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Dos Santos Angeli R, Ribeiro AL, Kohem CL, Xavier RM, Monticielo OA. Comparative study of two laboratory techniques for the detection of HLA-B27 in patients with axial spondyloarthritis: a cross-sectional analysis. Adv Rheumatol 2024; 64:42. [PMID: 38783377 DOI: 10.1186/s42358-024-00383-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND The diagnostic and prognostic relevance of Human Leukocyte Antigen B-27 (HLA-B27) in Axial Spondyloarthritis (AxSpA) is undeniable, with 70% of Ankylosing Spondylitis (AS) patients carrying the B27 gene, contrasted with a mere 4.35% in the general population. Flow cytometry (FC) and Polymerase Chain Reaction (PCR) have emerged as the predominant techniques for routine HLA-B27 typing. While various studies have compared these methods, none have catered to the unique characteristics of the Brazilian demographic. Therefore, this research aims to compare FC and PCR in a Brazilian cohort diagnosed with AxSpA. METHODS An analytical cross-sectional study was undertaken involving 62 AxSpA outpatients from a Brazilian University Hospital. Both FC and PCR-SSP assays were utilized to ascertain HLA-B27 typing. The outcomes (either confirming or refuting the allele's presence) underwent rigorous scrutiny. Agreement between the methodologies was assessed using the kappa statistic. A p-value of < 0.05 was deemed statistically significant. RESULTS Of the participants, 90.3% (n = 56) were HLA-B27 positive according to FC, while 79% (n = 49) were identified as positive using the PCR method. FC exhibited a sensitivity rate of 98% paired with a specificity of 38.5%. The Positive Predictive Value for FC stood at 85.7%, and the Negative Predictive Value was 83.5%. Consequently, the overall accuracy of the FC method was gauged at 85.5%. A kappa coefficient of κ = 0.454 was derived. CONCLUSIONS FC demonstrated noteworthy sensitivity and satisfactory accuracy in HLA-B27 detection, albeit with a reduced specificity when contrasted with PCR-SSP. Nevertheless, given its cost-effectiveness and streamlined operation relative to PCR, FC remains a pragmatic option for preliminary screening in clinical practice, especially in low-income regions. To optimize resource allocation, we advocate for a refined algorithm that initiates by assessing the relevance of HLA-B27 typing based on Choosing Wisely recommendations. It then leans on FC, and, if results are negative yet clinical suspicion persists, advances to PCR. This approach aims to balance diagnostic accuracy and financial prudence, particularly in regions contending with escalating medical costs.
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Affiliation(s)
- Ricardo Dos Santos Angeli
- Hospital de Clínicas de Porto Alegre, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - André Lucas Ribeiro
- Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre - HCPA, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Porto Alegre, Rio Grande do Sul, 90035-903, Brazil.
| | - Charles Lubianca Kohem
- Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre - HCPA, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Porto Alegre, Rio Grande do Sul, 90035-903, Brazil
| | - Ricardo Machado Xavier
- Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre - HCPA, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Porto Alegre, Rio Grande do Sul, 90035-903, Brazil
| | - Odirlei André Monticielo
- Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre - HCPA, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, Porto Alegre, Rio Grande do Sul, 90035-903, Brazil
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Geiger K, Zach C, Leiherer A, Fraunberger P, Drexel H, Muendlein A. Real-time PCR based HLA-B*27 screening directly in whole blood. HLA 2019; 95:189-195. [PMID: 31749313 DOI: 10.1111/tan.13767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/09/2019] [Accepted: 11/18/2019] [Indexed: 12/18/2022]
Abstract
The linkage between the occurrence of human leucocyte antigen B*27 (HLA-B*27) and ankylosing spondylitis or other related spondyloarthritides is well documented. PCR based methods are widely used for HLA-B*27 screening. To refine HLA-B*27 testing we aimed at establishing a real-time PCR protocol to detect the HLA-B*27 allele directly in blood samples, without DNA extraction. HLA-B*27 analysis was performed by two real-time PCRs using TaqMan primer-probe assays for B*27 specific amplification of exon 2 or exon 3 of the HLA-B gene together with a mutant of Taq polymerase for direct blood PCR. Conditions for direct blood PCR were optimized and the reliability of the direct blood PCR protocol was evaluated by re-genotyping over 200 blood samples from patients who previously underwent routine DNA-based HLA-B*27 testing. Heating blood samples at 95°C for 10 minutes significantly improved PCR performance. Results from real-time PCR based HLA-B*27 testing directly in blood of over 200 patients were in 100% concordance with results obtained by routine DNA-based HLA-B*27 genotyping. In summary, we present a reliable real-time PCR protocol for HLA-B*27 screening directly in whole blood supporting fast clarification of the presence of ankylosing spondylitis or other spondyloarthritides in suspected cases.
