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Carbone T, Pafundi V, Ciardo V, Infantino M, Muscella A, D'Angelo S. Harmonization of ANA testing challenge: quantification strategy to accurately predict end-point titers avoiding serial dilution. Immunol Res 2024; 72:96-102. [PMID: 37792145 DOI: 10.1007/s12026-023-09417-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/18/2023] [Indexed: 10/05/2023]
Abstract
Despite the advantages of automated systems for antinuclear antibody (ANA) analysis, the prediction of end-point titers avoiding serial dilutions is still in progress. The aims of this study were to set a conversion table providing discriminant ranges of fluorescence signal intensity values (FI) corresponding to the end-point titers and validate this tool in a real-life laboratory setting. Eight hundred ninety-four serum samples were analyzed for ANA using Image Navigator System. In order to classify FI into non-overlapping groups corresponding to conventional end-point titers, statistical discriminant analysis was used. Validation study was performed calculating agreement and error rates between visual readings and conversion table of 1119 routine ANA positive samples. Setting of FI ranges corresponding to the end-point titers for different staining patterns was computed. For samples showing single pattern, the overall agreement between visual readings and conversion table was 98.4% for all titers ranging from 1:160 to 1:2560, of which 68.0% had the same titer and 30.4% were within ± one titer difference. Concordance rates according to ANA patterns were as follows: (1) nuclear 98.4%, of which 67.0% had the same titer and 31.4% ± one titer; (2) cytoplasmic 100%, of which 72.7% had the same titer and 27.3% than ± one titer; (3) mitotic 66.6%, of which 33.3% had more ± one titer. Our study developed a quantification method for autoantibodies titers assessment based on just one single sample dilution instead of traditional serial dilution approach, providing significant advantages in routine laboratory in terms of reduction in hand-on time and harmonization of results.
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Affiliation(s)
- Teresa Carbone
- Immunopathology Laboratory, San Carlo Hospital, Potito Petrone St., 85100, Potenza, Italy
| | - Vito Pafundi
- Immunopathology Laboratory, San Carlo Hospital, Potito Petrone St., 85100, Potenza, Italy.
| | - Vito Ciardo
- Department of Biological and Environmental Science and Technologies, University of Salento, Lecce, Italy
| | - Maria Infantino
- Laboratorio Immunologia Allergologia, San Giovanni Di Dio Hospital, Firenze, Italy
| | - Antonella Muscella
- Department of Biological and Environmental Science and Technologies, University of Salento, Lecce, Italy
| | - Salvatore D'Angelo
- IReL - Rheumatology Institute of Lucania - San Carlo Hospital, Potenza, Italy
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Mouri A, Kaira K, Yamaguchi O, Hashimoto K, Miura Y, Shiono A, Kawasaki T, Kobayashi K, Imai H, Kagamu H. Clinical significance of antinuclear antibody as prognostic marker for first-line pembrolizumab in advanced non-small cell lung cancer. Int J Clin Oncol 2024; 29:124-133. [PMID: 38160406 DOI: 10.1007/s10147-023-02445-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND The relationship between antinuclear antibody (ANA) and the efficacy of programmed death-1 (PD-1) blockade remains controversial. Here, we investigated the prognostic significance of ANA titer in patients with non-small cell lung cancer (NSCLC) receiving pembrolizumab monotherapy as the first-line treatment, compared with that of platinum-based chemotherapy with PD-1 blockade. METHODS Our clinical data based on the ANA titer (1:80) were retrospectively reviewed for patients with advanced NSCLC, who were treated with first-line pembrolizumab monotherapy and platinum-based chemotherapy with PD-1 blockade. Immunohistochemical staining for tumor-infiltrating lymphocytes such as CD4, CD8 and Foxp3 was performed. RESULTS Among 106 patients treated with pembrolizumab, 19 (17.9%) tested high for ANA. Progression-free survival (PFS) and overall survival (OS) were significantly better in patients with high ANA than in those with low ANA, and high ANA was identified as an independent prognostic predictor, particularly in the subgroup with programmed death ligand-1 (PD-L1) ≥ 50%. However, no statistically significant difference in PFS and OS based on the ANA titer was observed in 59 patients treated with combinational chemotherapy and immunotherapy. High numbers of intratumoral Foxp3 and stromal CD8 were significantly associated with low ANA. CONCLUSIONS Assessment of preexisting ANA titers was useful to prognose PD-1 blockade as a first-line setting, particularly for the PD-L1 ≥ 50% subgroup, but not in the case of combined immunotherapy and chemotherapy.
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Affiliation(s)
- Atsuto Mouri
- Department of Respiratory Medicine, International Medical Center, Comprehensive Cancer Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, International Medical Center, Comprehensive Cancer Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan.
| | - Ou Yamaguchi
- Department of Respiratory Medicine, International Medical Center, Comprehensive Cancer Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Kosuke Hashimoto
- Department of Respiratory Medicine, International Medical Center, Comprehensive Cancer Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Yu Miura
- Department of Respiratory Medicine, International Medical Center, Comprehensive Cancer Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Ayako Shiono
- Department of Respiratory Medicine, International Medical Center, Comprehensive Cancer Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Tomonori Kawasaki
- Department of Pathology, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Kunihiko Kobayashi
- Department of Respiratory Medicine, International Medical Center, Comprehensive Cancer Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Hisao Imai
- Department of Respiratory Medicine, International Medical Center, Comprehensive Cancer Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, International Medical Center, Comprehensive Cancer Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
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Shah SK, Bowlus CL. Autoimmune Markers in Primary Biliary Cholangitis. Clin Liver Dis 2024; 28:93-101. [PMID: 37945165 DOI: 10.1016/j.cld.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease. The most common antibody associated with PBC is the anti-mitochondrial antibody (AMA), present in 90% to 95% of patients. For patients who are AMA-negative, novel biomarkers, such as antinuclear antibody-specific antibodies Sp100 and gp210 and anti-kelch-like-12 and anti-hexokinase-1 antibodies, may further aid in the diagnosis of PBC. Several laboratory methods, including immunofluorescence, enzyme-linked immunosorbent assay, immunoblotting, and bead-based assays, exist to evaluate for the presence of antibodies. This article describes various methods used to evaluate antibodies as well as describe the antibodies present in PBC.
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Affiliation(s)
- Shivani K Shah
- Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, 4150 V Street, PSSB 3500, Sacramento, CA 95817, USA
| | - Christopher L Bowlus
- Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, 4150 V Street, PSSB 3500, Sacramento, CA 95817, USA.
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Kumar M, Prakash G, Bal A, Kumari A, Kumar Y, Bhardwaj R, Malhotra P, Minz RW. Impact of Anti-nuclear Antibody Seropositivity on Clinicopathological Parameters, Treatment Response, and Survival in Lymphoma Patients. Asian Pac J Cancer Prev 2024; 25:73-78. [PMID: 38285769 PMCID: PMC10911730 DOI: 10.31557/apjcp.2024.25.1.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 01/18/2024] [Indexed: 01/31/2024] Open
Abstract
PURPOSE Lymphoproliferative disorders and autoimmune diseases both are interrelated. The high incidence of lymphoma in autoimmune diseases and frequent antinuclear antibody (ANA) positivity in lymphoma patients have been observed. But the impact of ANA positivity on various clinical parameters and responses to therapy has not been elucidated properly. METHODS In the present study, 73 treatment-naive lymphoma patients were recruited prospectively and samples were collected at baseline and after completion of therapy for evaluation of ANA. Comparative analysis was performed for various parameters between ANA-positive and ANA-negative groups. RESULTS The prevalence of ANA at baseline was 27% in lymphoma patients which further increased to 35% after chemotherapy. The ANA-positive group had a significantly higher mean age (58±14.7 vs 47±19.9; p=0.01), early stage (77% vs 38%; p=0.02,) and infrequent B-symptoms (25% vs 52%; p=0.03) as compared to ANA-negative group. No significant difference was observed in the response to therapy and survival (both event-free and overall survival). The most frequent ANA pattern was speckled (50%) at baseline, and homogenous (42%) after the therapy. CONCLUSION ANA is more frequent in lymphoma and increases further after chemotherapy. Higher mean age, early stage, and infrequent B symptoms were found to be significantly more frequent in ANA-positive lymphoma patients; however, only limited evidence supports its role as a prognostic marker or response to therapy. A wider study with appropriate follow-up data and molecular assay could shed light on the immunobiology of ANA production and its more defined clinical utility in lymphoma.
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Affiliation(s)
- Mahendra Kumar
- Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Gaurav Prakash
- Department of Clinical Hematology and Medical Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Amanjit Bal
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Anu Kumari
- Department of Clinical Hematology and Medical Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Yashwant Kumar
- Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Ranjeet Bhardwaj
- Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Pankaj Malhotra
- Department of Clinical Hematology and Medical Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Ranjana W Minz
- Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Kara M, Ozdemir GN, Tasdemir M, Ata S, Karini B, Valiyev E, Tutkun IT, Kose G, Ozkaya O. A case of Bartonellosis mimicking systemic lupus erythematosus. Eur J Ophthalmol 2023; 33:NP41-NP48. [PMID: 36345218 DOI: 10.1177/11206721221137163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
BACKGROUND AND AIM Cat-scratch disease (CSD) is a systemic bacterial infection caused by Bartonella henselae. The disease is typically characterized by regional lymphadenopathy developing after scratches from domestic or feral cats. Rarely, systemic involvement may be observed. The co-occurrence with glomerulonephritis and positive antinuclear antibody (ANA) tests have been reported before. In these cases, the disease can be misdiagnosed as systemic lupus erythematosus. Ocular involvement occurs in 5%-10% of the cases with CSD, and neuroretinitis is among the common manifestations. Administration of corticosteroids (CSs) in addition to antibiotics has been shown to improve prognosis in neuroretinitis cases. However, the optimal dose and duration, remain ill-defined. CASE REPORT In this article, we present an 11-year-old girl with CSD and neuroretinitis with a positive ANA test and hematuria, who benefited from high-dose methyl-prednisolone and antibiotics. CONCLUSION Further research is warranted in order to determine the dose and duration of CSs in the treatment of Bartonella neuroretinitis.
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Affiliation(s)
- Manolya Kara
- Department of Pediatric Infectious Diseases, Istinye University Faculty of Medicine, Liv Hospital Ulus, Istanbul, Turkey
| | - Gul Nihal Ozdemir
- Department of Pediatric Hematology, Istinye University Faculty of Medicine, Liv Hospital Ulus, Istanbul, Turkey
| | - Mehmet Tasdemir
- Department of Pediatric Nephrology, Istinye University Faculty of Medicine, Liv Hospital Ulus, Istanbul, Turkey
| | - Serap Ata
- Department of Pediatrics, Memorial Atasehir Hospital, Istanbul, Turkey
| | - Belma Karini
- Department of Ophthalmology, Memorial Sisli Hospital, Istanbul, Turkey
| | - Eldar Valiyev
- Department of Radiology, Liv Hospital Ulus, Istanbul, Turkey
| | - Ilknur Tugal Tutkun
- Department of Opthalmology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Gulsen Kose
- Department of Pediatric Neurology, Istinye University Faculty of Medicine, Liv Hospital Ulus, Istanbul, Turkey
| | - Ozan Ozkaya
- Department of Pediatric Rheumatology, Istinye University Faculty of Medicine, Liv Hospital Ulus, Istanbul, Turkey
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Wang R, Sun DR, Du Q, Zhang Y, Chen HX, Wang XF, Kong LY, Luo WQ, Shi ZY, Zhou HY. Serum antinuclear antibodies associate with severe disease activity in neuromyelitis optica spectrum disorder. J Neuroimmunol 2023; 382:578151. [PMID: 37453208 DOI: 10.1016/j.jneuroim.2023.578151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/29/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Studies suggest that antinuclear antibodies (ANAs) may correlate with the long-term prognosis of Neuromyelitis optica spectrum disorder (NMOSD). In this study, we investigated ANAs in Chinese patients with NMOSD and their relationship with disease outcomes. METHODS We retrospectively collected data from 525 patients diagnosed with NMOSD at West China Hospital between September 1, 2009, and October 1, 2021. Patients were classified into two groups: NMOSD with ANA (+) or without ANA (-). We compared the clinical characteristics, relapse rate, severe attacks, laboratory tests, Expanded Disability Status Scale (EDSS), and prognosis between the two groups. RESULTS Among the 525 NMOSD patients, those with ANA showed a higher frequency of AQP4-IgG (94.1% vs 79.3%, p < 0.001, false discovery rate (FDR) corrected p < 0.001), and anti-SSA (p < 0.001, FDR corrected p < 0.001), anti-SSB (p < 0.001, FDR corrected p < 0.001), anti-Ro52 antibodies (p < 0.001, FDR corrected p < 0.001), than those without ANA. ANA was detected in 403 patients during the acute phase. Patients with ANA (+) had higher EDSS scores in the acute stage (4.0 vs. 3.75, p = 0.013, FDR corrected p = 0.029) and at final follow-up (p = 0.032, FDR corrected p = 0.064). NMOSD patients with ANA (+) had a higher frequency of severe acute myelitis attack, severe acute myelitis and optic neuritis attack, motor and visual disability, compared to those with ANA (-) (42.1% vs. 27.8%, p = 0.001, FDR corrected p = 0.004, 19.3% vs. 10.3%, p = 0.004, FDR corrected p = 0.018, and 11.1% vs. 4.8%, p = 0.008, FDR corrected p = 0.022 respectively). The two groups had no significant difference in the annual recurrence rate (ARR). CONCLUSION ANA may be associated with more severe disease activity and disability in NMOSD.
