Como interpretar e valorizar adequadamente o teste de anticorpos antinúcleo

Dellavance, Alessandra; Andrade, Luís Eduardo Coelho

doi:10.1590/s1676-24442007000300004

Cited by 9 publications

(12 citation statements)

References 30 publications

(26 reference statements)

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“…These technological improvements greatly increased test sensitivity, and current tests detect antibodies at lower serum levels and less avidity than earlier assays. Therefore, the screening for antibodies against cellular antigens also exhibits a lower specificity [ 25 ]. In addition, the prescription of the ANA test started to be made by a broad spectrum of medical specialists, which was once primarily prescribed solely by rheumatologists.…”

Section: Discussionmentioning

confidence: 99%

Relationships among Antibodies against Extractable Nuclear Antigens, Antinuclear Antibodies, and Autoimmune Diseases in a Brazilian Public Hospital

Banhuk

Pahim

Jorge

et al. 2018

Autoimmune Diseases

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One characteristic of autoimmune diseases (ADs) is the production of autoantibodies for extractable nuclear autoantigens, which may aid in the discrimination of the different types of autoimmune diseases and is related to different antinuclear antibody (ANA) patterns. The present study verified the profile of patient samples tested for extractable nuclear antigens (ENA) antibodies in a public hospital and correlated the ENA results with ANA patterns and patient diagnoses. The study reviewed data in the medical records of patients who underwent anti-ENA tests at a public hospital in the West of the State of Paraná from February 2011 to January 2017. Patients were classified according to age, ethnicity, gender, anti-ENA test results, ANA results, and the presence or absence of AD. Thirty-six (20.9%) samples of the 172 anti-ENA tests were positive, seven (4.1%) samples were undetermined, and 129 (75%) exhibited negative results. The ANA reagent was found in 84.3% of the anti-ENA-positive samples. The anti-SSA/Ro autoantibody exhibited the highest frequency in the group, 41.7% (15/36). The most common pattern was nuclear fine speckled, which was found in 24.3% of the samples. The association results indicated a significant relationship between ANA titer and diagnosis in the anti-ENA- and ANA-positive patients. The anti-ENA-negative patients were diagnosed with an AD in 35% (45/129) of the cases, and 75% (27/36) of the anti-ENA-positive patients were diagnosed with an AD. Systemic lupus erythematosus and scleroderma were the most common pathologies in the antigen-positive patients. The anti-ENA test is a good marker to aid in the complex clinical diagnosis of patients with autoimmune diseases.

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Section: Discussionmentioning

confidence: 99%

Relationships among Antibodies against Extractable Nuclear Antigens, Antinuclear Antibodies, and Autoimmune Diseases in a Brazilian Public Hospital

Banhuk

Pahim

Jorge

et al. 2018

Autoimmune Diseases

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“…The representation of cells at different stages of cell division promotes detection of autoantibodies against a wide variety of autoantigens expressed in mitosis and interphase (phases G0, G1, G2 and S). Moreover, they feature multiple nucleoli and cytoplasm rich in organelles and cytoplasmic proteins (3,5) . Due to these characteristics, autoantibody screening against cellular components through IIF using HEp-2 cells as antigen substrate is currently recommended as the gold standard by the American College of Rheumatology (13) .…”

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confidence: 99%

Variability in the recognition of distinctive immunofluorescence patterns in different brands of HEp-2 cell slides

Dellavance

Cruvinel²,

Francescantônio³

et al. 2013

J. Bras. Patol. Med. Lab.

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Introduction: Indirect immunofluorescence on HEp-2 cells is considered the gold standard for the detection of autoantibodies against cellular antigens. However, the culture conditions, cell fixation and permeabilization processes interfere directly in the preservation and spatial distribution of antigens. Therefore, one can assume that certain peculiarities in the processing of cellular substrate may affect the recognition of indirect immunofluorescence patterns associated with several autoantibodies. Objective: To evaluate a panel of serum samples representing nuclear, nucleolar, cytoplasmic, mitotic apparatus, and chromosome plate patterns on HEp-2 cell substrates from different suppliers. Materials and methods: Seven blinded observers, independent from the three selected reference centers, evaluated 17 samples yielding different nuclear, nucleolar, cytoplasmic and mitotic apparatus patterns on HEp-2 cell slides from eight different brands. The slides were coded to maintain confidentiality of both brands and participating centers. Results: The 17 HEp-2 cell patterns were identified on most substrates. Nonetheless, some slides showed deficit in the expression of several patterns: nuclear coarse speckled/U1-ribonucleoprotein associated with antibodies against RNP (U1RNP), centromeric protein F (CENP-F), proliferating cell nuclear antigen (PCNA), cytoplasmic fine speckled associated with anti-Jo-1 antibodies (histidyl synthetase), nuclear mitotic apparatus protein 1 (NuMA-1) and nuclear mitotic apparatus protein 2 (NuMA-2). Conclusion: Despite the overall good quality of the assessed HEp-2 substrates, there was considerable inconsistency in results among different commercial substrates. The variations may be due to the evaluated batches, hence generalizations cannot be made as to the respective brands. It is recommended that each new batch or new brand be tested with a panel of reference sera representing the various patterns.

