1
|
Şahin N, Kısaarslan AP, Çiçek SÖ, Pınarbaşı AS, Günay N, Yel S, Dursun İ, Poyrazoğlu MH, Düşünsel R. Clinical usefulness of anti-nuclear antibody in childhood: real-world experience at a tertiary care center : Usefulness of ANA in pediatric autoimmune diseases. Eur J Pediatr 2023:10.1007/s00431-023-05017-w. [PMID: 37171519 DOI: 10.1007/s00431-023-05017-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 05/13/2023]
Abstract
We evaluated the reasons for requesting anti-nuclear antibody (ANA) analysis in clinical practice at a tertiary center and the performance of ANA in pediatric autoimmune diseases. Patients under 18 years of age who underwent ANA testing for various symptoms between 2013 and 2017 were included. We retrieved data from medical records, including demographic and clinical characteristics, diagnoses, ANA results, titers, and staining patterns. The performance assessment tools were calculated according to the ANA titer for autoimmune diseases. Risk factors for autoimmune diseases in ANA-positive patients were evaluated using logistic regression analysis. Changes in ANA titer and seroconversion were evaluated using repeated ANA analyses. A total of 3812 patients underwent ANA. Medical records of 3320 patients were obtained. The rate of ANA positivity was 27.4%. ANA was requested most frequently because of musculoskeletal findings in 1355 patients (40.8%). Juvenile idiopathic arthritis (n = 174, 20.2%) was the most common diagnosis in ANA-positive patients, followed by systemic lupus erythematosus (n = 52, 6%). For autoimmune diseases, a titer of ≥ 1:100, a sensitivity of 40.1%, and a specificity of 77.1% were observed. At a titer ≥ 1:1000, the sensitivity and specificity were 24.1% and 89%, respectively. Homogeneous staining was an additional risk factor for autoimmune diseases in ANA-positive patients by multivariate logistic regression analysis (OR [95% CI]: 4.562 [3.076-6.766], p < 0.001). Conclusion: Our results revealed that the performance of the ANA test in diagnosing autoimmune diseases in pediatric clinical practice was poor. Therefore, clinical findings should be carefully evaluated before ANA testing is performed. What is Known: • ANA can be detected in systemic autoimmune rheumatic diseases. • The diagnostic role of ANA is controversial, especially in childhood. What is New: • One in four patients who requested the ANA test had an autoimmune disease. • Less than half of patients with an autoimmune disease had ANA positivity.
Collapse
Affiliation(s)
- Nihal Şahin
- Department of Pediatrics, Division of Pediatric Rheumatology, Kocaeli University, Kocaeli University Research and Application Hospital Umuttepe, Campus 41380, İzmit, Kocaeli, Turkey.
| | - Ayşenur Paç Kısaarslan
- Department of Pediatrics, Division of Pediatric Rheumatology, Erciyes University, Kayseri, Turkey
| | | | - Ayşe Seda Pınarbaşı
- Department of Pediatric Nephrology, Diyarbakır Pediatric Hospital, Diyarbakır, Turkey
| | - Neslihan Günay
- Department of Pediatric Nephrology, Kayseri City Hospital, Kayseri, Turkey
| | - Sibel Yel
- Department of Pediatrics, Division of Pediatric Nephrology, Erciyes University, Kayseri, Turkey
| | - İsmail Dursun
- Department of Pediatrics, Division of Pediatric Nephrology, Erciyes University, Kayseri, Turkey
| | - Muammer Hakan Poyrazoğlu
- Department of Pediatrics, Division of Pediatric Nephrology and Division of Pediatric Rheumatology, Erciyes University, Kayseri, Turkey
| | - Ruhan Düşünsel
- Department of Pediatrics, Division of Pediatric Nephrology and Rheumatology, Yeditepe Univesity, Istanbul, Turkey
| |
Collapse
|
2
|
Chauhan R, Gupta N, Tiwari AK, Raina V, Nandi SP. Development of a Novel Multiplex Bead-based Assay for Measuring Autoantibodies on Flow Cytometric Platform. Immunol Invest 2020; 51:588-601. [PMID: 33287608 DOI: 10.1080/08820139.2020.1854782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Autoantibodies (AAbs) are important biomarkers for the diagnosis of Autoimmune Diseases (ADs). The detection of AAbs performed by current methods (indirect immunofluorescence test (IIFT)/Immunoblot (dot/line)/enzyme-linked immunosorbent assay ELISA) which have limitations in terms of performing multiple assays to arrive at laboratory diagnosis. We validated a novel multiplex bead-based assay (NMBA) that could quantify five common antibodies, simultaneously, on a flow-cytometry platform.Methods: A total of five recombinant antigens (SS-A Ro60, CENP B, RNP 70, Scl 70 and