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Affiliation(s)
- Rui Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Dong Ren Sun
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Qin Du
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Ying Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Hong Xi Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Xiao Fei Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Ling Yao Kong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Wen Qin Luo
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Zi Yan Shi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
| | - Hong Yu Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
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Khetan R, Sharma J, Mittal A, Mungi V, Misra V. Estimating autoimmune hepatitis in patients with hepatic dysfunction. Indian J Med Microbiol 2023; 45:100411. [PMID: 37573048 DOI: 10.1016/j.ijmmb.2023.100411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/02/2023] [Accepted: 06/13/2023] [Indexed: 08/14/2023]
Abstract
Autoimmune Hepatitis (AIH) is a chronic inflammatory disease of the liver of unknown aetiology characterized by polyclonal hypergammaglobulinemia and circulating autoantibodies. Objective of the study is to find out the prevalence of autoimmune hepatitis and its causative autoantibody (Anti-nuclear, anti-smooth muscle, anti-liver kidney microsomes-1) following comprehensive diagnostic criteria given by International Autoimmune Hepatitis Group. MATERIAL AND METHODS 250 patients with raised aminotransferase but, negative for the commonest three clinical conditions viz, viral hepatitis, drug induced liver injury and alcohol induced liver injury were suspected to be a case of autoimmune hepatitis. Recent IAIHG criteria was followed in making diagnosis of autoimmune hepatitis. We did the investigation for viral hepatitis (acute/chronic), drug induced liver injury and alcohol induced liver injury and then measured serum IgG. Indirect Immunofluorescence (IIF) was done for Anti-nuclear antibody and was also done for anti-smooth muscle antibody and anti-liver kidney microsomes-1 antibody simultaneously. RESULT As per IAIHG criteria, out of 250 patients, Ig "G" was elevated in 88 patients with significant titres for Anti-nuclear antibody (50 patients), anti-smooth muscle antibody (65 patients), anti-liver kidney microsomes-1 antibody (7 patients) and Anti-mitochondrial antibody (18 patients) were found. As per International Autoimmune Hepatitis Group Comprehensive scoring system, probable diagnosis was made in 83 patients (33.2%) and 12 were confirmed for autoimmune hepatitis (4.8%). CONCLUSION Female preponderance was observed and type 1 Autoimmune Hepatitis was most common whereas type 2 Autoimmune Hepatitis was found in few cases. Most patients had anti-smooth muscle antibody and anti-nuclear antibody positivity indicating the type, but no significant difference was seen in clinical symptoms or biochemical parameters between the different types. 162 patients couldn't be evaluated for autoimmune hepatitis because of serum IgG cut-off criteria >1500 mg/l.
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Affiliation(s)
- Richa Khetan
- Gajra Raja Medical College, Gwalior, M.P, India.
| | - Jyoti Sharma
- Gajra Raja Medical College, Gwalior, M.P, India.
| | - Anshu Mittal
- Gajra Raja Medical College, Gwalior, M.P, India.
| | - Vismit Mungi
- Gajra Raja Medical College, Gwalior, M.P, India.
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Weng MT, Chang TH, Lin CC, Wu CS. Rheumatic manifestations of hepatitis C virus infection are associated with autoantibodies but not viremia. J Microbiol Immunol Infect 2023; 56:739-746. [PMID: 37055257 DOI: 10.1016/j.jmii.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 02/22/2023] [Accepted: 03/23/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND To investigate the associations between extrahepatic manifestations, autoantibodies, and viremia in patients with hepatitis C virus (HCV) infection. METHODS This cross-sectional study recruited patients with HCV infection from the outpatient department of a tertiary medical center in Northern Taiwan between January 2017 and August 2019. Autoantibody profiles and the clinical parameters of HCV infection were evaluated using laboratory tests, and a questionnaire was used to record extrahepatic manifestations. HCV infection status, including inactive HCV infection, active hepatitis, and cirrhosis, was defined according to abdominal ultrasonography findings and alanine transaminase levels. RESULTS A total of 77 patients with HCV were recruited, with 19.5% and 16.9% of patients, respectively, presenting with arthritis and dry eyes. Autoantibody screening revealed rheumatoid factor (RF), antinuclear antibody (ANA), anti-Ro antibody, and anti-La antibody positivity in 20.8%, 23.4%, 13.0%, and 2.6% of the patients, respectively. The presence of RF was associated with arthritis, whereas the presence of ANA was associated with dry eyes but not dry mouth. Active hepatitis and HCV-related cirrhosis were associated with viremia, but not autoantibody profiles. CONCLUSION In this single-center study, the prevalence of extrahepatic manifestations and autoantibodies did not differ in patients stratified by the HCV infection status. Rheumatic manifestations were associated with the presence of autoantibodies but not with viremia.
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Affiliation(s)
- Meng-Tzu Weng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Medical Research, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan.
| | - Ting-Hui Chang
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
| | - Chien-Chu Lin
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
| | - Chien-Sheng Wu
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
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Kondeti RD, Venkatesh K, Murthy DVSBR, Kameti S, Devi KS, Chandrika KV. A Study of Clinical Manifestations and their Association with Antinuclear Antibodies in Various Autoimmune Connective Tissue Disorders. Indian J Dermatol 2023; 68:486. [PMID: 37822406 PMCID: PMC10564199 DOI: 10.4103/ijd.ijd_18_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
Background Autoimmune connective tissue diseases (AICTD) present with a myriad of clinical manifestations, including cutaneous. These disorders occur because of immune dysregulation that produces autoantibodies targeting connective tissue and internal organs. Screening these autoantibodies not only aids in the diagnosis but also in predicting specific organ involvement and the risk of complications related to the disease. Aims This study was conducted (a) to study various cutaneous and systemic manifestations of AICTD, (b) to study the antinuclear antibody (ANA) profile and (c) to determine the association between systemic manifestations and antinuclear antibodies. Methodology Thirty cases of autoimmune connective tissue disease were recruited for the study. A physical examination, clinical profile and ANA profile were done. Results Nonscarring alopecia (83.3%) was the commonest cutaneous manifestation noted, followed by photosensitivity (73.3%). The most common system affected was musculoskeletal (67%), followed by renal (40%). Anti-dsDNA antibodies were significantly associated with musculoskeletal involvement (85%) with a P value of 0.038 and anti-Sm antibodies with neurological involvement (87%), followed by renal involvement (75%) with a P value of 0.018 and 0.001, respectively. Anti-SCL 70 antibodies were significantly associated with lung involvement (75%), with a P value of 0.009 and the presence of anti-SS-A antibodies with cardiovascular involvement (40%) with a P value of 0.014. Conclusion Antinuclear antibodies are diagnostic as well as prognostic biomarkers for AICTD and contribute to precision medicine. These antibodies serve as markers to pursue involvement of organs, which in turn helps the treating physician to choose appropriate preventive measures.
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Affiliation(s)
- Rupa D. Kondeti
- From the Department of D. V. L., Katuri Medical College and Hospital, Guntur, Andhra Pradesh, India
| | - K. Venkatesh
- From the Department of D. V. L., Katuri Medical College and Hospital, Guntur, Andhra Pradesh, India
| | - D. V. S. B. Rama Murthy
- From the Department of D. V. L., Katuri Medical College and Hospital, Guntur, Andhra Pradesh, India
| | - Swapna Kameti
- From the Department of D. V. L., Katuri Medical College and Hospital, Guntur, Andhra Pradesh, India
| | - K. Sri Devi
- From the Department of D. V. L., Katuri Medical College and Hospital, Guntur, Andhra Pradesh, India
| | - K. V. Chandrika
- From the Department of D. V. L., Katuri Medical College and Hospital, Guntur, Andhra Pradesh, India
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Fukushige M, Lu X, Satoh M, Oda M, Ohba T, Katoh T. Association between antinuclear antibody positivity and chemical exposure among pregnant Japanese women: A cross-sectional study based on the Japan environment and Children's study. Int J Hyg Environ Health 2023; 248:114094. [PMID: 36610096 DOI: 10.1016/j.ijheh.2022.114094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/21/2022] [Accepted: 12/01/2022] [Indexed: 01/06/2023]
Abstract
Antinuclear antibodies (ANAs) are detected in healthy individuals, they are more prevalent in women than in men. Pregnant women are immunologically unique, but epidemiological data on ANA positivity in them remain limited. The exposure received from the mother during the fetal period impacts the future health of the fetus and has thus received increased attention in recent years. Thus, we investigated the association between ANA positivity and chemical exposure among pregnant Japanese women, registered in the Japan Environment and Children's Study (JECS). ANA titers were assessed by indirect immunofluorescence with HEp-2 cells at a cutoff dilution of 1:40. Sociodemographic and other data were obtained in the JECS from a self-administered questionnaire. We analyzed 1,235 Japanese women in their first trimester of pregnancy. The ANA prevalence was 17.2%. Among ANA-positive women, a speckled pattern was the most common (95.3%), followed by a homogeneous pattern (72.3%). Exposure to chemicals more than once a week significantly increased the probability of ANA positivity (kerosene, petroleum, benzene, or gasoline: adjusted odds ratio [AOR], 2.11; 95% confidence interval [95% CI], 1.03-4.34; chlorine bleach or germicide: AOR, 1.97; 95% CI, 1.10-3.54; organic solvents: AOR, 5.34; 95% CI, 1.40-20.36; and photocopying machines or laser printers: AOR, 1.73; 95% CI, 1.17-2.54). ANA positivity was associated with exposure to several chemicals in Japanese women. Our exploratory results suggested that ANAs as potential markers of chemical exposure warrant further research.
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Affiliation(s)
- Mami Fukushige
- Department of Nursing, Faculty of Life Sciences, Kumamoto University, 4-24-1 Kuhonji, Chuo-ku, Kumamoto-shi, Kumamoto, 862-0976, Japan; Department of Public Health, Faculty of Life Sciences, Kumamoto University, 1-1-1 Kuhonji, Chuo-ku, Kumamoto-shi, Kumamoto, 860-8556, Japan; Kumamoto University Regional Centre, The Japan Environment and Children's Study (JECS), 718, Medical Research Building, 1-1-1 Honjo, Chuo-ku, Kumamoto-shi, Kumamoto, 860-8556, Japan.
| | - Xi Lu
- Department of Public Health, Faculty of Life Sciences, Kumamoto University, 1-1-1 Kuhonji, Chuo-ku, Kumamoto-shi, Kumamoto, 860-8556, Japan
| | - Minoru Satoh
- Department of Clinical Nursing, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu-shi, Fukuoka, 807-8555, Japan; Department of Medicine, Kitakyushu Yahata-Higashi Hospital, 2-1-17 Nishihonmachi, Yahatahigashi-ku, Kitakyushu-shi, Fukuoka, 805-0061, Japan
| | - Masako Oda
- Kumamoto University Regional Centre, The Japan Environment and Children's Study (JECS), 718, Medical Research Building, 1-1-1 Honjo, Chuo-ku, Kumamoto-shi, Kumamoto, 860-8556, Japan
| | - Takashi Ohba
- Kumamoto University Regional Centre, The Japan Environment and Children's Study (JECS), 718, Medical Research Building, 1-1-1 Honjo, Chuo-ku, Kumamoto-shi, Kumamoto, 860-8556, Japan; Department of Obstetrics and Gynecology, Faculty of Life Science, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kitakyushu-shi, Fukuoka, 860-8556, Japan
| | - Takahiko Katoh
- Department of Public Health, Faculty of Life Sciences, Kumamoto University, 1-1-1 Kuhonji, Chuo-ku, Kumamoto-shi, Kumamoto, 860-8556, Japan; Kumamoto University Regional Centre, The Japan Environment and Children's Study (JECS), 718, Medical Research Building, 1-1-1 Honjo, Chuo-ku, Kumamoto-shi, Kumamoto, 860-8556, Japan
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Baba Ö, Kısaoğlu H, Kalyoncu M. Significance of the immunofluorescence staining patterns and titres of the antinuclear antibody test in paediatric rheumatology setting. Turk J Med Sci 2023; 53:193-198. [PMID: 36945955 PMCID: PMC10387863 DOI: 10.55730/1300-0144.5572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/17/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Antinuclear antibody (ANA) is among the most frequently ordered tests in paediatric rheumatology setting. Diseases like systemic lupus erythematosus and Sjögren syndrome is closely related with a positive ANA and classified as ANA associated diseases. Besides, ANA test is ordered in patients with juvenile idiopathic arthritis (JIA) to assess the risk for uveitis and a positive ANA could be detected in children with nonrheumaticrheumatic conditions. In this study, we aimed to investigate frequency of positive ANA in paediatric rheumatology setting and the association of immunofluorescence staining patterns and titres of ANA with rheumatic diseases. METHODS : Immunofluorescence staining patterns, and titres of the ANA and diagnoses of children who tested for ANA between January 2016 and December 2021 were retrospectively analysed. RESULTS Among 2477 patients with ANA tested, 28.1% had a positive ANA result. Among them, 39.2% had a diagnosis of a rheumatic disease. Most common rheumatic diagnosis was JIA (43.8%) and ANA associated diseases were observed in 24.5% of the patients with a rheumatic diagnosis. While ANA associated diseases had significantly more frequent homogenous staining, dense fine speckled pattern was significantly more common in children with nonrheumatic diagnoses. Despite ANA associated diseases was found to be significantly associated with higher titres, no difference was observed between patients with JIA and nonrheumatic conditions. DISCUSSION Our study showed that the majority of children with a positive ANA test were not diagnosed with a rheumatic disease. While titres and patterns of ANA were found to be important in diagnosis of rheumatic diseases, ordering ANA test with solid indications might give improved probability of rheumatic diagnoses in children with a positive test.
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Affiliation(s)
- Özge Baba
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Hakan Kısaoğlu
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Mukaddes Kalyoncu
- Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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12
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Ticconi C, Inversetti A, Logruosso E, Ghio M, Casadei L, Selmi C, Di Simone N. Antinuclear antibodies positivity in women in reproductive age: From infertility to adverse obstetrical outcomes - A meta-analysis. J Reprod Immunol 2023; 155:103794. [PMID: 36621091 DOI: 10.1016/j.jri.2022.103794] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/13/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023]
Abstract
This systematic review and meta-analysis were designed to identify possible correlations between isolated serum antinuclear antibody (ANA) and (i) infertility in the context of in-vitro fertilization (IVF), (ii) idiopathic recurrent pregnancy losses (RPL), and (iii) second/ third trimester pregnancy complications. We performed a systematic review and meta-analysis of the literature in PubMed Library database from inception to March 2022 following PRISMA guidelines. Our pooled results showed a lower pregnancy rate among ANA-positive women undergoing IVF/ICSI compared to ANA-negative women undergoing the same procedures (279/908 versus 1136/2347, random effect, odds ratio -OR- 0.50, 95% confidence interval -CI- 0.38-0.67, p 0.00001, I2 = 58%). We also reported a higher miscarriage rate among ANA-positive compared to ANA-negative women (48/223 versus 109/999, random effect, OR: 3.25 95% CI: 1.57-6.76, p = 0.002, I2 = 61%) and a lower implantation rate (320/1489 versus 1437/4205, random effect, OR: 0.51, 95% CI: 0.36-0.72, p = 0.0001, I2 = 78%). Regarding RPL, pooled results demonstrated a higher prevalence of ANA-positivity in RPL women compared to controls (698/2947 versus 240/3145, random effect, OR: 3.22, 95% CI: 2.12-4.88, p 0.00001, I2 77%), either using > 2 or > 3 pregnancy losses threshold for defining RPL. Heterogeneity of reporting outcome did not allow a quantitative analysis and led to no clear demonstration of an effect of serum ANA on the incidence of stillbirth, preeclampsia and hypertensive disorders. In conclusion, the unfavorable effect of serum ANA was observed in women following IVF. Similarly, ANA were associated with the risk of RPL, while data were unconclusive in terms of late pregnancy complications.
