ELISA is the superior method for detecting antineutrophil cytoplasmic antibodies in the diagnosis of systemic necrotising vasculitis.

Harris, Alan; Chang, Grace; Vadas, MA; Gillis, David

doi:10.1136/jcp.52.9.670

Cited by 29 publications

(10 citation statements)

References 27 publications

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“…However, they are associated with negative specific Enzyme Linked Immunosorbent Assay (ELISA) testing for anti-PR3 or anti-MPO. [3] In our case, the c-ANCA and p-ANCA were positive by IF and ELISA testing which confirmed that they were specific for anti-PR3 and anti-MPO.…”

Section: Discussionsupporting

confidence: 70%

Double ANCA-positive vasculitis in a patient with infective endocarditis

Veerappan¹,

Prabitha²,

Abraham³

et al. 2012

Indian J Nephrol

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The most common pattern of renal involvement in infective endocarditis is infection-associated glomerulonephritis. Due to clinical symptoms and signs that overlap with vasculitis, the diagnosis of infective endocarditis may be delayed. The unusual combination of reduced complement with positive antineutrophil cytoplasmic antibody should raise the suspicion of infections such as infective endocarditis.

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Section: Discussionsupporting

confidence: 70%

Double ANCA-positive vasculitis in a patient with infective endocarditis

Veerappan¹,

Prabitha²,

Abraham³

et al. 2012

Indian J Nephrol

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“…13,14 In these articles, pANCAs were evidenced by an indirect immunofluorescence test with a neutrophil substrate, which is not sensitive enough and does not identify the target antigen. 22 Moreover, the autoantibodies were often linked to the remaining circulating lactoferrin. In our hands, under dissociating conditions, the intensity of the response in symptomatic patients differed greatly from that in asymptomatic patients (0.27 vs. 0.82), but the prevalence of anti-lactoferrin-positive plasma was quite similar (64 vs. 70%), in contrast to normal donors without any detectable pANCA and HIV-2-positive patients (both ,0.05%).…”

Section: Discussionmentioning

confidence: 99%

Differential Pattern in Circulating Nitrogen Derivatives, Lactoferrin, and Anti-Lactoferrin Antibodies in HIV Type 1 and HIV Type 2 Infections

Dapsanse

Defer

Follezou

et al. 2001

AIDS Research and Human Retroviruses

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HIV-1 infection is associated with a dramatic reduction in antioxidative molecules both at the cellular level and in the circulation. This is particularly so for lactoferrin, an iron-binding protein involved in natural defenses (antimicrobial and antiviral activities, etc.) and found in whole secretions, including milk and mucus. In addition to its ability to chelate iron ions, lactoferrin inhibits hydroxy radical formation and interacts with nitric oxide (NO). Levels of plasma lactoferrin decreased in HIV-1-infected patients in correlation with progression of the disease, and highly specific anti-lactoferrin autoantibodies increased. This profile was specific to HIV-1 infection; it was not found in HIV-2-infected patients. In parallel with the drop in lactoferrin, a marked increase in circulating nitrogen derivatives was observed in HIV-1-infected patients, whereas low levels were found in normal donors and in HIV-2-infected patients. These data suggested hyperstimulation of the NO pathway throughout HIV-1 but not HIV-2 infection. This overproduction of NO could play an important role in the development of AIDS symptoms and signs.

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“…For example, a small focus of vasculitis or capillaritis could be overlooked when another pattern predominates. Although many hospital laboratories only perform IIF testing, it is highly recommended that a positive ANCA result be followed by an ELISA for PR-3 and/or myeloperoxidase (3,5,11,14,33,82,83,86,88). The pathologist should inquire as to what type of ANCA test was performed (IIF versus ELISA), where it was performed (hospital versus reference versus research laboratory), and whether multiple autoantibodies (antinuclear antibodies, rheumatoid factor, antiglomerular basement membrane (79) Anticytokeratins (80) antibody, or others) are present.…”

Section: Discussionmentioning

confidence: 99%

Antineutrophil Cytoplasmic Autoantibody in the Absence of Wegener's Granulomatosis or Microscopic Polyangiitis: Implications for the Surgical Pathologist

Gal

Velasquez

2002

Modern Pathology

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Antineutrophil cytoplasmic antibodies (ANCA) are useful serologic markers for the diagnosis and management of patients with Wegener's granulomatosis (WG) and microscopic polyangiitis (MPA). However, problems in diagnosis and classification may occur when patients with other disorders develop ANCA. A 7-year review (1993-1999) disclosed 247 patients whose sera tested positively for ANCA by an indirect immunofluorescence method: 166 patients for cytoplasmic-ANCA (C-ANCA) and 81 patients for perinuclear-ANCA (P-ANCA) Twenty-seven patients had active pulmonary disease and underwent openlung biopsy or transbronchial biopsy. Eight patients (30%) had a disease other than WG or MPA, and their clinical, pathological, and serological findings were reviewed. The patients, all women, ranged in age from 28 to 77 years (median, 37 y). Dyspnea (n ‫؍‬ 6), cough (n ‫؍‬ 6), chest pain (n ‫؍‬ 2), and/or hemoptysis (n ‫؍‬ 2) were present. The duration of symptoms lasted from 3 weeks to 6 years (median, 6 mo). ANCA titers were C-ANCA (n ‫؍‬ 4; range, 1:40 -1280) or P-ANCA (n ‫؍‬ 4; range, 1:40 -640). The lung biopsies disclosed nonspecific interstitial pneumonia (n ‫؍‬ 4), bronchiolitis obliterans organizing pneumonia (n ‫؍‬ 1), diffuse alveolar damage (n ‫؍‬ 1), organizing diffuse alveolar hemorrhage without capillaritis (n ‫؍‬ 1), and necrotic granuloma (n ‫؍‬ 1). No cases showed characteristic histology for WG or MPA. The final diagnoses were various connective tissue disorders (n ‫؍‬ 5), chronic hypersensitivity pneumonia (n ‫؍‬ 1), postinfectious bronchitis/bronchiectasis (n ‫؍‬ 1), and ulcerative colitis-related lung disease (n ‫؍‬ 1). Surgical pathologists should be aware that significantly elevated ANCA titers may be associated with diverse forms of pulmonary disease. ANCA positivity alone, in the absence of appropriate clinical or pathologic findings, should not be used to substantiate a diagnosis of WG or MPA.

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ELISA is the superior method for detecting antineutrophil cytoplasmic antibodies in the diagnosis of systemic necrotising vasculitis.

Cited by 29 publications

References 27 publications

Double ANCA-positive vasculitis in a patient with infective endocarditis

Double ANCA-positive vasculitis in a patient with infective endocarditis

Differential Pattern in Circulating Nitrogen Derivatives, Lactoferrin, and Anti-Lactoferrin Antibodies in HIV Type 1 and HIV Type 2 Infections

Antineutrophil Cytoplasmic Autoantibody in the Absence of Wegener's Granulomatosis or Microscopic Polyangiitis: Implications for the Surgical Pathologist

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