Histones) were covalently coupled onto beads and tested using known positive sera (positive for AAbs) and analyzed using flow cytometer.Results: The sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were obtained for each antigen, analyzed by both assays (NMBA and IIFT). It showed comparable or higher values for the NMBA. The Spearman's rank correlation coefficient (Rho) were ≥ 0.97, (P < .05), indicating that multiplexing of the five autoantigens did not alter the results obtained when antigens were tested individually. The mean intra-assay precision measured by coefficient of variation (CV) was7.56 ± 1.6% and the mean inter-assay CV was 10.03 ± 1.34%. The time taken from sample receipt to reporting of results was 90 minutes in NMBA as compared to 150 minutes of IIFTConclusion: The NMBA could quantitatively measure antibodies against five autoantigens, simultaneously in patient's sera. The assay is faster, objective, reproducible, requires low sample volume, and stable. Moreover, the flow cytometer in diagnostic laboratory settings for hematological and transplant immunology tests, can also be used for testing AAbs.
Collapse
Affiliation(s)
- Rajni Chauhan
- Department of Transfusion Medicine, Medanta-The Medicity, Molecular and Transplant Immunology Laboratory, Gurgaon, India.,Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India
| | - Nikita Gupta
- Department is Molecular Genetics, Chimera Transplant Research Foundation, New Delhi, India
| | - Aseem Kumar Tiwari
- Department of Transfusion Medicine, Medanta-The Medicity, Molecular and Transplant Immunology Laboratory, Gurgaon, India
| | - Vimarsh Raina
- Department is Molecular Genetics, Chimera Transplant Research Foundation, New Delhi, India
| | - Shoma Paul Nandi
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India
| |
Collapse
|
3
|
Wang YM, Yu YF, Liu Y, Liu S, Hou M, Liu XG. The association between antinuclear antibody and response to rituximab treatment in adult patients with primary immune thrombocytopenia. ACTA ACUST UNITED AC 2020; 25:139-144. [PMID: 32167032 DOI: 10.1080/16078454.2020.1740430] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Antinuclear antibodies (ANAs) can be detected in about 30% of patients with primary immune thrombocytopenia (ITP), yet their relationship with treatment response to rituximab remains elusive.Methods: we retrospectively reviewed the clinical records of hospitalized adult ITP patients who were treated with rituximab from three medical centers across China. Rituximab was given intravenously at 100 mg weekly for 4 weeks, or at a single dose of 375 mg/m2. All included patients had their ANAs tested before rituximab treatment.Results: A total of 287 patients fulfilled the inclusion criteria and were eligible for analysis. ANAs were positive in 98 (34.1%) of the included patients. The incidence of overall response and complete response (CR) in ANA-positive patients was significantly higher than that in ANA-negative patients (overall response: 76.5% vs. 55.0%, P < 0.001; CR: 46.9% vs. 29.1%, P = 0.003). However, sustained response (SR) rates in ANA-positive patients at 6, 12 and 24 months were all lower compared with ANA-negative patients (all P < 0.05). The overall duration of response (DOR) estimated by Kaplan-Meier analysis in ANA-negative patients was greater than that in ANA-positive patients (P < 0.001).Conclusion: ITP patients with positive ANA test were likely to achieve a better initial response to rituximab treatment, while their long-term outcome was unfavorable. Therefore, ANA test could be useful for predicting rituximab response in ITP.
Collapse
Affiliation(s)
- Yan-Ming Wang
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, People's Republic of China.,Department of Hematology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, People's Republic of China
| | - Ya-Fei Yu
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, People's Republic of China
| | - Yu Liu
- School of Chemistry and Pharmaceutical Engineering, Qilu University of Technology, Jinan, People's Republic of China
| | - Shuang Liu
- Department of Hematology, Taian Central Hospital, Taian, People's Republic of China
| | - Ming Hou
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, People's Republic of China.,Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Jinan, People's Republic of China
| | - Xin-Guang Liu
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, People's Republic of China
| |
Collapse
|