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Affiliation(s)
- Carlo Ticconi
- Department of Surgical Sciences, Section of Gynecology and Obstetrics, University Tor Vergata, 00168 Rome, Italy
| | - Annalisa Inversetti
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Milan, Pieve Emanuele, Italy; Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, via Manzoni 56, 20089 Milan, Rozzano, Italy
| | - Eleonora Logruosso
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Milan, Pieve Emanuele, Italy
| | - Matilda Ghio
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Milan, Pieve Emanuele, Italy
| | - Luisa Casadei
- Department of Surgical Sciences, Section of Gynecology and Obstetrics, University Tor Vergata, 00168 Rome, Italy
| | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Milan, Pieve Emanuele, Italy; Division of Rheumatology and Clinical Immunology, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, via Manzoni 56, 20089 Milan, Rozzano, Italy
| | - Nicoletta Di Simone
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Milan, Pieve Emanuele, Italy; Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, via Manzoni 56, 20089 Milan, Rozzano, Italy.
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13
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Vahabi M, Mirsharif ES, Ghazanfari T. Is COVID-19 severity unrelated to antinuclear antibodies? Transpl Immunol 2023; 78:101791. [PMID: 36682573 PMCID: PMC9851722 DOI: 10.1016/j.trim.2023.101791] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces an overreaction of the immune system, resulting in the production of auto-antibodies. Several studies have reported that autoantibodies are prevalent in COVID-19 patients. In our study, antinuclear antibodies were evaluated in patients with COVID-19. We examined 131 sera from patients (>17-year-old) with confirmed COVID-19. Samples were collected prior to receiving any medication and antinuclear antibodies (ANA) levels were measured by the indirect immunofluorescence (IIF) method. Furthermore, the immunoblotting test was used to determine the presence of anti-nuclear antigen antibodies. The IIF-ANA test was positive in 36.4% (48/131) of patients. Overall, non-ICU patients had higher IIF-ANA titers than ICU patients. In particular, ICU patients had fewer nuclear, cytoplasmic, and mitotic IIF-ANA antibodies than non-ICU patients. In conclusion, COVID-19 patients frequently have ANA possibly reflecting the immune dysregulation due to several damaged cells by SARS-CoV-2 virus.
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Affiliation(s)
- Maedeh Vahabi
- Immunology Department, Immunoregulation Research Center, Shahed University, Tehran, Iran
| | - Ensie Sadat Mirsharif
- Immunology Department, Immunoregulation Research Center, Shahed University, Tehran, Iran
| | - Tooba Ghazanfari
- Immunology Department, Immunoregulation Research Center, Shahed University, Tehran, Iran.
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Ahn SM, Choi EJ, Oh JS, Kim YG, Lee CK, Yoo B, Hong S. Prognostic factors for the development of systemic lupus erythematosus in patients with immune thrombocytopenia. Arthritis Res Ther 2022; 24:213. [PMID: 36068638 PMCID: PMC9446556 DOI: 10.1186/s13075-022-02901-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with immune thrombocytopenia (ITP) have a risk of developing systemic lupus erythematosus (SLE). We sought to examine the clinical characteristics of patients with primary ITP who later developed SLE and identified the risk factors for the development of SLE. METHODS We retrospectively examined patients who were diagnosed with primary ITP at a tertiary hospital between August 2001 and November 2019. We compared the clinical characteristics according to the development of SLE. Logistic regression analysis was performed to identify the factors associated with the development of SLE. RESULTS Of 130 patients with primary ITP, 10 (7.7%) were later diagnosed with SLE during follow-up (median, 30 months [IQR, 15.5-105]). The presence of skin bleeding, organ bleeding, lymphocytopenia, anemia, and antinuclear antibody (ANA) positivity (≥ 1:160) were more common among patients who later developed SLE than did those who did not develop SLE. Multivariate analysis showed that young age (< 40 years; odds ratio [OR], 6.307 [95% confidence interval (CI), 1.114-34.908]; P = 0.035), organ bleeding (OR, 13.672 [95% CI, 2.437-76.689]; P = 0.003), and ANA positivity (1:160; OR, 6.638 [95% CI, 1.399-31.504]; P = 0.017) were significantly associated with the development of SLE. CONCLUSIONS Young age (< 40 years), organ bleeding, and ANA positivity (≥ 1:160) were risk factors for the development of SLE in patients with primary ITP. Close follow-up is needed to detect the development of SLE in patients with ITP and the abovementioned risk factors.
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Affiliation(s)
- Soo Min Ahn
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun-Ji Choi
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Seon Oh
- Department of Information Medicine, Big Data Research Center, Asan Medical Center, Seoul, Republic of Korea
| | - Yong-Gil Kim
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang-Keun Lee
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Bin Yoo
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seokchan Hong
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Song Y, Zhang Y, Li Z, Liu J, Xiao J, Song H. Potential risk factors for the development from immune thrombocytopenia to systemic lupus erythematosus: a case-control study in Chinese children. Ann Hematol 2022; 101:1447-1456. [PMID: 35532821 DOI: 10.1007/s00277-022-04836-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/06/2022] [Indexed: 11/26/2022]
Abstract
Immune thrombocytopenia (ITP) patients are at risk developing to systemic lupus erythematosus (SLE) in the future. Our study attempted to explore the potential risk factors for the development from ITP to SLE in Chinese children by statistical analysis. This study was a retrospective case-control study. Patients diagnosed with ITP and developed to SLE after the diagnosis of ITP were defined as the case group. The control group consisted of children with ITP but without developing to SLE was recruited with a ratio of 1:2. Besides univariable analysis, multivariable logistic regression was built to evaluate the potential risk factors. A total of 150 children was included with 50 in the case group and 100 in the control group. Median developing time from ITP to SLE was 34.5 [IQR 12.5, 58.75] months. ANA was found significantly different between the two groups in our study in the univariable analysis but not in the multivariable analysis (OR = 4.50, 95% CI 0.97 to 21.01). Age diagnosed ITP was positively associated with SLE (OR = 1.07 every 5 years, 95% CI 1.01 to 1.15) with alert point at 8 years old (sensitivity 0.82, specificity 0.60). A lower level of complement was also positively associated with SLE (OR = 8.33, 95% CI 1.62 to 42.91). A minimum 3-year of close follow-up for pediatric ITP patients was recommended to monitor the risk for developing SLE. Older age and hypocomplementemia were potential risk factors for the development from ITP to SLE.
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Affiliation(s)
- Yuqing Song
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 ShuaiFuYuan Street, Dongcheng District, Beijing, 100730, China
| | - Yuelun Zhang
- Central Research Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhuo Li
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 ShuaiFuYuan Street, Dongcheng District, Beijing, 100730, China
| | - Jing Liu
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 ShuaiFuYuan Street, Dongcheng District, Beijing, 100730, China
| | - Juan Xiao
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 ShuaiFuYuan Street, Dongcheng District, Beijing, 100730, China.
| | - Hongmei Song
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 ShuaiFuYuan Street, Dongcheng District, Beijing, 100730, China.
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Wu H, Zhu L, Kinnear D, Triggs N, Quintanilla NM, Himes R. Clinical, Laboratory, and Histologic Correlates of Serum Antinuclear Antibody in Hispanic Pediatric Patients With Nonalcoholic Fatty Liver Disease. Am J Clin Pathol 2022; 158:221-227. [PMID: 35311933 DOI: 10.1093/ajcp/aqac028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/01/2022] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES The significance of antinuclear antibody (ANA) positivity in pediatric Hispanic patients with nonalcoholic fatty liver disease (NAFLD) is unknown. METHODS ANA status was correlated with clinical, laboratory, and histologic parameters in Hispanic patients with a histologic diagnosis of NAFLD. RESULTS Thirty-eight Hispanic children (27 male and 11 female) underwent liver biopsy at a median age of 12.1 years. Twenty patients (53%) had positive ANAs. The ANA-positive patients had higher fasting insulin levels (median [interquartile range (IQR)], 32.4 [25.4] µU/mL) and higher insulin resistance (median [Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) IQR], 5.9 [3.1]) than the ANA-negative patients (fasting insulin: median [IQR], 17 [13.9] µU/mL and median [HOMA-IR IQR], 3.5 [2.6] µU/mL; P = .05 and .01, respectively). Serum high-density lipoprotein (HDL) cholesterol levels were higher in the ANA-negative patients (median [IQR], 47 [18] mg/dL) than the ANA-positive patients (38 [12] mg/dL) (P = .03). There were no statistical differences in a series of demographic, clinical, laboratory, and histologic parameters between the ANA-positive and the ANA-negative patients. At a median follow-up of 2.6 years, alanine aminotransferase was significantly lower than the baseline levels in both groups. In 1 patient undergoing ANA retesting, the titer had normalized from a baseline of 1:1,280 3.8 years earlier. CONCLUSIONS In pediatric Hispanic patients with NAFLD, a positive ANA result is associated with insulin resistance and lower HDL cholesterol levels.
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Affiliation(s)
- Hao Wu
- Department of Pathology, Yale New Haven Hospital and Yale School of Medicine, New Haven, CT, USA
| | - Liang Zhu
- Biostatistics & Epidemiology Research Design Core, Center for Clinical and Translational Sciences, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Darryl Kinnear
- Departments of Pathology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
| | - Nicole Triggs
- Pediatrics (Section of Gastroenterology, Hepatology and Nutrition), Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
| | - Norma M Quintanilla
- Departments of Pathology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
| | - Ryan Himes
- Pediatric Gastroenterology, Hepatology and Nutrition, Ochsner Hospital for Children, New Orleans, LA, USA
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Zheng LH, Shang YL, Han ZY, Han Y. [Analysis of clinical features and prognosis of acute severe autoimmune hepatitis]. Zhonghua Gan Zang Bing Za Zhi 2022; 30:69-73. [PMID: 35152672 DOI: 10.3760/cma.j.cn501113-20201106-00603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: To analyze the clinical features and prognosis of acute severe autoimmune hepatitis (AIH). Methods: A retrospective analysis of the clinical data of patients with acute severe AIH admitted to our hospital from 2008 to 2019 was divided into acute AIH (A-AIH) and chronic acute AIH (AC-AIH) according to the presence or absence of liver diseases. Patients' general condition, liver biochemistry, immunology, histological features of liver, hormonal therapies prognosis and related factors were analyzed. Results: A total of 41 cases [39 females, age (54.24 ± 10.55) years] were collected. Alanine aminotransferase (ALT) and total bilirubin (TBil) were significantly increased, and the international normalized ratio (INR) was > 1.5. Acute lobular inflammation was the feature of acute and severe AIH in the histology of liver. The serum IgG level was (28.36 ± 8.35) g / L. The positive rate of antinuclear antibody (ANA) and anti-smooth muscle antibody (ASMA) was 82.9%, and 17.1%, respectively. Over 70% of acute severe AIHs were AC-AIH. The duration of onset of AC-AIH was > 8 weeks, while most A-AIHs < 8 weeks, and the differences between the two groups were statistically significant (P = 0.001). The mortality rate within 30 days after hormonal treatment was 19.5%. There were statistically significant differences in TBil, Model for End-Stage Liver Disease (MELD) score and leukocyte count between the death and survival group. Conclusion: The mortality rate in acute severe AIH is high, and most of them have the basis of chronic liver disease. Serum IgG level, autoantibodies and acute lobular inflammation are important factors for diagnosis. The prognosis of hormonal therapy is related to the patients' condition and course of disease.
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Affiliation(s)
- L H Zheng
- National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Xijing Hospital, Air Force Military Medical University, Xi'an 710032, China
| | - Y L Shang
- National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Xijing Hospital, Air Force Military Medical University, Xi'an 710032, China
| | - Z Y Han
- National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Xijing Hospital, Air Force Military Medical University, Xi'an 710032, China
| | - Y Han
- National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Xijing Hospital, Air Force Military Medical University, Xi'an 710032, China
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Vasdev V, Patnaik SK, Bhakuni DS, Shanmuganandan K, Bhayana A, Mullick G, Hegde A, Kumar A, Kumar A, Singh R. Assessment of ideal serum dilution for screening of antinuclear antibodies by an indirect immunofluorescence method in diagnosis of autoimmune disorders. Med J Armed Forces India 2022; 78:54-60. [PMID: 35035044 DOI: 10.1016/j.mjafi.2020.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 03/19/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Time and cost constraints lead to majority of clinical laboratories deviating away from an ideal practice of checking for antinuclear antibodies (ANAs) by indirect immunofluorescence (IIF) at multiple dilutions. Usage of screening dilution of 1:40 recommended by most manufacturers of commercial ANA kits results in numerous false positive-tests and misdiagnosis of connective tissue disorders (CTDs). We sought to study the ideal screening dilution for ANA by IIF for a diagnosis of ANA-related CTDs. METHODS Serum samples of patients with ANA-related conditions (n = 233) and healthy controls (n = 154) were evaluated by IIF using Immuno Concepts Hep-2000 ® ANA kits at dilutions from 1:40 to 1:640. Accuracy for diagnosis of CTDs for each serum dilution was assessed by receiver operating curve (ROC) analysis. RESULTS Antinuclear antibodies (ANA) positivity was observed in 19.5%, 10.4%, 4.55%, 0.65%, and 0% of healthy controls at dilutions of 1:40, 1:80, 1:160, 1:320, and 1:640, respectively. ANA positivity at 1:40 dilution was observed among 26.4% cases with mimics of CTDs. Prevalence of ANA positivity in ANA-related CTDs was 97.3%, 96.4%, 89.3%, 83.9%, and 71.4% at dilutions of 1:40, 1:80, 1:160, 1:320, and 1:640, respectively. ROC analysis revealed best test performance for distinction between healthy and ANA-related CTD populations at a serum dilution of 1 in 80. CONCLUSIONS Antinuclear antibodies (ANA) positivity at low titers (1:40) is highly prevalent in healthy population (19.5%) as well as amongst mimics of CTD (26.4%). Our study suggests a higher screening dilution of 1:80 for ANA by IIF for diagnosis of CTD maybe better. Combination of 1:80 and 1:160 dilutions provides optimum sensitivity and specificity for diagnosis of ANA-related disorders.