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Affiliation(s)
- Kathrin Geiger
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Christina Zach
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Medical Central Laboratories, Feldkirch, Austria
| | - Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Medical Central Laboratories, Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | | | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Triesen, Liechtenstein.,Division of Angiology, Swiss Cardiovascular Center, University Hospital of Berne, Berne, Switzerland.,Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Axel Muendlein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
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Zeng Y, Hiti A, Moranville S, Vicent G, Chavira S, de Arruda Indig M, Graminske S, Boerner A, Schmidt A, Oreizy F, Chen A, Saleminik M, Mosqueda F, Lin A, Judge K. Human HLA-B27 typing using the BD™ HLA-B27 kit on the BD FACSVia™ system: A multicenter study. CYTOMETRY PART B-CLINICAL CYTOMETRY 2018; 94:651-657. [PMID: 29476701 PMCID: PMC6174995 DOI: 10.1002/cyto.b.21630] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 02/03/2018] [Accepted: 02/20/2018] [Indexed: 12/01/2022]
Abstract
The BD FACSVia™ system is a novel flow cytometer with improved workflow efficiencies. To evaluate the HLA‐B27 application developed on the BD FACSVia system utilizing the BD™ HLA‐B27 kit, we conducted a concordance study at three centers to compare with the BD FACSCalibur™ system. Prepared donor samples (n = 594) were analyzed on both the BD FACSVia and BD FACSCalibur for the HLA‐B27 assay. Adjudication of HLA‐B27 discordant results was performed using the reverse sequence‐specific oligonucleotide (rSSO) DNA typing method (LABType® SSO, One Lambda). On the BD FACSVia system 80 B27 positive, 499 B27 negative and 15 “Inconclusive” samples were observed. The corresponding BD FACSCalibur results were 73 B27 positive, 502 B27 negative and 19 “gray zone” samples. The overall concordance of HLA‐B27 determination was 98% between the two systems with seven more positives identified on BD FACSVia as compared to BD FACSCalibur. The equivocal zone between positive and negative on BD FACSVia (named “Inconclusive”) and on BD FACSCalibur (named “gray zone”) is due to antibody cross reactivity of HLA‐B27 clone GS145.2. One negative sample verified with the rSSO DNA method was reported as HLA‐B27 positive by the BD FACSVia system leading to a false positive result. Our study demonstrated concordance results between the BD FACSVia system and BD FACSCalibur. Intersite reproducibility of BD HLA‐B27 assay remained within the limits of acceptability. © 2018 The Authors. Cytometry Part B: Clinical Cytometry published by Wiley Periodicals, Inc. on behalf of International Clinical Cytometry Society
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Affiliation(s)
- Yang Zeng
- BD Life Sciences, San Jose, California 95131
| | - Alan Hiti
- University of Southern California, Los Angeles, California 90033
| | | | - Gloria Vicent
- University of Southern California, Los Angeles, California 90033
| | - Sylvia Chavira
- University of Southern California, Los Angeles, California 90033
| | | | | | | | - Anna Schmidt
- BloodCenter of Wisconsin, Milwaukee, Wisconsin 53233
| | | | - Angela Chen
- BD Life Sciences, San Jose, California 95131
| | | | | | - Anna Lin
- BD Life Sciences, San Jose, California 95131
| | - Kevin Judge
- BD Life Sciences, San Jose, California 95131
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Seo BY, Won DI. Flow cytometric human leukocyte antigen-B27 typing with stored samples for batch testing. Ann Lab Med 2013; 33:174-83. [PMID: 23667843 PMCID: PMC3646191 DOI: 10.3343/alm.2013.33.3.174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 11/28/2012] [Accepted: 01/24/2013] [Indexed: 11/26/2022] Open