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“…A importância dessa discordância reside no fato de que os dois primeiros estão claramente associados a doenças autoimunes, como LES e Síndrome Sjögren, diferente do último, que não está relacionado com esse tipo de doença, não sendo recomendada a investigação sorológica subsequente do paciente com reatividade para esse padrão (4)(5)(6)(7)10) (Tabelas 2, 3 e 5).…”

Section: Discussionunclassified

“…Com o avanço da tecnologia, a medicina ganhou o amparo de propedêuticas laboratoriais e de imagem, que, consequentemente, permitiram a confirmação de diagnósticos menos prováveis (5) . No início da década de 1940, Hargraves notou no soro de pacientes portadores de lúpus eritematoso sistêmico (LES) a presença de material amorfo fagocitado dentro do citoplasma de neutrófilos.…”

Section: Introductionunclassified

“…O teste do FAN passou a ser denominado FAN HEp-2 e, progressivamente, a ser utilizado como teste para rastreamento de doenças autoimunes. No entanto, a utilização indiscriminada do teste em populações com baixa prevalência de doenças autoimunes levou a um aumento expressivo nos resultados falso-positivos (5,7,11,12,14,15,17,18) . Com o objetivo de estabelecer parâmetros para a realização do teste, padronizar a liberação dos laudos e, por conseguinte, orientar a interpretação dos resultados do teste do FAN HEp-2, foi elaborado em nosso país o Consenso Brasileiro de FAN HEp-2, que se encontra em sua terceira edição (2,3,8) .…”

Section: Introductionunclassified

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Análise comparativa de quatro kits de FAN HEp-2 para a detecção de autoanticorpos séricos

Mello¹,

Rezende²,

Coutinho³

et al. 2012

J. Bras. Patol. Med. Lab.

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Introdução: O objetivo deste estudo foi avaliar a concordância entre os kits de fator antinúcleo (FAN) HEp-2 em relação aos padrões de fluorescência observados. Objetivou-se, ainda, avaliar o desempenho dos kits em relação à intensidade de fluorescência apresentada pelo uso dos conjugados fluorescentes, o número de mitoses por campo presentes no poço de reação e a titulação necessária para se obter o limiar de reatividade mínima (1+) dos soros controle reagentes presentes nos kits. Materiais e métodos: Setenta e quatro amostras com resultados conhecidos foram testadas em quatro kits comerciais para a pesquisa de FAN HEp-2. O processamento estatístico foi feito pelo programa STATA ® 9.2 e a concordância entre os resultados foi aferida pelo teste Kappa. Resultados: O índice de concordância entre os kits, obtido pelo teste Kappa, foi superior a 0,94. Houve grande variabilidade quanto ao número de mitoses por campo presentes por poço de reação e quanto à intensidade de fluorescência dos conjugados, além de ter havido significativa diferença em dois kits em relação à diluição necessária para obtenção do limiar de reatividade mínima (1+). Conclusão: A taxa de concordância geral obtida pelo teste Kappa foi elevada, atingindo índice superior a 0,94. As maiores diferenças foram devido à presença de amostras com padrão variando entre nuclear pontilhado fino (PF), nuclear pontilhado fino denso (PFD) e nuclear homogêneo (HOMO). É necessária maior padronização dos kits quanto ao soro controle para a obtenção do limiar de reatividade mínima e em relação à intensidade de fluorescência dos conjugados.

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Como interpretar e valorizar adequadamente o teste de anticorpos antinúcleo

Cited by 9 publications

References 30 publications

Relationships among Antibodies against Extractable Nuclear Antigens, Antinuclear Antibodies, and Autoimmune Diseases in a Brazilian Public Hospital

Relationships among Antibodies against Extractable Nuclear Antigens, Antinuclear Antibodies, and Autoimmune Diseases in a Brazilian Public Hospital

Variability in the recognition of distinctive immunofluorescence patterns in different brands of HEp-2 cell slides

Análise comparativa de quatro kits de FAN HEp-2 para a detecção de autoanticorpos séricos

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