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Yoon S, Moon HW, Kim H, Hur M, Yun YM. Clinical Performance of Two Automated Immunoassays, EliA CTD Screen and QUANTA Flash CTD Screen Plus, for Antinuclear Antibody Screening. Ann Lab Med 2022; 42:63-70. [PMID: 34374350 PMCID: PMC8368234 DOI: 10.3343/alm.2022.42.1.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/26/2021] [Accepted: 07/06/2021] [Indexed: 12/31/2022] Open
Abstract
Background Recently, two fully automated immunoassays for antinuclear antibody (ANA) screening were introduced EliA CTD Screen (Thermo Fisher Scientific, Freiburg, Germany) and QUANTA Flash CTD Screen Plus (Inova Diagnostics, San Diego, USA). We evaluated their clinical performance in comparison with the indirect immunofluorescence assay (IIFA) and analyzed samples with discrepant results. Methods In total, 406 serum samples (206 from patients undergoing routine checkups and 200 from rheumatology clinic patients) were assayed using EliA, QUANTA Flash, and IIFA. We evaluated assay concordance and agreement and confirmed the presence of anti-extractable nuclear antigen (ENA) antibodies in samples with discrepant automated immunoassay and IIFA results. Additionally, we compared the clinical performance of each assay in diagnosing ANA-associated rheumatic disease (AARD) and adjusted the cut-off values. Results In rheumatology clinic samples, the concordance and agreement were 91.5% and strong between EliA and QUANTA Flash, 79.0% and weak between EliA and IIFA, and 80.5% and moderate between QUANTA Flash and IIFA, respectively. In automated immunoassay-positive, IIFA-negative samples (N=15), all anti-ENA antibodies detected (6/15) were anti-Sjögren’s syndrome antigen A/Ro (Ro60) antibodies. The automated immunoassays and IIFA showed high accuracy for diagnosing AARD, and adjusted cut-off values improved their sensitivities (EliA with 0.56 ratio, 82.9% sensitivity; QUANTA Flash with 9.7 chemiluminescent units, 87.8% sensitivity). Conclusions The two automated immunoassays showed reliable performance compared with IIFA and can be efficiently used with the IIFA in clinical immunology laboratories. Clinical cut-off values can be adjusted according to the workflow in each laboratory.
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Affiliation(s)
- Sumi Yoon
- Department of Laboratory Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hee-Won Moon
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hanah Kim
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Mina Hur
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Yeo-Min Yun
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea
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Tsuzuki H, Nagatsuka Y, Iwata M, Kitamura N, Nagasawa Y, Matsumoto T, Ito R, Takahashi T, Ito M, Nakamura H, Takei M. Antinuclear antibodies produced in HLA-DR transgenic humanized mice developed chronic graft-versus-host disease. Heliyon 2021; 7:e08380. [PMID: 34825089 PMCID: PMC8605287 DOI: 10.1016/j.heliyon.2021.e08380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 10/07/2021] [Accepted: 11/10/2021] [Indexed: 11/19/2022] Open
Abstract
Background Chronic graft versus host disease (GVHD) has been reported in humanized mice after the implantation of human hematopoietic stem cells (hu-HSC). As such, humanized mice have been applied to a mouse model of chronic GVHD; however, B-cell activation and autoantibody production did not occur, and the clinical features of chronic GVHD were not sufficiently reproduced. The purpose of this study was to establish an improved humanized mouse model with chronic GVHD using HLA-DR transgenic NOD/Shi-scid, IL-2RγKO (NOG) mice. Methods CD34-positive cells were isolated from blood extracted from HLA-DRB1∗0405-positive umbilical cords using magnetic cell isolation. Then these were transplanted into NOG-Iab KO, HLA-DR 0405 Tg mice aged 8–16 weeks. GVHD symptoms were observed 26 weeks after transplantation. Histological findings of the skin, lung, liver, and spleen were compared with those of non-humanized mice. Antinuclear antibodies (ANA) were measured by indirect immunofluorescence using sera isolated 26 weeks after transplantation. Results Although GVHD symptoms were not observed in humanized (hu-HSC) NOG-Iab KO, HLA-DR 0405 Tg mice during the observation period, histological findings of human T-cell infiltration were observed in the skin, liver, and lung, suggesting that GVDH was present; human tingible body macrophages or clusters of BCL-6-positive human B-cells were observed in the spleen. Furthermore, human IgG ANA with peripheral or homogeneous staining patterns were also detected in the sera. Conclusion Hu-HSC NOG-Iab KO, HLA-DR 0405 Tg mice differed from conventional models in terms of B-cell activation and ANA production. This study is the first to report on B-cell activation and autoantibody production in humanized mice with chronic GVHD, suggesting that hu-HSC NOG-Iab KO, HLA-DR 0405 Tg mice could be applied to a new humanized mouse model of chronic GVHD.
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Affiliation(s)
- Hiroshi Tsuzuki
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuko Nagatsuka
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Mitsuhiro Iwata
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Noboru Kitamura
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yosuke Nagasawa
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Taro Matsumoto
- Division of Cell Regeneration and Transplantation, Department of Functional Morphology, Nihon University School of Medicine, Tokyo, Japan
| | - Ryoji Ito
- Central Institute for Experimental Animals, Kawasaki, Japan
| | | | - Mamoru Ito
- Central Institute for Experimental Animals, Kawasaki, Japan
| | - Hideki Nakamura
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Masami Takei
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
- Corresponding author.
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21
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Vilas Boas L, Bezerra Sobrinho C, Rahal D, Augusto Capellari C, Skare T, Nisihara R. Antinuclear antibodies in patients with endometriosis: A cross-sectional study in 94 patients. Hum Immunol 2021; 83:70-73. [PMID: 34686383 DOI: 10.1016/j.humimm.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 01/12/2023]
Abstract
Markers of autoimmunity, such as autoantibodies, have been found in patients with endometriosis. These include the antinuclear antibodies (ANA). We aimed to evaluate the prevalence of ANA in a sample of patients with endometriosis and its possible clinical associations. Ninety-four patients with endometriosis and 91 controls were studied for ANA and extractable nuclear antigen (ENA; anti-Ro, anti-La, anti-Sm, and anti-RNP) profiles and anti-dsDNA. Epidemiological, clinical, and staging data in endometriosis were obtained. Patients with autoimmune disorders were excluded. Patients with endometriosis had a 21.2% prevalence of positive ANA vs. 5.4% in controls (P = 0.001). The ENA profile and anti-dsDNA were negative. Patients with positive ANA were more asymptomatic (P = 0.03) and had less dysmenorrhea. No associations with disease duration, patient age, or endometriosis stage were found. We found a high prevalence of positive ANA in patients with endometriosis. The presence of this autoantibody may be linked to a milder clinical expression of the disease.
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Affiliation(s)
- Laura Vilas Boas
- Mackenzie Evangelical School of Medicine Paraná, Curitiba, Brazil
| | | | - Danilo Rahal
- Post Graduate Program in Gynecology and Obstetrics, Federal University of Paraná, Curitiba, Brazil
| | - Cesar Augusto Capellari
- Post Graduate Program in Gynecology and Obstetrics, Federal University of Paraná, Curitiba, Brazil
| | - Thelma Skare
- Mackenzie Evangelical School of Medicine Paraná, Curitiba, Brazil
| | - Renato Nisihara
- Mackenzie Evangelical School of Medicine Paraná, Curitiba, Brazil; Post Graduate Program in Gynecology and Obstetrics, Federal University of Paraná, Curitiba, Brazil.
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22
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Mobini M, Ghasemian R, Vahedi Larijani L, Mataji M, Maleki I. Immunologic markers, vasculitis-associated autoantibodies, and complement levels in patients with COVID-19. J Res Med Sci 2021; 26:103. [PMID: 34899941 PMCID: PMC8607177 DOI: 10.4103/jrms.jrms_923_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/15/2020] [Accepted: 02/24/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The cause of coronavirus disease 2019 (COVID-19) is a virus which can lead to severe acute respiratory syndrome-CoV-2 (SARS-COV-2). There are evidences of involvement of immune system in pathogenesis of this disease. We investigated the presence of various vasculitis-associated autoantibodies and complement levels in patients with COVID-19. MATERIALS AND METHODS Patients with severe or critical type of COVID-19 were evaluated for symptoms, signs, and laboratory tests of vasculitis syndromes including rheumatoid factor (RF), antinuclear antibody (ANA), anti-double-stranded DNA, c and p anti-neutrophilic cytoplasmic antibody (c ANCA and P ANCA), and complement levels. RESULTS The study was performed in forty patients with severe or critical illness. The mean age of the participants was 48.5 ± 9.8 years. All patients had pulmonary involvement in lung computed tomography scans. Vasculitis laboratory test results included RF in two patients, ANA in three patients, and ANCA in one patient. Seventeen (42.5%) patients had hypocomplementemia in one or more complement tests. Four patients expired, of whom three had a decrease in complement level. CONCLUSION Decrease in complement levels may predict a critical state of COVID-19 disease. Therefore, measuring its levels may be of great benefit in making earlier decisions to initiate disease-suppressing treatments including corticosteroids.
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Affiliation(s)
- Maryam Mobini
- Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Roya Ghasemian
- Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Laleh Vahedi Larijani
- Immunogenetic Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maede Mataji
- Department of Internal Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Iradj Maleki
- Gut and Liver Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
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23
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Zheng L, Liu Y, Shang Y, Han Z, Han Y. Clinical characteristics and treatment outcomes of acute severe autoimmune hepatitis. BMC Gastroenterol 2021; 21:93. [PMID: 33648445 PMCID: PMC7923616 DOI: 10.1186/s12876-021-01653-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/07/2021] [Indexed: 12/29/2022] Open
Abstract
Background and aim Acute severe autoimmune hepatitis (AS-AIH) is a rare cause of acute liver failure (ALF), which is often neglected and delayed in treatment. The purpose of this study was to analyze the clinical characteristics and therapeutic effects of AS-AIH. Methods Retrospective analysis was performed. AIH was diagnosed according to the International Autoimmune Hepatitis Group (IAIHG) criteria revised in 1999. AS-AIH was defined as an acute presentation (onset of symptoms to presentation of ≤ 26 weeks) and INR of ≥ 1.5, and no histologic evidence of cirrhosis. Results Twelve patients were diagnosed as AS-AIH. At baseline, median immunoglobulin G was 28.35 g/L (range, 11.4–49.2). Ten (83.3%) patients were antinuclear antibodies and/or anti-smooth muscle antibodies positive. The prominent histologic characteristics were lobular necrosis/inflammation (91.7%) and plasma cell infiltration (100%). All patients received corticosteroid therapy. Death occurred in 2 (16.7%) patients within 30 days resulted from ALF. The average interval between the onset of symptoms and initiation of corticosteroid therapy in deceased patients was 65 days, compared with 19 days for survivors. Conclusions AS-AIH is an uncommon disease with poor outcomes. Patients with acute severe hepatitis of unknown cause should be minded the possibility of AS-AIH and corticosteroids should be considered as soon as possible.
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Affiliation(s)
- Linhua Zheng
- National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Xijing Hospital, Air Force Military Medical University, Xi'an, 710032, China
| | - Yansheng Liu
- National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Xijing Hospital, Air Force Military Medical University, Xi'an, 710032, China
| | - Yulong Shang
- National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Xijing Hospital, Air Force Military Medical University, Xi'an, 710032, China.
| | - Zheyi Han
- National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Xijing Hospital, Air Force Military Medical University, Xi'an, 710032, China
| | - Ying Han
- National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Xijing Hospital, Air Force Military Medical University, Xi'an, 710032, China.
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24
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Kutlu Ö, Çetinkaya P, Şahin T, Ekşioğlu HM. The Effect of Biological Agents on Antinuclear Antibody Status in Patients with Psoriasis: A Single-Center Study. Indian Dermatol Online J 2020; 11:904-909. [PMID: 33344337 PMCID: PMC7734973 DOI: 10.4103/idoj.idoj_164_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/03/2020] [Accepted: 09/12/2020] [Indexed: 11/28/2022] Open
Abstract
Background and Aims: Biological agents are being used as treatment of psoriasis for years. However, autoimmunity can develop after the using of these agents. Antinuclear antibody (ANA) status changes during biological therapy can be affected by certain factors including the presence of immunosuppression. We aimed to evaluate the effect of antitumor necrosis factor agents and ustekinumab on ANA status, as well as other factors leading to change in ANA status such as history of phototherapy and methotrexate combination therapy. Methods: In this study, the laboratory findings of thirty-one patients with psoriasis who received biological agents including infliximab, etanercept, adalimumab, and ustekinumab from 2016 to 2018 managed at the department of dermatology were reviewed. The ANA status of the patients was evaluated every 2–3 months. Results: Twelve (38.7%) out of the thirty-one patients developed ANA positivity during treatment. Nine patients receiving infliximab, two patients receiving etanercept, and one patient receiving adalimumab developed ANA positivity. The nuclear homogeneous, nuclear fine speckled, and nuclear large/coarse speckled were the most common patterns of ANA. A patient receiving infliximab also developed anti-dsDNA positivity. None of the patients developed drug-induced lupus erythematosus or any autoimmune diseases. Concomitant methotrexate use and phototherapy history had no effect on ANA status statistically (P = 0.240 and 0.717, respectively). Conclusion: The emergence of ANA positivity during infliximab therapy among all biological agents was more common. ANA positivity during biologic agents does not cause any signs and symptoms of autoimmune diseases in patients with psoriasis; thus, it can be suggested that biological agents are not major risk factors for autoimmunity.
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Affiliation(s)
- Ömer Kutlu
- Department of Dermatology and Venereology, Uşak University Faculty of Medicine, Turkey
| | - Pınar Çetinkaya
- Department of Dermatology and Venereology, Aydın Nazilli State Hospital, Turkey
| | - Tijen Şahin
- Department of Dermatology and Venereology, Health Sciences University, Ankara Training and Research Hospital, Turkey
| | - Hatice Meral Ekşioğlu
- Department of Dermatology and Venereology, Health Sciences University, Ankara Training and Research Hospital, Turkey
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Lerma LA, Chaudhary A, Bryan A, Morishima C, Wener MH, Fink SL. Prevalence of autoantibody responses in acute coronavirus disease 2019 (COVID-19). J Transl Autoimmun 2020; 3:100073. [PMID: 33263103 PMCID: PMC7691817 DOI: 10.1016/j.jtauto.2020.100073] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 02/06/2023] Open
Abstract
Immunopathology may play a significant role in the pathogenesis of Coronavirus-Induced Disease-19 (COVID-19). Immune-mediated tissue damage could result from development of rapid autoimmune responses, characterized by production of self-reactive autoantibodies. In this study, we tested specimens from acutely ill patients hospitalized with COVID-19 for autoantibodies against nuclear, vasculitis-associated, and phospholipid antigens. Detectable autoantibodies were present in 30% of the patients in our cohort, with the majority of reactive specimens demonstrating antibodies to nuclear antigens. However, antinuclear antibodies were only weakly reactive and directed to single antigens, as is often seen during acute infection. We identified strongly reactive antibodies to nuclear antigens only in patients with a prior history of autoimmune disease. In our cohort, the prevalence of antiphospholipid antibodies was low, and we did not detect any vasculitis-associated autoantibodies. We found similar levels of inflammatory markers and total immunoglobulin levels in autoantibody positive versus negative patients, but anti-SARS-CoV-2 antibody levels were increased in autoantibody positive patients. Together, our results suggest that acute COVID-19 is not associated with a high prevalence of clinically significant autoantibody responses of the type usually associated with autoimmune rheumatic disease. Autoantibodies against nuclear antigens are detectable in 25% of patients hospitalized with acute COVID-19. Anti-nuclear antigen antibodies were weakly reactive and most often directed to single antigens. Vasculitis-associated autoantibodies were not detected in specimens from patients with acute COVID-19. Anti-phospholipid antibodies were infrequently detected in patients with acute COVID-19.
