in 1 of 6 mixed connective tissue disease cases, in 2 of 38 patients with systemic sclerosis but in none of the sera from 96 normal subjects. All anti-nDNA antibodies were associated with antinuclear antibodies (ANA). However, occasionally sera were encountered in routine screening which appear to be positive for anti-DNA antibodies but negative for ANA. Studies of such sera indicate that this is a nonspecific reaction which can be abolished by treating sera with dextran sulfate or heparin. Treatment of SLE sera with these agents had no effect on their anti-nDNA antibody activity. Absorption of sera with Aerosil eliminated the false positive reactions with C. luciliae; however, this treatment also removed immunoglobulins, ANA and anti-nDNA antibodies. Evidence is reviewed which points to a role of complexes of low density lipoprotein and IgG in the nonspecific binding reactions with C. luciliae which is seen as false positive reactions for anti-nDNA antibodies.

Homologies between paraflagellar rod proteins from trypanosomes and euglenoids revealed by a monoclonal antibody

A Nonidet P 40 insoluble fraction was isolated from Trypanosoma brucei and was used to raise a monoclonal antibody (5E9). The antigen was localized by indirect immunofluorescence in the flagellum of T. brucei and of two species of euglenoids, Euglena gracilis and Distigma proteus. In immunoblot analysis, 5E9 appeared to bind to paraflagellar rod proteins PFR1 and PFR2 of T. brucei (72000 and 75000 mol. wt.) and of E. gracilis (67000 and 76000 mol. wt.). The presence of a common epitope in paraflagellar rod proteins from species of trypanosomes and euglenoids shows that despite distinct structures of the rods some identical domain exists in the proteins that could be involved in their supramolecular assembly into a similar organelle. The antigenic determinant defined by 5E9 was also shown to be present in a 87000 molecular weight polypeptide located in the proximal part of the flagellum of Crithidia oncopelti in which a paraflagellar rod is not detectable at the ultrastructural level.

Anti-DNA antibodies: the choice of assays for routine diagnostic work

Sixty-six sera from 23 patients with systemic lupus erythematosus (SLE), 26 sera from patients with rheumatoid arthritis (RA), and 22 sera from normal healthy subjects were tested for the presence of antibodies against native (ds) DNA by the Crithidia luciliae immunofluorescence test and by the Farr assay, and for the presence of antibodies against denaturated (ss) DNA by the enzyme-linked immunosorbent assay (ELISA). Anti-dsDNA antibodies were detected in 57% of the SLE patients by the Crithidia test and in 65% by the Farr assay. Two of the RA sera were positive in the Crithidia test, whereas all were Farr negative. Anti-ssDNA antibodies of IgG class could be detected in 74% of the SLE patients and in none of the RA sera, while anti-ssDNA antibodies of IgM class were found in 26% of the SLE patients and in one RA serum. There was a good correlation between the results of the Farr assay and the IgG-anti-ssDNA ELISA but no agreement was found between the results of the Farr assay and the Crithidia test. We also measured the amount of C-reactive protein (CRP) in the sera but no correlation was seen between the levels of CRP and anti-DNA antibodies. We conclude that the demonstration of anti-ssDNA antibodies of IgG class is a good screening method in the diagnosis of SLE, and that antibodies against native DNA should be determined, preferably both by the Crithidia test and the Farr assay to confirm the diagnosis and in the follow-up of the patients.

The binding of antihistone antibodies to Crithidia luciliae kinetoplasts is growth cycle-dependent

The Crithidia luciliae immunofluorescence (CLIF) assay is widely used to test for native DNA (nDNA) antibodies in the diagnosis and management of systemic lupus erythematosus. However, sera from patients with drug-induced lupus erythematosus or rheumatoid arthritis, which should not contain nDNA antibodies, occasionally react with the CL kinetoplast. We examined 36 sera from patients with systemic lupus erythematosus, rheumatoid arthritis, Sjögren's syndrome, and drug-induced lupus erythematosus, who had positive CLIF tests. All 36 sera were also antinuclear antibody-positive with homogeneous and/or peripheral staining patterns on mouse kidney substrates. After hydrochloric acid extraction of the CL smears to remove histone and other nuclear protein antigens, 14 of the 36 sera no longer produced a positive result on the CLIF test. Ten of these 14 sera again gave a positive CLIF result after the hydrochloric acid-extracted Crithidia substrate had been reconstituted with purified histone. These studies demonstrated that kinetoplast binding was due to antihistone antibodies in at least 10 of 36 initially CLIF-positive sera. Antihistone antibodies were then purified with a histone-affinity column, and these purified antibodies were reactive with CL kinetoplasts. Thus, the CLIF test is not specific for nDNA antibodies. Additional studies using CL from different days of culture indicated that histone antigen expression in the CL kinetoplast was a function of the life cycle of this organism and is most readily detected 2 days after initiation of culture.

