Autoimmune serology

(Table 3-18)
Antinuclear Antibody (ANA) (Figure 3.31A–D)
  • Family of autoantibodies which may be directed at one or several of the following nuclear antigens:
    • Extractable nuclear antigens (ENAs)
      • Sm (Smith)
      • RNP (U1 ribonucleoprotein)
      • Ro (SSA)
      • La (SSB)
      • Scl-70
      • Jo-1
    • Non-ENAs
      • ds-DNA (double stranded)
      • Histone
      • Nuclear RNA
  • ANA assay measures the amount (titer) and pattern of antibodies in a patient’s serum that bind autoantigens present in the nucleus of cells
  • The titer represents the last doubling dilution in order to produce a sample with no fluorescence (ANA-free)
  • Two types of assays: indirect IF (IIF) and ELISA
    • IIF: most accurate, uses Hep-2 epithelial carcinoma cells as substrate (due to ↑ nuclear/cytoplasmic ratio)
    • ELISA: more popular due to decreased cost
  • Patterns of nuclear fluorescence if ANA titer positive:
    • Homogenous (diffuse) suggests anti-dsDNA (SLE)
    • Peripheral (rim) suggests anti-dsDNA (SLE)
    • Speckled suggests anti-U1RNP (MCTD, Sjögren)
    • Centromeric stains kinetochore (CREST)
    • Nucleolar suggests anti-fibrillarin (SSc)
  • Five percent of normal population with elevated ANA but nonsignificant; ANA increases with age (i.e. 15% patients >55 years of age with ↑ ANA titer but no clinical significance)
   
 
Table 3-18 Autoimmune Antibodies
AntibodyAntigenPrevalenceClinical Associations
Systemic Lupus Erythematosus (SLE)
 
Anti-dsDNA
Native DNA
40–90%
Highly specific, lupus nephritis, correlates with disease activity, early/severe disease
 
Anti-Sm
Ribonucleoprotein
10–30%
Highly specific, lupus nephritis
 
Anti-rRNP
 
Ribosomal P protein
 
10%
 
Highly specific, neuropsychiatric LE
 
Anti-Ro (SSA)
Ribonucleoprotein
40–60%
Mild SLE, photosensitivity, SCLE, neonatal LE/congenital heart block
 
Anti-La (SSB)
 
Ribonucleoprotein
 
20–30%
 
Same as anti-Ro associations
 
Anti-U1RNP
Ribonucleoprotein
30–60%
SCLE, mild SLE with limited systemic involvement
 
Anti-histone
Histone
40%
Drug-induced

{SLE mainly but can also be seen in SCLE}
 
Anti-Ku
p70/p80 nucleolar protein (DNA repair)
10%
SLE with polymyositis
 
Anti-ssDNA
 
Denatured DNA
 
70%
 
Possible risk for SLE in DLE patients
 
Anti-C1q
C1q of complement
60%
Severe SLE, lupus nephritis
 
Anti-cardiolipin
 
Cardiolipin (phospholipid)
 
50%
  
Sjögren Syndrome
 
Anti-α-fodrin
 
Actin-binding ptn
 
70%
  
 
Anti-Ro
Ribonucleoprotein
60%
↑ Risk of systemic disease and lymphoma
 
Anti-La
 
Ribonucleoprotein
 
35-85%
 
Same as anti-Ro
Systemic Sclerosis
 
Anti-Scl-70
DNA topoisomerase I
25%
Diffuse skin disease, interstitial lung disease
 
Anti-RNA polymerase III
RNA polymerase III
20%
Rapid-onset and severe disease with major organ and diffuse cutaneous involvement
 
Anti-fibrillarin
U3RNP
Diffuse skin disease, pulmonary HTN
 
Anti-centromere
 
5–30%
   
CREST
 
Anti-Ku
p70/p80 nucleolar protein (DNA repair)
10%
Dermatomyositis
 
Anti-155 kDa and anti-Se
 
Uncharacterized nuclear proteins
 
80%
 
Amyopathic dermatomyositis, cancer - associated dermatomyositis
 
Anti-Jo1
Histidyl tRNA synthetase
20%
Antisynthetase syndrome: Raynaud’s phenomenon, mechanic’s hands, pulmonary fibrosis, arthritis, myositis
 
Anti-SRP
 
Signal recognition particle
 
5%
 
Cardiac involvement, severe DM/PM, poor prognosis
 
Anti-Mi2
Nuclear helicase
15%
Hallmark skin lesions, good prognosis
 
Anti-Ku
 
p70/p80 protein
 
<5%
 
DM/PM overlap with SLE or scleroderma
 
Anti-PM/Scl
Nucleolar proteins
<10%
DM/PM overlapping with scleroderma
 
PL-7, PL-12
 
tRNA synthetase
 
3%
 
Antisynthetase syndrome
Mixed Connective Tissue Disease (MCTD)
 
Anti-U1RNP
Ribonucleoprotein
100%
  
        
 
   
Figure 3.31 ANA patterns A: Homogenous* B: Nucleolar* C: Centromeric* *Reprint from Cuenca S, et al. Rationelle und rationale Laboratorium diagnostik in der Hals-Nasen-Ohren-Heilkunde. HNO. 2008: 56 (9); 855–73 D: Speckled (Reprint from Vergani D, et al. Autoimmune Hepatitis. Seminars in Immunopathology. 2009: 31 (3); 421–435)
Figure 3.31
ANA patterns
A: Homogenous*
B: Nucleolar*
C: Centromeric*
*Reprint from Cuenca S, et al.
Rationelle und rationale
Laboratorium diagnostik in der
Hals-Nasen-Ohren-Heilkunde.
HNO. 2008: 56 (9); 855–73

D: Speckled
(Reprint from Vergani D, et al.
Autoimmune Hepatitis. Seminars
in Immunopathology. 2009: 31
(3); 421–435
)