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Affiliation(s)
- L Angelica Lerma
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Anu Chaudhary
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Andrew Bryan
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Chihiro Morishima
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Mark H Wener
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Susan L Fink
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
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26
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Łebkowska A, Krentowska A, Adamska A, Lipińska D, Piasecka B, Kowal-Bielecka O, Górska M, Semple RK, Kowalska I. Type B insulin resistance syndrome associated with connective tissue disease and psoriasis. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM200027. [PMID: 32755965 PMCID: PMC7424346 DOI: 10.1530/edm-20-0027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/13/2020] [Indexed: 12/21/2022] Open
Abstract
SUMMARY Type B insulin resistance syndrome (TBIR) is characterised by the rapid onset of severe insulin resistance due to circulating anti-insulin receptor antibodies (AIRAs). Widespread acanthosis nigricans is normally seen, and co-occurrence with other autoimmune diseases is common. We report a 27-year-old Caucasian man with psoriasis and connective tissue disease who presented with unexplained rapid weight loss, severe acanthosis nigricans, and hyperglycaemia punctuated by fasting hypoglycaemia. Severe insulin resistance was confirmed by hyperinsulinaemic euglycaemic clamping, and immunoprecipitation assay demonstrated AIRAs, confirming TBIR. Treatment with corticosteroids, metformin and hydroxychloroquine allowed withdrawal of insulin therapy, with stabilisation of glycaemia and diminished signs of insulin resistance; however, morning fasting hypoglycaemic episodes persisted. Over three years of follow-up, metabolic control remained satisfactory on a regimen of metformin, hydroxychloroquine and methotrexate; however, psoriatic arthritis developed. This case illustrates TBIR as a rare but severe form of acquired insulin resistance and describes an effective multidisciplinary approach to treatment. LEARNING POINTS We describe an unusual case of type B insulin resistance syndrome (TBIR) in association with mixed connective tissue disease and psoriasis. Clinical evidence of severe insulin resistance was corroborated by euglycaemic hyperinsulinaemic clamp, and anti-insulin receptor autoantibodies were confirmed by immunoprecipitation assay. Treatment with metformin, hydroxychloroquine and methotrexate ameliorated extreme insulin resistance.
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Affiliation(s)
- Agnieszka Łebkowska
- Department of Internal Medicine and Metabolic Diseases, Diabetology and Internal Medicine
| | - Anna Krentowska
- Department of Internal Medicine and Metabolic Diseases, Diabetology and Internal Medicine
| | | | - Danuta Lipińska
- Department of Endocrinology, Diabetology and Internal Medicine
| | - Beata Piasecka
- Department of Endocrinology, Diabetology and Internal Medicine
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Diseases, Medical University of Bialystok, Bialystok, Poland
| | - Maria Górska
- Department of Endocrinology, Diabetology and Internal Medicine
| | - Robert K Semple
- Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Irina Kowalska
- Department of Internal Medicine and Metabolic Diseases, Diabetology and Internal Medicine
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27
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Patrikiou E, Liaskos C, Mavropoulos A, Ntavari N, Gkoutzourelas A, Simopoulou T, Fechner K, Scheper T, Meyer W, Katsiari CG, Roussaki-Schulze A, Zafiriou E, Sakkas LI, Bogdanos DP. Autoantibodies against specific nuclear antigens are present in psoriatic disease and are diminished by secukinumab. Clin Chim Acta 2020; 510:400-407. [PMID: 32710943 DOI: 10.1016/j.cca.2020.07.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 07/18/2020] [Accepted: 07/19/2020] [Indexed: 02/07/2023]
Abstract
Anti-nuclear antibodies (ANA) are frequently detected in patients with psoriasis (Ps) and psoriatic arthritis (PsA), but their target autoantigens remain unknown. We assessed antibody (ab) reactivity against 23 known nuclear antigens in patients with Ps and PsA and assess the effects of secukinumab (anti-IL17A) treatment on ANA levels. A total of 201 patients, 101 with Ps and 100 with PsA, and 50 ANA-negative healthy controls (HCs) were tested for ANAs by a line immunoassay testing reactivity to 23 nuclear antigens. Ab reactivity to at least 1 antigen was found in 20.4% psoriatic disease patients (25.7% Ps and 15% PsA) compared to 8% HCs (p = ns), the most frequent being against dense fine speckled 70 (DFS70) (6.5%). In Ps and PsA patients with secukinumab-induced remission, anti-DFS70 and other antigen-specific autoantibodies were diminished over time. No decline was noted for IgG abs against antigens from pathogens such as cytomegalovirus, Epstein-Barr virus and Helicobacter pylori. Autoantibody decrease was associated with significant reduction of plasmablasts, follicular B and follicular T cells. In conclusion, one third of antigen-specific ANA patients with psoriatic disease recognize DFS70. Secukinumab decreases nuclear antigen autoreactivity, plasmablasts, follicular B and follicular T cells, highlighting a new mechanism of its action.
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Affiliation(s)
- Eleni Patrikiou
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Christos Liaskos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Athanasios Mavropoulos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Niki Ntavari
- Department of Dermatology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Athanasios Gkoutzourelas
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Theodora Simopoulou
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Kai Fechner
- Institute of Immunology Affiliated to Euroimmun AG, Lübeck, Germany
| | - Thomas Scheper
- Institute of Immunology Affiliated to Euroimmun AG, Lübeck, Germany
| | - Wolfgang Meyer
- Institute of Immunology Affiliated to Euroimmun AG, Lübeck, Germany
| | - Christina G Katsiari
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Aggeliki Roussaki-Schulze
- Department of Dermatology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Efterpi Zafiriou
- Department of Dermatology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Lazaros I Sakkas
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Dimitrios P Bogdanos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece. http://www.autorheumatology.com
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Chen S, Yang G, Wu P, Sun Y, Dai F, He Y, Qian H, Liu Y, Shi G. Antinuclear antibodies positivity is a risk factor of recurrent pregnancy loss: A meta-analysis. Semin Arthritis Rheum 2020; 50:534-543. [PMID: 32442739 DOI: 10.1016/j.semarthrit.2020.03.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/06/2020] [Accepted: 03/23/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Immunologic mechanisms have been proposed as part of the pathogenesis mechanisms involved in recurrent pregnancy loss (RPL). Presence of positive antinuclear antibodies (ANA) is regarded as a typical feature of autoimmunity. Many studies had tried to clarify the association of ANA with RPL, but the conclusions were controversial. The aim of this meta-analysis was to assess whether ANA was positively associated with increased RPL risk. METHODS We searched PubMed and Embase databases for relevant literatures on the association between ANA positivity and RPL. The odds ratios (OR) with 95% confidence intervals (95%CI) were pooled using meta-analysis, and either fixed-effect or random-effect model was used based on heterogeneity across the included studies. RESULTS Twenty-one studies with 5038 participants (including 2683 RPL patients and 2355 controls) met the inclusion criteria were included. The total positive rate of ANA was 22.0% (591/2683) in RPL group, and 8.3% (196/2355) in the control group. RPL patients had a significantly higher ANA positive rate than controls (OR = 2.97, 95%CI 1.91-4.64, P<0.00001; I² = 75%), and a significant association between positive ANA and unexplained RPL was also observed (OR = 3.27, 95%CI 2.01-5.31, P<0.00001; I² = 70%). ANA positivity was also significantly associated with increased risk of RPL in women without defined autoimmune diseases (OR = 2.23, 95%CI 1.40-3.55, P=0.0007). Subgroup analysis demonstrated low titers of ANA (1:40≤ANA≤1: 80) were not associated with RPL (OR = 2.44, 95%CI 0.42-14.06, P=0.32), while higher ANA titer (≥1:160) had a significant association with RPL (OR = 45.89, 95%CI 8.44-249.45, P<0.00001). A higher rate of homogenous pattern in RPL patients was observed (OR = 4.89, 95%CI 2.20-10.87, P<0.001), and no significant difference in speckled pattern or nucleolar pattern was found. CONCLUSIONS This study demonstrated that ANA positivity was positively associated with increased RPL risk. ANA positivity is an important risk factor for RPL which needed to be screened among women with RPL.
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Affiliation(s)
- Shiju Chen
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, China.
| | - Guomei Yang
- Medical College, Xiamen University, Xiamen, China.
| | - Puqi Wu
- Medical College, Xiamen University, Xiamen, China.
| | - Yuechi Sun
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, China.
| | - Fan Dai
- Medical College, Xiamen University, Xiamen, China.
| | - Yan He
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, China.
| | - Hongyan Qian
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, China.
| | - Yuan Liu
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, China.
| | - Guixiu Shi
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, Xiamen, China.
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Abstract
We herein report an unusual case of primary Sjögren's syndrome in a 38-year-old woman with typical clinical symptoms (joint pain, dry mouth, and positive Schirmer test) and immunoglobulin G positivity but negativity for antinuclear antibody and all antinuclear antibody spectrum antibodies. Emission computed tomography demonstrated normal ingestion but impaired secretion by the submandibular and bilateral parotid glands. Labial gland biopsy revealed chronic tissue inflammatory changes and Chisholm grade 4 lymphocyte infiltration, confirming primary Sjögren's syndrome. The patient's condition was successfully controlled by nonsteroidal treatment with tacrolimus. Patients presenting with chronic dry mouth should be examined by a Schirmer test, lip gland biopsy, and salivary gland emission computed tomography for possible Sjögren's syndrome, even if serological autoantibodies are negative, to facilitate early intervention. Tacrolimus is a potential treatment option in patients intolerant of steroidal drugs.
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Affiliation(s)
- Xiaoli Pan
- Department of Nephrology and Rheumatology, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Fei Huang
- Department of Nephrology and Rheumatology, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Zhijun Pan
- College of Anesthesia, Guizhou Medical University, Guizhou, China
| | - Mei Tian
- Department of Nephrology and Rheumatology, Affiliated Hospital of Zunyi Medical University, Guizhou, China
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Akinci B, Meral R, Rus D, Hench R, Neidert AH, DiPaola F, Westerhoff M, Taylor SI, Oral EA. The complicated clinical course in a case of atypical lipodystrophy after development of neutralizing antibody to metreleptin: treatment with setmelanotide. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM190139. [PMID: 32213649 PMCID: PMC7159256 DOI: 10.1530/edm-19-0139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/05/2020] [Indexed: 12/24/2022] Open
Abstract
SUMMARY A patient with atypical partial lipodystrophy who had a transient initial response to metreleptin experienced acute worsening of her metabolic state when neutralizing antibodies against metreleptin appeared. Because her metabolic status continued to deteriorate, a therapeutic trial with melanocortin-4 receptor agonist setmelanotide, that is believed to function downstream from leptin receptor in the leptin signaling system, was undertaken in an effort to improve her metabolic status for the first time in a patient with lipodystrophy. To achieve this, a compassionate use (investigational new drug application; IND) was initiated (NCT03262610). Glucose control, body fat by dual-energy X-ray absorptiometry and MRI, and liver fat by proton density fat fraction were monitored. Daily hunger scores were assessed by patient filled questionnaires. Although there was a slight decrease in hunger scales and visceral fat, stimulating melanocortin-4 receptor by setmelanotide did not result in any other metabolic benefit such as improvement of hypertriglyceridemia or diabetes control as desired. Targeting melanocortin-4 receptor to regulate energy metabolism in this setting was not sufficient to obtain a significant metabolic benefit. However, complex features of our case make it difficult to generalize these observations to all cases of lipodystrophy. It is still possible that melanocortin-4 receptor agonistic action may offer some therapeutic benefits in leptin-deficient patients. LEARNING POINTS A patient with atypical lipodystrophy with an initial benefit with metreleptin therapy developed neutralizing antibodies to metreleptin (Nab-leptin), which led to substantial worsening in metabolic control. The neutralizing activity in her serum persisted for longer than 3 years. Whether the worsening in her metabolic state was truly caused by the development of Nab-leptin cannot be fully ascertained, but there was a temporal relationship. The experience noted in our patient at least raises the possibility for concern for substantial metabolic worsening upon emergence and persistence of Nab-leptin. Further studies of cases where Nab-leptin is detected and better assay systems to detect and characterize Nab-leptin are needed. The use of setmelanotide, a selective MC4R agonist targeting specific neurons downstream from the leptin receptor activation, was not effective in restoring metabolic control in this complex patient with presumed diminished leptin action due to Nab-leptin. Although stimulating the MC4R pathway was not sufficient to obtain a significant metabolic benefit in lowering triglycerides and helping with her insulin resistance as was noted with metreleptin earlier, there was a mild reduction in reported food intake and appetite. Complex features of our case make it difficult to generalize our observation to all leptin-deficient patients. It is possible that some leptin-deficient patients (especially those who need primarily control of food intake) may still theoretically benefit from MC4R agonistic action, and further studies in carefully selected patients may help to tease out the differential pathways of metabolic regulation by the complex network of leptin signaling system.