Immunoperoxidase assay for anti-dsDNA antibodies using Crithidia luciliae substrates

In studies on 779 fresh, unselected ANA+ sera, 50 (6.4%) were found to have anti-dsDNA antibodies, by using CIP (C. luciliae immunoperoxidase), and 84% of the 50 patients met the criteria for definite SLE. After freezing 36 of these sera for 13 +/- 1 months, only 52.8% were again positive by CIP. Using CIF (C. luciliae immunofluorescence), 16.7% and 52.8% of the same stored sera were anti-dsDNA+, with transmitted and epi-illumination, respectively. We favour CIP to CIF because: slide files are permanent, overcoming any lability of antibodies in frozen sera; kinetoplast, flagellum and nucleus are easily distinguished; perikinetoplast staining is avoided; specialized microscopic equipment is not needed.

[Levels of anti-nDNA using immunofluorescence on Crithidia luciliae. II. Prognostic value of complement-fixing anti-nDNA. Longitudinal study of 16 lupus disorders]

Measurements of the hemolytic complement level and titrations of anti dS DNA antibodies by immunofluorescence using Crithidia luciliae and by the Farr binding assay were performed in 13 females and 3 males suffering from systemic lupus erythematosus (SLE). In each patient, 2 to 5 serum samples were analyzed during a mean follow up time of 16.6 months. The complement fixing ability of the anti dS DNA antibodies was also investigated. In this longitudinal study the titers of the dS DNA antibodies detected by immunofluorescence correlated with the Farr binding assay results. Mean anti dS DNA antibody titers were significantly higher and CH 50 levels were lower when SLE was active. Among sera with anti dS DNA antibodies, only sera with high titers (greater than or equal to 1/80), fixed complement. Study of individual cases disclosed that an increase in complement fixing anti dS DNA antibodies could occur in the absence of disease activity. Sera from patients with severe organ involvement, in particular with nephritis had low titers of anti dS DNA antibodies with no complement fixation activity. There was no relationship between falls in serum complement level and the complement fixation ability of anti dS DNA antibodies. Thus, complement fixation capacity of anti dS DNA antibodies correlates better with antibody titer than with SLE severity or activity.

Induction of heart alterations by immunization with subcellular fractions from Crithidia fasciculata

Immunization of mice with subcellular fractions of C. fasciculata led to myocarditis and electrocardiographic alterations similar to those induced by immunization with T. cruzi, the etiological agent of Chagas' disease, suggesting the presence of similar cardiotoxic antigens in both trypanosomatid flagellates.

DNA antibodies with and without complement-binding ability

The relationship between immunoglobulin class and complement-binding ability of DNA antibodies was studied by indirect immunofluorescence and Crithidia luciliae (CL) as substrate in the sera of 28 patients with SLE and antibodies to CL-DNA. In 15 of 28 cases the antibodies bound complement and were IgG either alone or in combination with IgA and IgM. In the remaining 13 sera the antibodies were either IgA or IgM and did not bind complement. Only one of nine patients with nephritis had CL-DNA antibodies of IgM alone, whereas that was true for 10 of 19 patients without nephritis. The factors influencing the complement binding were further studied by using purified IgM rheumatoid factors. Their ability to 'mask' the IgG-type CL-DNA antibodies and to inhibit the binding of complement was confirmed. These findings suggest that complement activation in SLE does not occur in patients with IgM-type anti-ds-antibodies or in patients with rheumatoid factor activity.

The Crithidia luciliae and Farr assays for the detection of systemic lupus erythematosus

The specificity and sensitivity of two commercial systems for the detection of anti-native deoxyribonucleic acid (DNA) antibodies in the diagnosis of active systemic lupus erythematosus were evaluated. Sera containing antinuclear antibodies from 64 patients were tested by an indirect immunofluorescent antibody technique employing the protozoan Crithidia luciliae as substrate and immunoradioassay based on the Farr technique. Twenty one patients had active systemic lupus erythematosus, 21 had other collagen vascular diseases, and 22 had miscellaneous non-collagen vascular diseases. The immunofluorescence test was 100 percent specific and 66.7 percent sensitive for systemic lupus erythematosus, whereas the radioimmunoassay was 90.7 percent specific and 80.9 percent sensitive. There was agreement between methods in 57 of the 64 (89.1 percent) sera tested.

[New technic for detecting anti-double-stranded DNA antibodies. Value in disseminated lupus erythematosus in children]

Two assays for antibodies to double stranded (ds) DNA were compared in children with systemic lupus erythematosus (SLE). An indirect immunofluorescent test using Crithidia luciliae (IF-CL) was more specific but slightly less sensitive than the DNA binding assay (RIA). Detection of antibodies to ds-DNA (anti-ds-DNA) by IF on 3 different trypanosoma (T. brusei, T. equiperdum, and T. musculi) was as specific and as sensitive as IF-CL, but more difficult to read microscopically. No correlation was found between immunoglobulin (Ig) class of circulating anti-ds-DNA and severity of renal disease in SLE. A comparison of serologic and immunohistopathologic (kidney and skin) data in 12 children with SLE showed that immune-complex glomerulonephritis was more frequently encountered when anti-ds-DNA was detected in serum, and that Ig deposits were found only in the skin when anti-ds-DNA could not be detected in serum.