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Ke PF, Zhu YT, Cao SL, Wang Y, Wu ST, He QQ, Liang LF, Li JC. Identification of pattern recognition receptor genes in peripheral blood mononuclear cells and monocytes as biomarkers for the diagnosis of lupus nephritis. Clin Chim Acta 2024; 554:117785. [PMID: 38228224 DOI: 10.1016/j.cca.2024.117785] [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: 12/20/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/18/2024]
Abstract
BACKGROUND The study aimed to investigate the diagnostic value of lupus-related pattern recognition receptors (PRRs) genes in peripheral blood mononuclear cells (PBMCs) and monocytes (MONs) for lupus nephritis (LN). METHODS PBMCs were isolated from a cohort with 37 LN patients and 39 healthy controls (HCs), and MONs were derived from another cohort with 70 LN patients and 66 HCs. Q-PCR was used to measure the mRNA levels of CGAS, IFNB1, AIM2, IL1Β, NLRC4, NLRP3, NLRP12 and ZBP1 in the PBMCs and MONs. The Mann-Whitney U test was used to compare the data in LN patients and HCs. Eleven GEO datasets of SLE/LN were used to perform differentially expressed genes (DEGs) analysis to these PRR genes. Receiver operating characteristic (ROC) curve analysis was employed to assess the performance of individual genes or the disease prediction model established by combining multiple genes in LN diagnosis. Spearman correlation method was done to analyze the correlation between these PRRs and other clinical characteristics. RESULTS The mRNA levels of five genes (AIM2, NLRC4, IL1B, NLRP12 and ZBP1) in PBMCs, and seven genes (CGAS, IFNB1, AIM2, IL1B, NLRP3, NLRP12 and ZBP1) in MONs of LN patients were significantly higher than those of HCs (P < 0.05). DEGs analysis based on the GEO datasets showed that ZBP1, AIM2 and IL1B were significantly increased in several datasets. The ROC curve analysis indicated that the area under curve (AUC) of the LN prediction models derived from PBMCs or MONs were 0.82 or 0.91 respectively. In addition, the expression levels of these PRRs were correlated with other clinical features in LN patients, including Anti-Sm, ESR, serum Cr, and C3. CONCLUSION Our study suggests that these lupus-related PRRs might be served as potential biomarkers of LN.
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Affiliation(s)
- Pei-Feng Ke
- Medical Research Center, Yue Bei People's Hospital, Shantou University Medical College, Shaoguan 512025, China; Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China
| | - Yan-Ting Zhu
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510120, China
| | - Song-Ling Cao
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510120, China
| | - Yi Wang
- Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China; Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510120, China
| | - Shi-Ting Wu
- Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China
| | - Qian-Qian He
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510120, China
| | - Li-Fang Liang
- Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, China
| | - Ji-Cheng Li
- Medical Research Center, Yue Bei People's Hospital, Shantou University Medical College, Shaoguan 512025, China; Institute of Cell Biology, Zhejiang University, Hangzhou 310031, China.