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Affiliation(s)
- Baris Akinci
- Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
- Division of Endocrinology and Metabolism, Dokuz Eylul University, Izmir, Turkey
| | - Rasimcan Meral
- Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - Diana Rus
- Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - Rita Hench
- Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - Adam H Neidert
- Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - Frank DiPaola
- Division of Pediatric Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | - Maria Westerhoff
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Simeon I Taylor
- Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Elif A Oral
- Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
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Ekhzaimy A, Masood A, Alzahrani S, Al-Ghamdi W, Alotaibi D, Mujammami M. Rare occurrence of central diabetes insipidus with dermatomyositis in a young male. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM190070. [PMID: 32031964 PMCID: PMC7040529 DOI: 10.1530/edm-19-0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/02/2020] [Indexed: 11/28/2022] Open
Abstract
SUMMARY Central diabetes insipidus (CDI) and several endocrine disorders previously classified as idiopathic are now considered to be of an autoimmune etiology. Dermatomyositis (DM), a rare autoimmune condition characterized by inflammatory myopathy and skin rashes, is also known to affect the gastrointestinal, pulmonary, and rarely the cardiac systems and the joints. The association of CDI and DM is extremely rare. After an extensive literature search and to the best of our knowledge this is the first reported case in literature, we report the case of a 36-year-old male with a history of CDI, who presented to the hospital's endocrine outpatient clinic for evaluation of a 3-week history of progressive facial rash accompanied by weakness and aching of the muscles. LEARNING POINTS Accurate biochemical diagnosis should always be followed by etiological investigation. This clinical entity usually constitutes a therapeutic challenge, often requiring a multidisciplinary approach for optimal outcome. Dermatomyositis is an important differential diagnosis in patients presenting with proximal muscle weakness. Associated autoimmune conditions should be considered while evaluating patients with dermatomyositis. Dermatomyositis can relapse at any stage, even following a very long period of remission. Maintenance immunosuppressive therapy should be carefully considered in these patients.
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Affiliation(s)
- Aishah Ekhzaimy
- Department of Medicine and College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Afshan Masood
- Obesity Research Center, and College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Seham Alzahrani
- Department of Medicine and College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Waleed Al-Ghamdi
- Department of Medicine and College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Daad Alotaibi
- Department of Medicine and College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Muhammad Mujammami
- Department of Medicine and College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Tomkins M, Tudor RM, Smith D, Agha A. Propylthiouracil-induced antineutrophil cytoplasmic antibody-associated vasculitis and agranulocytosis in a patient with Graves' disease. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM190135. [PMID: 31917676 PMCID: PMC6993247 DOI: 10.1530/edm-19-0135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 12/11/2019] [Indexed: 11/26/2022] Open
Abstract
SUMMARY This case is the first to describe a patient who experienced concomitant agranulocytosis and anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis as an adverse effect of propylthiouracil treatment for Graves' disease. A 42-year-old female with Graves' disease presented to the emergency department (ED) with a 2-week history of fevers, night sweats, transient lower limb rash, arthralgia, myalgia and fatigue. She had been taking propylthiouracil for 18 months prior to presentation. On admission, agranulocytosis was evident with a neutrophil count of 0.36 × 109/L and immediately propylthiouracil was stopped. There was no evidence of active infection and the patient was treated with broad-spectrum antibodies and one dose of granulocyte colony-stimulation factor, resulting in a satisfactory response. On further investigation, ANCAs were positive with dual positivity for proteinase 3 and myeloperoxidase. There was no evidence of end-organ damage secondary to vasculitis, and the patient's constitutional symptoms resolved completely on discontinuation of the drug precluding the need for immunosuppressive therapy. LEARNING POINTS Continued vigilance and patient education regarding the risk of antithyroid drug-induced agranulocytosis is vital throughout the course of treatment. ANCA-associated vasculitis is a rare adverse effect of antithyroid drug use. Timely discontinuation of the offending drug is vital in reducing end-organ damage and the need for immunosuppressive therapy in drug-induced ANCA-associated vasculitis. Similarities in the pathogenesis of agranulocytosis and drug-induced ANCA-associated vasculitis may offer insight into an improved understanding of vasculitis and agranulocytosis.
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Affiliation(s)
- Maria Tomkins
- Department of Endocrinology and Diabetes, Beaumont Hospital Dublin, Dublin, Ireland
| | - Roxana Maria Tudor
- Department of Endocrinology and Diabetes, Beaumont Hospital Dublin, Dublin, Ireland
| | - Diarmuid Smith
- Department of Endocrinology and Diabetes, Beaumont Hospital Dublin, Dublin, Ireland
| | - Amar Agha
- Department of Endocrinology and Diabetes, Beaumont Hospital Dublin, Dublin, Ireland
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Kotani M, Tamura N, Inoue T, Tanaka I. A case of type B insulin resistance syndrome treated with low-dose glucocorticoids. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190115. [PMID: 31743096 PMCID: PMC6865357 DOI: 10.1530/edm-19-0115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/23/2019] [Indexed: 11/25/2022] Open
Abstract
SUMMARY Type B insulin resistance syndrome is characterized by the presence of autoantibodies to the insulin receptor. We present a 57-year-old male admitted to a hospital due to body weight loss of 16 kg and hyperglycemia of 13.6 mmol/L. He was diagnosed with type B insulin resistance syndrome because the anti-insulin receptor antibodies were positive. We informed him that some hyperglycemic cases of this syndrome had been reported to be spontaneously remitted in 5 years, and he did not agree to be treated with high-dose glucocorticoids and/or immunosuppressive agents due to his concern for their adverse effects such as hyperglycemia and immunosuppression. He chose to be treated with insulin and voglibose, but fair glucose control could not be obtained. Six years later, he agreed to be treated with low-dose glucocorticoids practicable in outpatient settings. One milligram per day of betamethasone was tried orally and reduced gradually according to the values of glycated hemoglobin. After 30 months of glucocorticoid treatment, the anti-insulin receptor antibodies became undetectable and his fasting plasma glucose and glycated hemoglobin were normalized. This case suggests that low-dose glucocorticoids could be a choice to treat type B insulin resistance syndrome in outpatient settings. LEARNING POINTS Type B insulin resistance syndrome is an acquired autoimmune disease for insulin receptors. This case suggested the possibility of long-lasting, low-dose glucocorticoid therapy for the syndrome as an alternative for high-dose glucocorticoids or immunosuppressive agents. Since the prevalence of autoimmune nephritis is high in the syndrome, a delay of immunosuppressive therapy initiation might result in an exacerbation of nephropathy.
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Affiliation(s)
- Masato Kotani
- Center for Diabetes, Endocrinology and Metabolism
- Research Support Center, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
- Asahina Shinryoujo, Fujieda, Shizuoka, Japan
| | - Naohisa Tamura
- Center for Diabetes, Endocrinology and Metabolism
- Research Support Center, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | | | - Issei Tanaka
- Center for Diabetes, Endocrinology and Metabolism
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Li X, Pan J, Zhou H, He M, Li W, Chen Z, Dai W, Wang F, Wei Q, Lao X, Zhang L, Li L, Hu H, Li M, Qiu Y, Hou T. A multi-centre study for standardization of antinuclear antibody indirect immunofluorescence screening with automated system. J Immunol Methods 2020; 477:112701. [PMID: 31705859 DOI: 10.1016/j.jim.2019.112701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 11/03/2019] [Accepted: 11/04/2019] [Indexed: 12/23/2022]
Abstract
INTRODUCTION ndirect immunofluorescence assay (IFA) using HEp-2 as substrate plays a consolidate role for the detection and measurement of ANA, which is currently considered as the reference method for detection. Manual operation is still very common in China, therefore, the need of standardization and automation for ANA-IFA detecting has been highlighted. OBJECTIVE The current multi-center study is aimed to evaluate if HELIOS (AESKU Diagnostics, Wendelsheim, Germany) contributes to comparability of ANA screening results among different labs,and establish application specification of HELIOS for standardization of ANA detection. METHODS ANA detection by manual IFA method and HELIOS on 230 clinical serum samples in eight laboratories. The performance to discriminate positive/negative screening results, endpoint titer estimation and pattern recognition were evaluated in HELIOS and manual visual. RESULTS The positive coincident rate for ANA detection by manual IFA ranges from 87.7% to 97.8%, the negative coincidence rate ranges from 68.8% to 100%, the correctly estimated titer evaluation were 80 to 171 cases, the correct pattern in 146 to 161 cases, respectively. The positive coincident rate of HELIOS for ANA detection ranges from 91.2% to 97.7%, the negative coincidence rate ranges from 96.5% to 100%, the correctly estimated titer evaluation were 145 to 157 cases, the correct pattern in 123 to 140 cases, respectively. CONCLUSION HELIOS could provide accurate diagnostic results, this include not only positive/negative results, but also endpoint titer, common patterns. The application of this system can help to promote standardization of ANA detection.
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Abstract
Systemic lupus erythematosus (SLE) is a prototypic autoimmune disease with highly variable clinical and immunological manifestations. In the classification of patients with this condition, the presence of an antinuclear antibody (ANA) is an important element, with new criteria from the American College of Rheumatology and European League against Rheumatism positioning ANA positivity by an immunofluorescence assay on HEp2-cells (HEp2-IFA) or by an equivalent solid phase assay as the entry criterion. This positioning is based on assumptions about the frequency of ANA positivity in SLE as well as the reliability of the assays. Studies indicate that these assumptions are still a matter of uncertainty since both types of assay show considerable variability and patients with SLE may display negative results in ANA testing. These findings suggest caution in positioning ANA positivity as an entry criterion for classification and point to the value of alternative serological approaches for ANA determinations.
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Affiliation(s)
- David S Pisetsky
- Departments of Medicine and Immunology, Duke University Medical Center and Medical Research Service, Veterans Administration Medical Center, Durham, NC, USA.
| | - Xavier Bossuyt
- Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
| | - Pier Luigi Meroni
- Immunorheumatology Research Laboratory, IRCCS Instituto Auxologico Italiano, Milan, Italy
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Aygün E, Kelesoglu FM, Dogdu G, Ersoy A, Basbug D, Akça D, Çam ÖN, Akyüz B, Günsay T, Kapici AH, Aydin NG, Karapinar E, Atay S, Saglam N, Okumus NK, Can MZ, Yazici F, Ömeroglu RE. Antinuclear antibody testing in a Turkish pediatrics clinic: is it always necessary? Pan Afr Med J 2019; 32:181. [PMID: 31312295 PMCID: PMC6620086 DOI: 10.11604/pamj.2019.32.181.13793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 12/28/2018] [Indexed: 01/04/2023] Open
Abstract
Introduction The term anti-nuclear antibody (ANA) is used to define a large group of autoantibodies which specifically bind to nuclear elements. Although healthy individuals may also have ANA positivity, the measurement of ANA is generally used in the diagnosis of autoimmune disorders. However, various studies have shown that ANA testing may be overused, especially in pediatrics clinics. Our aim was to investigate the reasons for antinuclear antibody (ANA) testing in the general pediatrics and pediatric rheumatology clinics of our hospital and to determine whether ANA testing was ordered appropriately by evaluating chief complaints and the ultimate diagnoses of these cases. Methods The medical records of pediatric patients in whom ANA testing was performed between January 2014 and June 2016 were retrospectively evaluated. Subjects were grouped according to the indication for ANA testing and ANA titers. Results ANA tests were ordered in a total of 409 patients during the study period, with 113 positive ANA results. The ANA test was ordered mostly due to joint pain (50% of the study population). There was an increased likelihood of autoimmune rheumatic diseases (ARDs) with higher ANA titer. The positive predictive value of an ANA test was 16% for any connective tissue disease and 13% for lupus in the pediatric setting. Conclusion in the current study, more than one-fourth of the subjects were found to have ANA positivity, while only 15% were ultimately diagnosed with ARDs. Our findings underline the importance of an increased awareness of correct indications for ANA testing.
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Affiliation(s)
- Erhan Aygün
- Department of Pediatrics, Istanbul Medical School, Istanbul University, Millet Caddesi, Fatih, Istanbul, Turkey
| | - Fatih Mehmet Kelesoglu
- Department of Pediatric Rheumatology, Istanbul Medical School, Istanbul University, Millet Caddesi, Fatih, Istanbul, Turkey
| | - Gafur Dogdu
- Department of Pediatric Cardiology, Istanbul Medical School, Istanbul University, Millet Caddesi, Fatih, Istanbul, Turkey
| | - Aysenur Ersoy
- Student, Istanbul University, Istanbul Medical Faculty, Millet Caddesi, Fatih, Istanbul, Turkey
| | - Dilruba Basbug
- Student, Istanbul University, Istanbul Medical Faculty, Millet Caddesi, Fatih, Istanbul, Turkey
| | - Dilara Akça
- Student, Istanbul University, Istanbul Medical Faculty, Millet Caddesi, Fatih, Istanbul, Turkey
| | - Özge Nur Çam
- Student, Istanbul University, Istanbul Medical Faculty, Millet Caddesi, Fatih, Istanbul, Turkey
| | - Berat Akyüz
- Student, Istanbul University, Istanbul Medical Faculty, Millet Caddesi, Fatih, Istanbul, Turkey
| | - Tülay Günsay
- Student, Istanbul University, Istanbul Medical Faculty, Millet Caddesi, Fatih, Istanbul, Turkey
| | - Ahmet Hakki Kapici
- Student, Istanbul University, Istanbul Medical Faculty, Millet Caddesi, Fatih, Istanbul, Turkey
| | - Nur Gökçe Aydin
- Student, Istanbul University, Istanbul Medical Faculty, Millet Caddesi, Fatih, Istanbul, Turkey
| | - Edanur Karapinar
- Student, Istanbul University, Istanbul Medical Faculty, Millet Caddesi, Fatih, Istanbul, Turkey
| | - Sirin Atay
- Student, Istanbul University, Istanbul Medical Faculty, Millet Caddesi, Fatih, Istanbul, Turkey
| | - Nesibe Saglam
- Student, Istanbul University, Istanbul Medical Faculty, Millet Caddesi, Fatih, Istanbul, Turkey
| | - Nazli Kübra Okumus
- Student, Istanbul University, Istanbul Medical Faculty, Millet Caddesi, Fatih, Istanbul, Turkey
| | - Melike Zeynep Can
- Student, Istanbul University, Istanbul Medical Faculty, Millet Caddesi, Fatih, Istanbul, Turkey
| | - Fatmatüzzehra Yazici
- Student, Istanbul University, Istanbul Medical Faculty, Millet Caddesi, Fatih, Istanbul, Turkey
| | - Rukiye Eker Ömeroglu
- Department of Pediatric Rheumatology, Istanbul Medical School, Istanbul University, Millet Caddesi, Fatih, Istanbul, Turkey
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Abstract
Indirect immunofluorescence assay (IFA) has been used for detection of autoantibodies against cellular antigens for more than 50 years. Originally using rodent tissue as substrate, the method was optimized by using the human immortal HEp-2 cell line derived from a larynx epidermal carcinoma. The HEp-2/IFA platform allows for optimal visualization of several cellular domains recognized by autoantibodies in the samples being tested. Serial dilution allows for the estimation of the concentration (titer) of the autoantibodies in the sample. Judicious analysis of the topographic distribution of the immunofluorescence (pattern) provides useful hints on the most plausible autoantigens being recognized, vis-à-vis the cognate autoantibodies. The importance of the HEp-2/IFA pattern has been recently emphasized by the International Consensus on ANA Patterns (ICAP), an initiative that established a comprehensive classification of the most relevant and prevalent HEp-2/IFA patterns (designated anti-cell (AC) patterns) and harmonized its nomenclature. The former designation "antinuclear antibody test" has been progressively replaced by the term "anti-cell antibody test," due to the recognition that the HEp-2/IFA method in fact allows the detection of autoantibodies to several cellular domains, such as the cytoplasm and mitotic apparatus.The performance of the HEp-2/IFA test is strongly influenced by several technical details, including cell culture conditions, cell fixation and permeabilization methods, choice and titration of fluorochrome-conjugated secondary antibody, use and choice of blocking solutions, washing buffers, and antifading mounting medium. The several steps of the procedure must be carefully performed in order to avoid the formation of false positive fluorescent artifacts. The quality control of the assay involves the use of serum standards for negative, low positive and strongly positive reaction in each run of the assay. In addition, every new lot or new brand of HEp-2 slides should be evaluated by using a panel of standard sera yielding the most relevant AC patterns. Special attention should be dedicated to the training of personnel for the analysis of the slides at the microscope. These should be able to identify possible artifacts, recognize all relevant AC patterns, and formulate possible reflex tests according to the observed AC patterns.