Abstract
Background Flow cytometry (FC) HLA-B27 typing is still used extensively for the diagnosis of spondyloarthropathies. If patient blood samples are stored for a prolonged duration, this testing can be performed in a batch manner, and in-house cellular controls could easily be procured. In this study, we investigated various methods of storing patient blood samples. Methods We compared four storage methods: three methods of analyzing lymphocytes (whole blood stored at room temperature, frozen mononuclear cells, and frozen white blood cells [WBCs] after lysing red blood cells [RBCs]), and one method using frozen platelets (FPLT). We used three ratios associated with mean fluorescence intensities (MFI) for HLAB27 assignment: the B27 MFI ratio (sample/control) for HLA-B27 fluorescein-5-isothiocyanate (FITC); the B7 MFI ratio for HLA-B7 phycoerythrin (PE); and the ratio of these two ratios, B7/B27 ratio. Results Comparing the B27 MFI ratios of each storage method for the HLA-B27+ samples and the B7/B27 ratios for the HLA-B7+ samples revealed that FPLT was the best of the four methods. FPLT had a sensitivity of 100% and a specificity of 99.3% for HLA-B27 assignment in DNA-typed samples (N=164) when the two criteria, namely, B27 MFI ratio >4.0 and B7/B27 ratio <1.5, were used. Conclusions The FPLT method was found to offer a simple, economical, and accurate method of FC HLA-B27 typing by using stored patient samples. If stored samples are used, this method has the potential to replace the standard FC typing method when used in combination with a complementary DNA-based method.
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Affiliation(s)
- Bo Young Seo
- Department of Clinical Pathology, Kyungpook National University School of Medicine, Daegu, Korea
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Darke C, Coates E. One-tube HLA-B27/B2708 typing by flow cytometry using two "Anti-HLA-B27" monoclonal antibody reagents. CYTOMETRY PART B-CLINICAL CYTOMETRY 2009; 78:21-30. [PMID: 19693889 DOI: 10.1002/cyto.b.20490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Flow cytometry-based methods are widely used to detect the ankylosing spondylitis-associated HLA-B27/B2708 antigens. However, the generally used "HLA-B27" monoclonal antibodies (moabs) cross-react with many HLA specificities, including the common HLA-B7 antigen. Thus, using two "B27" moabs is highly recommended. METHODS The assay used two "HLA-B27" reagents, FITC and PE conjugated, respectively and a PE-Cy5 anti-CD3 antibody. Assay verification used 51 reference subjects possessing B*2705, B*2702, and B*2708 and a range of cross-reactive HLA antigens. A total of 1,006 consecutive patients' samples, referred for "HLA-B27 typing", were assayed alongside our standard flow cytometry method. A further 12 low frequency HLA-B*27 specificities were tested. Samples reacting with one "B27" moab only were B*27 allele typed by PCR using sequence-specific primers. RESULTS All patient B27/B2708 positives (28.3%) were identified by our one-tube method which detected B*2705, B*2702, B*2708, and 8/12 other B*27 specificities. It was unaffected by HLA-B7 and other cross-reactive antigens but required a minor adjustment, a reduction in the volume of one of the "B27" moabs used, to avoid detecting a minority of HLA-B57 subjects. CONCLUSIONS Our one-tube B27/B2708 assay is simple, robust, uses two "B27" moabs for typing precision and security, does not suffer from interference by HLA-B7 or other cross-reactive antigens and has the obvious advantage of using a single tube per typing.
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Affiliation(s)
- Chris Darke
- Welsh Transplantation and Immunogenetics Laboratory, Welsh Blood Service, Wales, United Kingdom.