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Rojo R, Calvo Alén J, Prada Á, Valor S, Roy G, López-Hoyos M, Cervera R, Sánchez Mateos P, Jurado Roger A. Recommendations for the use of anti-dsDNA autoantibodies in the diagnosis and follow-up of systemic lupus erythematosus - A proposal from an expert panel. Autoimmun Rev 2023; 22:103479. [PMID: 37967782 DOI: 10.1016/j.autrev.2023.103479] [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: 10/26/2023] [Accepted: 11/10/2023] [Indexed: 11/17/2023]
Abstract
Anti-dsDNA autoantibodies are listed as one of the classification criteria for systemic lupus erythematosus (SLE) and are relatively effective indicators for monitoring disease activity and treatment response. Therefore, clinicians rely on them to diagnose and adjust medication and treatment strategies for SLE patients. However, the use of anti-dsDNA antibodies is not free from controversy. Part of this controversy stems from the fact that anti-dsDNA antibodies are found in several disorders, besides SLE. In addition to this, anti-dsDNA antibodies are a heterogeneous group of antibodies, and their determination still lacks proper standardization. Moreover, anti-dsDNA testing specificity and diagnostic performance change depending on the population under study. These and other issues result in inconsistency and encumber the clinical use of anti-dsDNA antibodies. A panel of medical laboratory and clinical experts on SLE discussed such issues based on their clinical experience in a first meeting, establishing a series of recommendations. The proceedings of this first meeting, plus an exhaustive review of the literature, were used to compose a paper draft. The panel subsequently discussed and refined this draft in a second meeting, the result of which is this paper. This document is relevant to clinical laboratories as it guides to improving diagnosis and monitoring of SLE. Simultaneously, it will help laboratories compile more informative reports, not limited to a mere number. It is also relevant to clinical doctors who wish to better understand laboratory methods so that they can do a more efficient, better-aimed laboratory test ordering.
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Affiliation(s)
- Ricardo Rojo
- Specialist Consultant at the Immunology Department of the University Hospital of A Coruña, Spain
| | - Jaime Calvo Alén
- Head of the Rheumatology Department at the Araba University Hospital, Vitoria, Spain
| | - Álvaro Prada
- Head of Section at the Immunology Laboratory of the University Hospital of Donostia, Spain
| | | | - Garbiñe Roy
- Head of the Autoimmunity Section at the Immunology Department of the Ramón y Cajal University Hospital, Madrid, Spain
| | - Marcos López-Hoyos
- Head of the Immunology Department at the Marqués de Valdecilla-IDIVAL University Hospital, Santander. Full Professor, Molecular Biology Department at the University of Cantabria, Santander, Spain.
| | - Ricard Cervera
- Head of the Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Paloma Sánchez Mateos
- Full Professor at the Complutense University, and Specialist Consultant at the Immunology Department of the Gregorio Marañón General University Hospital, Madrid, Spain
| | - Aurora Jurado Roger
- Head of Section at the Immunology and Allergology Department of the Reina Sofía University Hospital, Córdoba, Spain
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Trujillo Aguilera A, Bernardo Serrano R, Navas A, Alcaide Molina J, Alvarez Romero P, Jurado Roger A. Longitudinal study of patients with discrepant results in CLIFT and a solid-phase dsDNA antibody assay: does a gold standard dsDNA assay exist? Lupus Sci Med 2023; 10:e000984. [PMID: 37903589 PMCID: PMC10618974 DOI: 10.1136/lupus-2023-000984] [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: 06/22/2023] [Accepted: 09/24/2023] [Indexed: 11/01/2023]
Abstract
OBJECTIVE Antidouble-stranded DNA (dsDNA) antibodies are essential for diagnosis and follow-up of systemic lupus erythematous (SLE). To ensure the best diagnostic approach, most healthcare laboratories opt for a combination of highly sensitive methods, such as solid-phase immunoassays, and highly specific methods, such as the Crithidia luciliae indirect immunofluorescence test (CLIFT). Even so, discordant results are common, thus hindering the diagnostic process. Therefore, this study aimed to characterise a cohort of patients with discrepant results for a dsDNA fluorescence enzyme immunoassay (FEIA) and CLIFT during 2016-2018 and to follow patients up until December 2021. METHODS We performed an observational, longitudinal and retrospective study on 417 samples from 257 patients who had been referred for suspected connective tissue diseases or followed up after diagnosis. All of them were positive for antinuclear antibodies (ANAs) using an indirect immunofluorescence assay (IFA) on Hep-2 cells, the entry criterion in our laboratory, and positive for FEIA dsDNA. Samples were then tested with CLIFT according to our routine protocol, which includes CLIFT testing after FEIA dsDNA results ≥10 UI/ml. After the assessment of data quality, the final analysis was based on 222 patients. RESULTS Eighty-three patients (37.4%) had positive results in both tests and met the diagnostic criteria for SLE. However, 139 patients (62.6%) had discrepant results (FEIA+, CLIFT-). Of these, 58 patients (41.7%) had a diagnosis of SLE, with 47 (33.8%) having been previously diagnosed and under treatment. The remaining 11 patients (7.9%) had a new diagnosis of SLE, which was made up within 4 years of the initial screening. A total of 81 of the 139 patients (57.5%) with discrepant results did not meet lupus criteria during the follow-up period. CONCLUSIONS The study showed that CLIFT could be negative in both treated and newly diagnosed SLE, thus underlining the importance of follow-up of dsDNA-positive results using solid-phase tests. Therefore, quantitative tests such as FEIA could add value to the diagnosis and management of patients with suspected SLE.
