Laboratorio Immunologia Allergologia, Ospedale San Giovanni di Dio, Firenze, Italy.
IReL, Istituto Reumatologico Lucano, Ospedale San Carlo, Potenza, Italy.
Autoimmun Rev. 2020 Aug;19(8):102588. doi: 10.1016/j.autrev.2020.102588. Epub 2020 Jun 12.
The commercial tests currently available as second-level tests to detect ANA sub-specificities are generally used independently from the ANA immunofluorescence (IIF) pattern. The aim of this study was to evaluate the efficacy of the use of a customizable pattern-oriented antigenic panel by immunoblot (IB) using the International Consensus on ANA Patterns (ICAP) classification scheme, in order to introduce a novel and updated autoimmune diagnostic flowchart. 710 sera referred for routine ANA testing were selected on the basis of the ANA pattern according to the ICAP nomenclature (nuclear speckled AC-2,4,5; nucleolar AC-8,9,10,29; cytoplasmic speckled AC-18,19,20) and on an IIF titer ≥1:320. They were then assayed by three experimental IB assays using a panel of selected antigens. ICAP-oriented IB detected 515 antibody reactivities vs. 457 of traditional anti-ENA in the nuclear speckled pattern group, 108 vs. 28 in the nucleolar pattern group, and 43 vs. 34 in the cytoplasmic speckled pattern. This pilot study may lead the way for a new approach introducing an ICAP pattern-oriented follow up testing as a valid alternative to the existing standard panels, thus enabling more patients with autoimmune rheumatic disease to be accurately diagnosed.
目前市售的用于检测 ANA 亚特异性的二级检测试验通常与 ANA 免疫荧光（IIF）模式独立使用。本研究旨在评估使用基于免疫印迹（IB）的可定制的抗原谱模式导向的方法的效果，该方法使用国际 ANA 模式共识（ICAP）分类方案，以引入一种新颖且更新的自身免疫诊断流程图。根据 ICAP 命名法（核斑点 AC-2、4、5；核仁 AC-8、9、10、29；细胞质斑点 AC-18、19、20）和 IIF 滴度≥1:320，基于 ANA 模式选择了 710 份用于常规 ANA 检测的血清。然后，通过使用选定抗原的面板进行三种实验性 IB 检测来检测它们。ICAP 定向 IB 在核斑点模式组中检测到 515 种抗体反应性，而传统抗 ENA 为 457 种；核仁模式组为 108 种，而传统抗 ENA 为 28 种；细胞质斑点模式组为 43 种，而传统抗 ENA 为 34 种。这项初步研究可能为引入基于 ICAP 模式的后续检测提供新方法，作为现有标准面板的有效替代方案，从而使更多的自身免疫性风湿病患者得到准确诊断。