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Goobie GC, Ford-Sahibzada CA, Fritzler MJ, Johannson KA, Fell CD. Autoantibody status is not associated with change in lung function or survival in patients with idiopathic pulmonary fibrosis. Respir Med 2019; 153:85-90. [PMID: 31176275 DOI: 10.1016/j.rmed.2019.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/27/2019] [Accepted: 05/28/2019] [Indexed: 01/20/2023]
Abstract
INTRODUCTION A proportion of patients with idiopathic pulmonary fibrosis (IPF) have autoantibodies directed against intracellular targets. This study aimed to determine the relationship between serologic status, lung function decline and survival. METHODS IPF patients assessed for antinuclear antibody (ANA) and related antigen-specific serology detected by addressable laser bead immunoassay (ALBIA) were included. Demographics, serial pulmonary function tests and survival were compared between patients with and without autoantibodies. Linear mixed models were used to estimate changes in forced vital capacity (FVC) and diffusion capacity for carbon monoxide (DLCO) over time. Cox-proportional hazards models were used to compare survival, adjusted for a composite score including age, sex and baseline lung function. RESULTS Of 61 included patients, the mean baseline age was 70 years (SD = 9), 77% were male, and 87% were Caucasian. Either ANA or antigen-specific serology by ALBIA was positive in 25 (41%) during follow-up. ANA was detected in 23 (38%), and specific autoantibodies by ALBIA in 6 (10%). There was no difference in age, sex, race, smoking status, anti-fibrotic use or baseline FVC or DLCO in patients with and without autoantibodies. There was no association between autoantibody status and survival (HR = 1.18, 95% CI 0.61, 2.29), rate of decline in FVC or DLCO (difference in FVC = 4.2 mL/year, p = 0.82; difference in DLCO = 4.6*10-4 mL/min/mmHg/year, p = 0.20). CONCLUSION These data suggest that autoantibodies are common in IPF and that patients with a subset of autoantibodies, but without features of autoimmunity, demonstrate similar disease behaviour to those without autoantibodies.
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Affiliation(s)
- Gillian C Goobie
- Division of Respirology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Chelsea A Ford-Sahibzada
- Bachelor of Health Sciences Program, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marvin J Fritzler
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kerri A Johannson
- Division of Respirology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Charlene D Fell
- Division of Respirology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Jeong J, Kim DH, Park G, Park S, Kim HS. Clinical significance of anti-dense fine speckled 70 antibody in patients with fibromyalgia. Korean J Intern Med 2019; 34:426-433. [PMID: 29166758 PMCID: PMC6406084 DOI: 10.3904/kjim.2016.276] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 12/29/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND/AIMS Fibromyalgia (FM) is a common rheumatologic disease characterized by chronic widespread pain, along with various clinical manifestations including atypical autoimmune characteristics. Despite its high prevalence, there remain no approved laboratory tests to identify specific manifestations of FM, or to rule out FM from other rheumatic diseases. Anti-dense fine speckled 70 (anti-DFS70) antibodies were initially identified as a form of anti-nuclear antibodies in a patient with interstitial cystitis. Anti-DFS70 antibodies are found in ≤ 10% of healthy individuals, but have suggestive negative association with autoimmune diseases; however, the clinical significance of these autoantibodies in FM patients remains poorly understood. METHODS We examined 39 patients with FM, along with 17 patients with systemic lupus erythematosus (SLE), and 19 healthy individuals (HI). Patients were compared based on physical measurements, disease duration, tender point counts, FM Impact Questionnaire (FIQ) scores, visual analog scale (VAS) for pain, somatic symptoms, and anti-DFS70 antibodies. RESULTS Levels of anti-DFS70 antibodies were significantly higher in the FM and HI groups than in those with SLE. Both anti-DFS70 antibodies and VAS scores were positively correlated with FM. Within the FM group, patients with arthralgia had higher anti-DFS70 antibody values compared to those without arthralgia (p = 0.024); antibody levels were also higher in patients with sleep disturbances relative to those without sleep issues (p = 0.024). In contrast, there were no correlations between anti-DFS70 antibodies and age, body mass index, disease duration, tender point counts, FIQ, short-form health survey results, or other clinical manifestations. CONCLUSION Anti-DFS70 antibodies may represent a useful biomarker for differentiating between FM and other autoimmune diseases. The levels of anti-DFS70 antibodies were also significantly higher among patients with arthralgia and sleep disturbances. Further investigations are necessary to evaluate the relationships between anti-DFS70 antibodies and other cytokines as a predictive marker for pain.
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Affiliation(s)
- Jisoo Jeong
- Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Seoul, Korea
| | - Dong Hyun Kim
- Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Gun Park
- Department of Laboratory Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Suyeon Park
- Department of Biostatistics, Soon Chun Hyang University College of Medicine, Seoul, Korea
| | - Hyun-Sook Kim
- Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Seoul, Korea
- Correspondence to Hyun-Sook Kim, M.D. Division of Rheumatology, Department of Internal Medicine, Soon Chun Hyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu. Seoul 04414, Korea Tel: +82-2-710-3060 Fax: +82-2-709-9554 E-mail:
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Abstract
Systemic lupus erythematosus is a chronic autoimmune condition with variable organ system involvement; manifestations can range from mild to potentially life threatening. Early diagnosis is important, as progression of disease can be halted. Diagnosis is made by review of signs and symptoms, imaging, and serology.
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Affiliation(s)
- Ruba Kado
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Suite 7C27 North Ingalls Building, 300 North Ingalls SPC 5422, Ann Arbor, MI 48109-5422, USA.
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Minchenberg SB, Chaparala G, Oaks Z, Banki K, Perl A. Systemic lupus erythematosus-myasthenia gravis overlap syndrome: Presentation and treatment depend on prior thymectomy. Clin Immunol 2018; 194:100-104. [PMID: 30025818 PMCID: PMC6089637 DOI: 10.1016/j.clim.2018.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 07/13/2018] [Indexed: 01/08/2023]
Abstract
In this study, we investigated four patients who met the diagnostic criteria for overlapping systemic lupus erythematosus (SLE) and myasthenia gravis (MG) but responded differently to treatment. All patients were acetylcholine receptor (AChR) and antinuclear antibody positive at the time of SLE diagnosis. Two patients presented with SLE who have been effectively treated with cholinesterase inhibitors for MG. These patients developed SLE with photosensitivity, rash, and arthritis post thymectomy, which had been performed 29 years and 40 years earlier, respectively. Two other patients were found to have AChR antibodies and MG in the context on new-onset SLE. These subjects were responsive to hydroxychloroquine and immunosuppression but failed cholinesterase inhibitors. The evolution of these cases is relevant for the role of thymus in lupus pathogenesis during aging and for treatment selection in SLE-MG overlap patients.
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Affiliation(s)
- Scott Brian Minchenberg
- Division of Rheumatology, Department of Medicine, State University of New York, Upstate Medical University, College of Medicine, Syracuse, New York, USA
| | - Geeta Chaparala
- Division of Rheumatology, Department of Medicine, State University of New York, Upstate Medical University, College of Medicine, Syracuse, New York, USA
| | - Zachary Oaks
- Division of Rheumatology, Department of Medicine, State University of New York, Upstate Medical University, College of Medicine, Syracuse, New York, USA
| | - Katalin Banki
- Department of Pathology, State University of New York, Upstate Medical University, College of Medicine, Syracuse, New York, USA
| | - Andras Perl
- Division of Rheumatology, Department of Medicine, State University of New York, Upstate Medical University, College of Medicine, Syracuse, New York, USA.
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Joshita S, Yoshizawa K, Umemura T, Ohira H, Takahashi A, Harada K, Hiep NC, Tsuneyama K, Kage M, Nakano M, Kang JH, Koike K, Zeniya M, Yasunaka T, Takaki A, Torimura T, Abe M, Yokosuka O, Tanaka A, Takikawa H; Japan Autoimmune Hepatitis Study Group (JAIHSG). Clinical features of autoimmune hepatitis with acute presentation: a Japanese nationwide survey. J Gastroenterol 2018; 53:1079-88. [PMID: 29476251 DOI: 10.1007/s00535-018-1444-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/15/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Autoimmune hepatitis (AIH) is characterized by progressive inflammation and necrosis of hepatocytes and eventually leads to a variety of phenotypes, including acute liver dysfunction, chronic progressive liver disease, and fulminant hepatic failure. Although the precise mechanisms of AIH are unknown, environmental factors may trigger disease onset in genetically predisposed individuals. Patients with the recently established entity of AIH with acute presentation often display atypical clinical features that mimic those of acute hepatitis forms even though AIH is categorized as a chronic liver disease. The aim of this study was to identify the precise clinical features of AIH with acute presentation. METHODS Eighty-six AIH patients with acute presentation were retrospectively enrolled from facilities across Japan and analyzed for clinical features, histopathological findings, and disease outcomes. RESULTS Seventy-five patients were female and 11 were male. Patient age ranged from adolescent to over 80 years old, with a median age of 55 years. Median alanine transaminase (ALT) was 776 U/L and median immunoglobulin G (IgG) was 1671 mg/dL. There were no significant differences between genders in terms of ALT (P = 0.27) or IgG (P = 0.51). The number of patients without and with histopathological fibrosis was 29 and 57, respectively. The patients with fibrosis were significantly older than those without (P = 0.015), but no other differences in clinical or histopathological findings were observed. Moreover, antinuclear antibody (ANA)-positive (defined as × 40, N = 63) and -negative (N = 23) patients showed no significant differences in clinical or histopathological findings or disease outcomes. Twenty-five patients experienced disease relapse and two patients died during the study period. ALP ≥ 500 U/L [odds ratio (OR) 3.20; 95% confidence interval (CI) 1.12-9.10; P < 0.030] and GGT ≥ 200 U/L (OR 2.98; 95% CI 1.01-8.77; P = 0.047) were identified as independent risk factors of disease relapse. CONCLUSIONS AIH with acute presentation is a newly recognized disease entity for which diagnostic hallmarks, such as ALT, fibrosis, and ANA, are needed. Further investigation is also required on the mechanisms of this disorder. Clinicians should be mindful of disease relapse during patient care.
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Abstract
Sjögren's syndrome is currently considered an "autoimmune epithelitis," as exocrine glands, especially salivary and lacrimal, are progressively destructed by an immune-mediated process associated with specific serum autoantibodies and local lymphocyte infiltrate. Xerostomia remains a key complain in patients with Sjögren's syndrome but should be evaluated also for other causes such as xerogenic medications, followed by radiation and chemotherapy for head and neck cancers, hormone disorders, infections, or other connective tissue diseases. Further, xerophtalmia (also known as dry eye) frequently associated with keratoconjunctivitis sicca cumulatively affects approximately 10-30% of the general population with increasing incidence with age and is more frequently secondary to non-autoimmune diseases. On the other hand, numerous patients with Sjögren's syndrome manifest signs of systemic dryness involving the nose, the trachea, the vagina, and the skin, suggesting that other glands are also affected beyond the exocrine epithelia. Skin involvement in Sjögren's syndrome is relatively common, and various manifestations may be present, in particular xeroderma, eyelid dermatitis, annular erythema, and cutaneous vasculitis. Additional skin non-vasculitic manifestations include livedo reticularis which may occur in the absence of vasculitis, and localized nodular cutaneous amyloidosis possibly representing lymphoproliferative diseases related to Sjögren's syndrome. The treatment of skin and mucosal manifestations in Sjögren's syndrome is similar regardless of the cause, starting from patient education to avoid alcohol and tobacco smoking and to pursue dental hygiene. In conclusion, a strict collaboration between the dermatologist and the rheumatologist is essential in the adequate management of Sjögren's syndrome skin and mucosal manifestations.
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Baradaranfar M, Dadgarnia M, Zand V, Vaziribozorg S, Mirzade FS, Mirzade M. The Role of Immunological Factors on Sudden Sensoryneural Hearing Loss. Iran J Otorhinolaryngol 2018; 30:219-223. [PMID: 30083528 PMCID: PMC6064766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
INTRODUCTION In this study, we examined the role of immunological factors on sudden sensory neural hearing loss (SSNHL). MATERIALS AND METHODS This prospective case-controlled study was performed in patients with SSNHL who referred to the ear, nose, and throat (ENT) ward. Fifty-six patients with SSNHLoccurring within a 72-hr period were selected as the case group and 56 participants who had no recent history of disease were assigned to the control group. Mean levels of immunological factors including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), antinuclear antibody (ANA), anti-neutrophil cytoplasmic antibody (ANCA) (C, P), anti-cyclic citrullinated peptide (anti-CCP), DSM, hemoglobin (Hb), complement component 3 (C3), and complement component 4 (C4) were evaluated in the blood samples in each group. RESULTS There were 31 male and 25 female participants in the control group, while the case group had 26 male and 30 female participants. The mean age of the participants was 36.2 ± 13.4 years in the control group and 40.80 ± 13.37 years in the case group. The two groups differed significantly in terms of mean ESR, ANA, C3, C4 and monocytes, with higher levels in the case group (P<0.05). However, differences in mean CRP, anti-Ds DNA, Hb, anti-CCP, white blood cells (WBC), neutrophils, lymphocytes, eosinophils, and platelets were not statistically significant between the case and control groups (P>0.05). CONCLUSION Because some of the immunological factors investigated in this study were significantly higher in patients with SSNHL, it can be concluded that there is an association between these immunological factors and SSNHL. Further studies are recommended to accurately determine the effect of these factors on the development of SSNHL and its treatment.