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Affiliation(s)
- Antonio Trujillo Aguilera
- Department of Immunology and Allergy, Hospital Universitario Reina Sofia, Cordoba, Spain
- GC01 Immunology and Allergy, Maimonides Biomedical Research Institute of Cordoba, Cordoba, Spain
| | - Raquel Bernardo Serrano
- Department of Immunology and Allergy, Hospital Universitario Reina Sofia, Cordoba, Spain
- GC01 Immunology and Allergy, Maimonides Biomedical Research Institute of Cordoba, Cordoba, Spain
| | - Ana Navas
- Department of Immunology and Allergy, Hospital Universitario Reina Sofia, Cordoba, Spain
- GC01 Immunology and Allergy, Maimonides Biomedical Research Institute of Cordoba, Cordoba, Spain
| | - Juan Alcaide Molina
- Department of Immunology and Allergy, Hospital Universitario Reina Sofia, Cordoba, Spain
- GC01 Immunology and Allergy, Maimonides Biomedical Research Institute of Cordoba, Cordoba, Spain
| | - Paula Alvarez Romero
- Department of Immunology and Allergy, Hospital Universitario Reina Sofia, Cordoba, Spain
- GC01 Immunology and Allergy, Maimonides Biomedical Research Institute of Cordoba, Cordoba, Spain
| | - Aurora Jurado Roger
- Department of Immunology and Allergy, Hospital Universitario Reina Sofia, Cordoba, Spain
- GC01 Immunology and Allergy, Maimonides Biomedical Research Institute of Cordoba, Cordoba, Spain
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Nieto-Aristizábal I, España LJ, Ortega J, Ruiz-Ordoñez I, Vivas ÁJ, Castaño GL, Castillo C, Bautista-Vargas M, Suárez A, Cañas CA, Tobón GJ. Diagnostic Performance of Anti-dsDNA Tests by Indirect Immunofluorescence and Enzyme-linked Immunosorbent Assay in Patients with Systemic Lupus Erythematosus. J Appl Lab Med 2023; 8:713-725. [PMID: 37018046 DOI: 10.1093/jalm/jfad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/17/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Several laboratory techniques for anti double-stranded (ds) DNA detection in systemic lupus erythematosus (SLE) are available, with variable diagnostic performance. We aimed to evaluate anti-dsDNA's diagnostic performance by indirect immunofluorescence (IIF) and enzyme-linked immunosorbent assay (EIA). METHODS We conducted a single-center retrospective (2015 to 2020) study. Patients with anti-dsDNA tests by IIF and EIA were included. We evaluated the indications, applications, concordance, positive predictive value (PPV) of anti-dsDNA to confirm SLE diagnosis or flares, and associations of disease manifestations with positivity with each technique. RESULTS A total of 1368 reports of anti-dsDNA tests by IIF and EIA and the corresponding medical records of the patients were analyzed. The main indication for anti-dsDNA testing was to help in the diagnosis of SLE in 890 (65%) of the samples, and the main application after obtaining the results was SLE exclusion in 782 (57.2%) cases. The combination with the highest frequency was the negativity result by both techniques in 801 (58.5%) cases (Cohen kappa 0.57). Both methods were positive in 300 patients with SLE (Cohen kappa 0.42). The PPVs of anti-dsDNA tests to confirm diagnosis/flare was 79.64% (95% CI, 75.35-83.35) by EIA, 78.75% (95% CI, 74.27-82.62) by IIF, and 82% (95% CI, 77.26-85.93) when both were positive. CONCLUSIONS Anti-dsDNA detection by IIF and EIA are complementary and may indicate different clinical patterns in patients with SLE. The detection of anti-dsDNA antibodies by both techniques has a higher PPV than either separately for confirming SLE diagnosis or flares. These results highlight the need for evaluating both methods in clinical practice.
