IV Consenso Brasileiro para pesquisa de autoanticorpos em células HEp-2

Abstract

The 4th ANA Consensus included three novel patterns into the existing algorithm (cytoplasmic Rods and Rings, nuclear Quasi-homogeneous, and CENP-F). Emphasis was given to the need of attention in describing the peculiar mixed pattern elicited by anti-DNA topoisomerase I (Scl-70) autoantibodies, comprising nuclear fine specked, nucleolar homogeneous pattern, NOR staining in metaphase plates, and cytoplasmic fine speckled patterns. The group also emphasized the need for continuous quality control in indirect immunofluorescence assays, the establishment of screening dilutions, as well as conjugate titration. An alert was made regarding the heterogeneity of commercial kits in defining patterns and the use of solid phase methodologies to determine the presence of autoantibodies.

Report of the First International Consensus on Standardized Nomenclature of Antinuclear Antibody HEp-2 Cell Patterns 2014–2015

“…The classification tree for most staining patterns is presented in Figure 1 and they are segregated into nuclear, cytoplasmic, and mitotic patterns. In accord with the Brazilian Consensus strategy ( 11 ), certain patterns are recommended for mandatory reporting, while others are for expert-level reporting. During the write-up of this manuscript, in addition to comments from the reviewers, there were some concerns that “mandatory” might not fit well with dictating the requirements for clinical immunology laboratories, especially in an international setting.…”

“…Most of these patterns yield no consistent staining in the interphase cells but in prophase and metaphase cells, fluorescence may be observed in the chromosomal region and be seen as fine zipper-like streaks perpendicular to the edge of the metaphase plate, representing the contractile ring. In telophase cells, the staining is usually restricted to the cleavage furrow with two bright spots at the boundary point of both daughter cells ( 11 ). In interphase, namely the S and G2 phase, cells may be stained with discrete or patchy nuclear speckles ( 12 ).…”

“…These earlier publications were in Portuguese with some including English abstracts. The report for the fourth Brazilian ANA consensus meeting in 2013 was published entirely in English ( 11 ). Other reports with a focus on nomenclature/consensus in ANA on HEp-2 cells are acknowledged and were referred to during the ICAP meeting and writing of this report ( 12 – 15 ).…”

Reactivity analisys of "rods and rings" pattern in diferent HEp-2 ANA kits

“…Dessa forma, estudos que avaliam o grau de concordância dos kits na demonstração dos padrões são extremamente relevantes. 8 Um dos padrões de FAN que não apresentam boa concordância entre os diversos substratos é "anéis e bastões", padrão descrito recentemente, comumente associado a portadores de hepatite por vírus C. É comum que esse padrão seja expresso em um substrato e não em outro, fazendo com que o mesmo paciente possa ter resultados distintos quando realizados em laboratórios que utilizam kits comerciais diferentes. 4,9 Desse modo, este estudo objetiva comparar a reatividade para o padrão "anéis e bastões" em diferentes kits comerciais de fator antinúcleo (FAN) HEp-2.…”

Pneumonia intersticial com aspectos autoimunes: sobrevivência e evolução funcional em pacientes com autoimunidade sistêmica e doença pulmonar intersticial predominante

“…(39) Entretanto, a discussão sobre histologia parece assumir aspectos de menor relevância se considerarmos, primeiro, que biópsia pulmonar cirúrgica no Tabela 4: Principais características das doenças do tecido conjuntivo com acometimento intersticial pulmonar frequente. Adaptado de Wells, A e Denton, C. (35) Característica ES AR MII DMTC SSj LES DPI (36,52) 40-75% 10-30% 30-50% 35-66% 3-8% 3-11% Morfologia (35,36) PINE (4,36,53,54) FAN (55) (1,8,35,36) Se preferirmos a cautela em assumir que, radiologicamente, a distinção morfológica entre PII e DTC não é evidente, pode-se contudo com boa confiança extrapolar informações prognósticas dos padrões tomográficos apresentados, substituindo as eventuais informações que viriam das amostras histológicas. (15,36) Uma outra peculiaridade relevante das DTC é a terapia farmacológica, em que pese a sua boa resposta à terapia imunossupressora, em contraste ao aumento de mortalidade do uso dessas alternativas na FPI.…”