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Affiliation(s)
- Mohammadhossein Baradaranfar
- Department of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Mohammadhossein Dadgarnia
- Department of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Vahid Zand
- Department of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Sedighe Vaziribozorg
- Department of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Fatemeh Sadat Mirzade
- Department of Internal Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Mojtaba Mirzade
- Department of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Corresponding Author: Department of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Tel: 00983538224000, E-mail:
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Nordal E, Rypdal V, Christoffersen T, Aalto K, Berntson L, Fasth A, Herlin T, Nielsen S, Peltoniemi S, Straume B, Zak M, Rygg M. Incidence and predictors of Uveitis in juvenile idiopathic arthritis in a Nordic long-term cohort study. Pediatr Rheumatol Online J 2017; 15:66. [PMID: 28821293 PMCID: PMC5562983 DOI: 10.1186/s12969-017-0195-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/11/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The incidence of uveitis associated with juvenile idiopathic arthritis (JIA) varies around the world. Our aim was to investigate the incidence and predictors of uveitis in a Nordic population-based cohort. METHODS Consecutive JIA cases from defined geographical areas in Denmark, Finland, Sweden and Norway with disease onset between January 1997 to June 2000 were followed for median 98 months in this prospective longitudinal cohort study. Potential clinical and immunological predictors of uveitis were identified with logistic regression analysis. RESULTS Uveitis occurred in 89 (20.5%) of the 435 children with regular ophtalmologic follow-up among the 500 included. Chronic asymptomatic uveitis developed in 80 and acute symptomatic uveitis in 9 children. Uveitis developed at a median interval of 0.8 (range - 4.7 to 9.4) years after onset of arthritis. Predictors of uveitis were age < 7 years at JIA onset (Odds ratio (OR) 2.1, 95% confidence interval (CI) 1.3 to 3.5), presence of antihistone antibodies (AHA) > 15 U/ml (OR 4.8 (1.8 to 13.4)) and antinuclear antibodies (ANA) (OR 2.4 (1.5 to 4.0)). Mean combined IgM/IgG AHA was significantly higher in the uveitis group (19.2 U/ml) than in the non-uveitis group (10.2 U/ml) (p = 0.002). Young age at JIA onset predicted uveitis in girls (p < 0.001), but not in boys (p = 0.390). CONCLUSION Early-onset arthritis and presence of AHA in girls, as well as presence of ANA in both genders, were significant predictors of chronic uveitis. The high incidence of uveitis in this long-term Nordic JIA cohort may have severe implications in a lifelong perspective.
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Affiliation(s)
- Ellen Nordal
- Department of Pediatrics, University Hospital of North Norway, and Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
| | - Veronika Rypdal
- 0000000122595234grid.10919.30Department of Pediatrics, University Hospital of North Norway, and Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Terje Christoffersen
- 0000000122595234grid.10919.30Department of Ophtalmology, University Hospital of North Norway, and Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Kristiina Aalto
- 0000 0004 0410 2071grid.7737.4Pediatric Rheumatology Clinic, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Lillemor Berntson
- 0000 0004 1936 9457grid.8993.bDepartment of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Anders Fasth
- 0000 0000 9919 9582grid.8761.8Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Troels Herlin
- 0000 0004 0512 597Xgrid.154185.cDepartment of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Susan Nielsen
- grid.475435.4Pediatric Rheumatology Clinic, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Suvi Peltoniemi
- 0000 0004 0410 2071grid.7737.4Pediatric Rheumatology Clinic, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Bjørn Straume
- 0000000122595234grid.10919.30Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Marek Zak
- grid.475435.4Pediatric Rheumatology Clinic, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Marite Rygg
- 0000 0001 1516 2393grid.5947.fDepartment of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, and Department of Pediatrics, St. Olavs Hospital, Trondheim, Norway
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Yoo IY, Oh JW, Cha HS, Koh EM, Kang ES. Performance of an Automated Fluorescence Antinuclear Antibody Image Analyzer. Ann Lab Med 2017; 37:240-247. [PMID: 28224770 PMCID: PMC5339096 DOI: 10.3343/alm.2017.37.3.240] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/08/2016] [Accepted: 01/26/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The gold standard for antinuclear antibody (ANA) screening is the indirect immunofluorescence (IIF) assay with human epithelial cells (HEp-2). However, a number of substantial disadvantages of manual IIF assays have highlighted the need for the automation and standardization of fluorescent ANA (FANA) testing. We evaluated the performance of EUROPattern Suite (Euroimmun AG, Germany), an automated FANA image analyzer, with regard to ANA detection and pattern recognition compared with conventional manual interpretation using the fluorescence microscopic IIF assay. METHODS A total of 104 samples including 70 ANA-positive sera and 34 ANA-negative sera collected from September to October 2015 were included. The sensitivity, specificity, and pattern recognition function were evaluated to determine the performance of EUROPattern Suite compared with the manual IIF assay results. RESULTS The sensitivity and specificity of EUROPattern Suite for ANA detection were 94.3% and 94.1%, respectively. The concordance rate between the two methods was 94.2%. For pattern recognition, 45.7% of the samples were assigned identical ANA patterns including simple and mixed. When major pattern matching was considered, 83.7% (41/49) and 95.2% (20/21) of the samples with simple and mixed patterns, respectively, showed concordant results between the two methods. CONCLUSIONS EUROPattern Suite, an automated FANA image analyzer, provides a viable option for distinguishing between positive and negative results, although the ability to assign specific patterns is insufficient to replace manual microscopic interpretation. This automated system may increase efficiency in laboratories, in which a large number of samples need to be processed.
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Affiliation(s)
- In Young Yoo
- Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Won Oh
- Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hoon Suk Cha
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Mi Koh
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Suk Kang
- Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Mortezagholi S, Babaloo Z, Rahimzadeh P, Namdari H, Ghaedi M, Gharibdoost F, Mirzaei R, Bidad K, Salehi E. Evaluation of TLR9 expression on PBMCs and CpG ODN-TLR9 ligation on IFN-α production in SLE patients. Immunopharmacol Immunotoxicol 2017; 39:11-18. [PMID: 28049380 DOI: 10.1080/08923973.2016.1263859] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CONTEXT Systemic lupus erythematosus (SLE) is a systemic autoimmune disease characterized by autoreactive antibodies. Recent findings revealed the importance of innate immune responses, especially Toll-like receptors (TLRs) in the pathogenesis of SLE. OBJECTIVE In this study, the level of TLR9 expression on peripheral blood mononuclear cells (PBMCs) was analyzed. The levels of produced IFN-α were also measured in supernatant of PBMCs from SLE patients and healthy controls after stimulation with CpG ODN2216 which is a plasmocytoid dendritic cell (pDC)-specific TLR9 ligand. MATERIALS AND METHODS TLR9 expression was analyzed by real-time polymerase chain reaction (PCR) and flow cytometry in 35 SLE patients and 38 healthy controls and IFN-α concentration was measured in supernatants using enzyme-linked immunosorbent assay (ELISA). RESULTS The results showed that the TLR9 expression in the mRNA and the protein level was significantly higher in PBMCs from SLE patients. However, IFN-α concentration in patients and controls significantly increased in response to CpG stimulation but this increase was significantly higher in healthy controls compared with SLE patients. Our results do not show any association between taking hydroxychloroquine and reduction in IFN-α production in SLE patients. DISCUSSION AND CONCLUSIONS Regarding the findings of the study, there is the possibility that TLR9 has played a role in SLE pathogenesis, and consequently it implies that TLRs can be considered to be the therapeutic targets for systemic autoimmunity. We may conclude that PBMCs in patients are functionally impaired in response to TLR ligation via innate response stimulating pathogen-associated molecular patterns (PAMPs).
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Affiliation(s)
- Sahar Mortezagholi
- a Department of Immunology, School of Medicine , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Zohreh Babaloo
- a Department of Immunology, School of Medicine , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Parisa Rahimzadeh
- b Department of Immunology, School of Public Health , Tehran University of Medical Sciences , Tehran , Iran
| | - Haideh Namdari
- c Department of Immunology, School of Medicine , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Mojgan Ghaedi
- b Department of Immunology, School of Public Health , Tehran University of Medical Sciences , Tehran , Iran
| | - Farhad Gharibdoost
- d Department of Rheumatology, Rheumatology Research Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Reza Mirzaei
- e Department of Immunology, School of Medicine , Tehran University of Medical Sciences , Tehran , Iran
| | | | - Eisa Salehi
- e Department of Immunology, School of Medicine , Tehran University of Medical Sciences , Tehran , Iran
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Zhong YH, Zhong ZG, Zhou Z, Ma ZY, Qiu MY, Peng FH, Zhang WX. Comparisons of presentations and outcomes of neuromyelitis optica patients with and without Sjögren's syndrome. Neurol Sci 2017; 38:271-7. [PMID: 27817092 DOI: 10.1007/s10072-016-2751-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/24/2016] [Indexed: 01/08/2023]
Abstract
Patients with neuromyelitis optica (NMO) often have an accompanying autoimmune disease, most commonly, but not limited to Sjögren's syndrome (SS). The aim of this study was to compare clinical and laboratory features between NMO patients with and without SS and to investigate the prognosis of NMO in patients with and without SS. Twenty-three NMO patients with SS and 42 NMO patients without SS were included. Clinical and laboratory profiles were compared, including annual relapse rate and time from onset of NMO to Expanded Disability Status Scale (EDSS) scores of 4.0 and 6.0. More NMO patients with SS than those without SS had anti-nuclear antibody, anti-SS-A/Ro and anti-SS-B/La antibodies (91.3 vs. 35.7%, p < 0.001, 87.0 vs. 2.3%, p < 0.001, and 34.8 vs. 0.0%, p < 0.001, respectively). Serum immunoglobulins (IgA, IgM and IgG) were markedly increased in NMO patients with SS in comparison with those without SS. Annual relapse rate and the time from disease onset to an EDSS score of 4.0 and 6.0 were not significantly different between the two groups. No differences between the two groups were found for the other parameters, including AQP-4 antibody status, length of spinal cord lesion and brain lesions. These results imply that NMO in SS more likely represents coexistence with SS rather than representing the result of direct central nervous system involvement in SS. Autoimmune response appears to be more intense in the NMO group with SS, but did not cause a more severe prognosis in comparison with the group without SS, indicating that we should pay attention to the potential benefit of the antinuclear antibodies in NMO.
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Daves M, Blecken J, Matthias T, Frey A, Perkmann V, Dall Acqua A, Joos A, Platzgummer S. New automated indirect immunofluorescent antinuclear antibody testing compares well with established manual immunofluorescent screening and titration for antinuclear antibody on HEp-2 cells. Immunol Res 2016; 65:370-374. [PMID: 27743128 DOI: 10.1007/s12026-016-8874-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The IIF using the HEp-2 cell substrate should be still considered the "gold standard" techniques for determination of antinuclear antibody (ANA). Standardization and automation can be considered to be still in progress. Aim of this study was to evaluate the performance of the commercially automated indirect immunofluorescent antinuclear HEp-2 antibody assay. The study was designed to compare two commercially available HEp-2 ANA by indirect immunofluorescent antibody assays using a sensitivity panel (120 clinically determined patients) and a specificity panel consisting of 78 clinically confirmed negative patients. We compared the NOVA View® system [INOVA Diagnostics San Diego, USA] with the new HELIOS Processor from AESKU Systems/AESKU.Diagnostics (Wendelsheim, Germany) to assess their capability for screening, pattern recognition and titration of the samples. These automated methods were directly compared to manual reading of the same processed slides on respective microscopes and also compared with the known clinical information. The results of the two automated methods were in very good agreement with recognizing negative and positive samples. The HELIOS system detected 188 samples correctly as negative or positive versus 187 detected by the NOVA View® system. The diagnostic sensitivity of the systems was 95.8 versus 96.7 % for HELIOS and NOVA View®, respectively. The systems exhibited a diagnostic specificity of 93.5 % for the HELIOS system and 91.0 % for the NOVA View®. Both systems are suitable for fast and reliable detection of positivity/negativity due to their high sensitivity and will lead to a further increase of standardization in autoimmunity.
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Affiliation(s)
- M Daves
- Clinical Pathology Laboratory, Hospital of Merano, Via Rossini 5, 39011, Merano, Italy.
| | - J Blecken
- AESKU.DIAGNOSTICS, Mikroforum Ring 2, 55234, Wendelsheim, Germany
| | - T Matthias
- AESKU.DIAGNOSTICS, Mikroforum Ring 2, 55234, Wendelsheim, Germany
| | - A Frey
- AESKU.DIAGNOSTICS, Mikroforum Ring 2, 55234, Wendelsheim, Germany
| | - V Perkmann
- Clinical Pathology Laboratory, Hospital of Merano, Via Rossini 5, 39011, Merano, Italy
| | - A Dall Acqua
- Clinical Pathology Laboratory, Hospital of Merano, Via Rossini 5, 39011, Merano, Italy
| | - A Joos
- Clinical Pathology Laboratory, Hospital of Merano, Via Rossini 5, 39011, Merano, Italy
| | - S Platzgummer
- Clinical Pathology Laboratory, Hospital of Merano, Via Rossini 5, 39011, Merano, Italy
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Chander R, Singh S, Kalantri SA, Charan S, Gupta A. Sero-Negative Systemic Sclerosis: A Rare Presentation. J Clin Diagn Res 2016; 10:OD12-3. [PMID: 27504337 DOI: 10.7860/jcdr/2016/16780.7973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 05/07/2016] [Indexed: 11/24/2022]
Abstract
Systemic Sclerosis is a multisystem disease associated with progressive fibrosis of skin and internal organs. It is diagnosed by presence of characteristic clinical findings and is supported by specific serologic abnormalities. ANA is positive in case of systemic sclerosis in 90 percent of cases. We report a rare case of this rare disease where patient was ANA, Antitopoisomerase I (anti-Scl-70), Anticenteromere antibody negative.
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Affiliation(s)
- Rakesh Chander
- Assistant Professor, Department of Medicine, Government Medical College , Amritsar, India
| | - Santokh Singh
- Principal and Head, Department of Medicine, Government Medical College , Amritsar, India
| | - Siddhesh Arun Kalantri
- Post Graduate Student, Department of Medicine, Government Medical College , Amritsar, India
| | - Shiv Charan
- Associate Professor, Department of Medicine, Government Medical College , Amritsar, India
| | - Abhishek Gupta
- Post Graduate Student, Department of Medicine, Government Medical College , Amritsar, India
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