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Affiliation(s)
- Ivana Nieto-Aristizábal
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cra. 98 No. 18-49, Cali 760032, Colombia
| | | | - Jorge Ortega
- Universidad Icesi, Facultad de Ciencias de la Salud, Cali, Colombia
| | - Ingrid Ruiz-Ordoñez
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cra. 98 No. 18-49, Cali 760032, Colombia
| | - Álvaro J Vivas
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cra. 98 No. 18-49, Cali 760032, Colombia
| | - Gloria L Castaño
- Fundación Valle del Lili, Laboratorio Clínico, Cra. 98 No. 18-49, Cali 760032, Colombia
| | - Carmen Castillo
- Fundación Valle del Lili, Laboratorio Clínico, Cra. 98 No. 18-49, Cali 760032, Colombia
| | | | - Ana Suárez
- Universidad Icesi, Facultad de Ciencias de la Salud, Cali, Colombia
| | - Carlos A Cañas
- Universidad Icesi, CIRAT: Centro de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Cali, Colombia
- Fundación Valle del Lili, Unidad de Reumatología, Cra. 98 No. 18-49, Cali 760032, Colombia
| | - Gabriel J Tobón
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cra. 98 No. 18-49, Cali 760032, Colombia
- Department of Medical Microbiology, Immunology and Cell Biology, Southern Illinois University, Springfield, IL 62901, United States
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Zhan M, Wang Z, Bao H, Di C, Xia C, Zhang X, Liu Y. Antibodies against neutrophil extracellular traps (NETs) potentiate clinical performance of anti-double-stranded DNA antibodies in systemic lupus erythematosus. Clin Immunol 2023; 249:109297. [PMID: 36940814 DOI: 10.1016/j.clim.2023.109297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/23/2023]
Abstract
Autoantibodies against NETs (ANETA) are present in SLE patients. We aimed to determine the clinical relevance of ANETA in SLE. Serum from 129 SLE patients, 161 patients with various rheumatoid diseases (DC), and 53 healthy controls (HC) were tested by a home-made ANETA ELISA platform. ANETA showed a sensitivity of 35.7% and a specificity of 92.5%, respectively, in the diagnosis of SLE. The combination of ANETA with anti-dsDNA antibody increased the diagnostic sensitivity from 49.6% to 62.8% for SLE. The presence of ANETA potentiates the clinical utility of anti-dsDNA antibodies in identifying a subset of SLE patients with higher disease activity and hematological abnormalities. The binding of ANETA to NETs did not inhibit the immunostimulatory effect of NETs. Our findings suggested that ANETA have potential as clinically relevant biomarkers that potentiate the clinical performance of anti-dsDNA antibodies in the diagnosis, risk stratification and subtyping of patients with SLE.
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Affiliation(s)
- Minghua Zhan
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China; Department of Clinical Laboratory, First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China; Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Ziwei Wang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Huizhang Bao
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Chun Di
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Changsheng Xia
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Xuan Zhang
- Department of Rheumatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Clinical Immunology Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
| | - Yudong Liu
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China; Department of Rheumatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Clinical Immunology Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
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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: 0] [Impact Index Per Article: 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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