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Cho SY, Lee KG, Park SY, Lee HJ. Utility of In-House PCR for HLA-B27 Typing: Comparison of Concordance Rate between PCR Kit and In-House PCR. Ann Lab Med 2008; 28:239-43. [DOI: 10.3343/kjlm.2008.28.3.239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Sun Young Cho
- Department of Laboratory Medicine, Kyung-Hee Medical Center, School of Medicine, Kyoung-Hee University, Seoul, Korea
| | - Kwang Gil Lee
- Department of Laboratory Medicine, Kyung-Hee Medical Center, School of Medicine, Kyoung-Hee University, Seoul, Korea
| | - Su Yon Park
- Department of Laboratory Medicine, Kyung-Hee Medical Center, School of Medicine, Kyoung-Hee University, Seoul, Korea
| | - Hee Joo Lee
- Department of Laboratory Medicine, Kyung-Hee Medical Center, School of Medicine, Kyoung-Hee University, Seoul, Korea
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Gouda BP, Asnani S, Fonseca VA. Effects of thiazolidinediones on cardiovascular risk factors. COMPREHENSIVE THERAPY 2003; 28:200-6. [PMID: 12506489 DOI: 10.1007/s12019-002-0018-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The thiazolidinediones are the insulin sensitizers used in the management of Type 2 diabetes mellitus. These drugs can potentially decrease the risk of cardiovascular disease by correcting the different components of the insulin resistance syndrome.
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Affiliation(s)
- Biswanath P Gouda
- Department of Medicine, Section of Endocrinology, Tulane University Health Sciences Center, New Orleans, LA, USA
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Macardle PJ, McEvoy R, Jovanovich S. HLA-B27 expression by flow cytometry: an analysis of 7 years quality assurance data. J Immunol Methods 2000; 243:51-7. [PMID: 10986406 DOI: 10.1016/s0022-1759(00)00227-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The Royal College of Pathologists of Australasia Quality Assurance Programs Pty. Ltd. has been monitoring HLA-B27 assignment by flow cytometry for 7 years as part of the Immunology Program. Here we present data that demonstrates a gradual improvement in reports of false positive and negative results. Many participating laboratories demonstrate an ability to assign HLA-B27 status correctly by flow cytometric means. This ability appears to be independent of reagent and methodology. However a small number of laboratories produce consistently unacceptable results that suggest poor quality assurance practice.
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Affiliation(s)
- P J Macardle
- Department of Immunology, Allergy and Arthritis, Flinders Medical Centre, Adelaide SA5047, Bedford Park, Australia.
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Huhtinen M, Karma A. HLA-B27 typing in the categorisation of uveitis in a HLA-B27 rich population. Br J Ophthalmol 2000; 84:413-6. [PMID: 10729301 PMCID: PMC1723428 DOI: 10.1136/bjo.84.4.413] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To determine whether HLA-B27 typing helps the clinician in the diagnostic examination of uveitis in a HLA-B27 rich population and also whether the clinical picture of HLA-B27 positive unilateral acute or recurrent anterior uveitis (AAU) is distinguishable from the idiopathic negative form. METHODS During a 3 year period 220 consecutive patients with undetermined uveitis at onset were examined in the Helsinki University Eye Clinic. HLA-B27 antigen was tested for 85% of the patients. Other laboratory or x ray examinations were performed on the basis of the anatomical classification of uveitis and the biomicroscopic features characteristic of uveitis associated systemic diseases. RESULTS HLA-B27 antigen was found significantly more often in patients with anterior (71%) and acute/recurrent unilateral (79%) uveitis than in patients with intermediate, posterior panuveitis (7%), and chronic (7%) or bilateral (12%) forms. Of the 16 cases of HLA-B27 negative unilateral AAU, five showed biomicroscopic features representing uveitis entities. The remaining 11 cases did not differ in any respect from the cases of HLA-B27 positive unilateral AAU. CONCLUSION HLA-B27 antigen helps the clinician in the diagnostic examination of unilateral AAU. Positive test results serve as a clue to search for spondyloarthropathies, and negative results indicate the need to look for specific uveitis entities and other systemic diseases. The occurrence of HLA-B27 positivity in conjunction with uveitis entities other than unilateral AAU is of the same level or less than in the population of Finland in general.
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Affiliation(s)
- M Huhtinen
- Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
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