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Category: Immunology
Antinuclear Antibody Tests, Page 1 of 2
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Autoantibodies are historical hallmarks in the establishment of the concept of autoimmunity and in the definition of the clinical limits of several autoimmune diseases. On a day-to-day basis, autoantibodies are helpful elements not only in the diagnosis of autoimmune diseases, but also frequently in the establishment of prognosis and in the monitoring of disease activity.
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LE cell phenomenon. Viable neutrophils have their nucleus (thin arrow) displaced to the periphery of the cell due to the phagocytosis of a large piece of opsonized chromatin (wide arrow) from dead cells.
LE cell phenomenon. Viable neutrophils have their nucleus (thin arrow) displaced to the periphery of the cell due to the phagocytosis of a large piece of opsonized chromatin (wide arrow) from dead cells.
Influence of cell substrate on the ANA pattern. (A and B) Sample with anti-U1 RNP antibodies processed on slides from two different suppliers. The expected nuclear coarse speckled pattern is observed with the slide brand shown in panel A, whereas a nonspecific nuclear fine speckled pattern is observed the slide brand depicted in panel B. (C and D) Sample with anti-PCNA (proliferating cell nuclear antigen) antibody processed on slides from two different suppliers. The expected pleomorphic PCNA pattern is observed in the slide brand shown in panel C, whereas a nonspecific pattern is observed in the slide brand shown in panel D. Indirect immunofluorescence on HEp-2 cells; magnification, ×400.
Influence of cell substrate on the ANA pattern. (A and B) Sample with anti-U1 RNP antibodies processed on slides from two different suppliers. The expected nuclear coarse speckled pattern is observed with the slide brand shown in panel A, whereas a nonspecific nuclear fine speckled pattern is observed the slide brand depicted in panel B. (C and D) Sample with anti-PCNA (proliferating cell nuclear antigen) antibody processed on slides from two different suppliers. The expected pleomorphic PCNA pattern is observed in the slide brand shown in panel C, whereas a nonspecific pattern is observed in the slide brand shown in panel D. Indirect immunofluorescence on HEp-2 cells; magnification, ×400.
Checkerboard titration of the conjugate. A sample with known ANA titer is used to gauge the dilution of the conjugate that will reproduce the expected titer for that sample.
Checkerboard titration of the conjugate. A sample with known ANA titer is used to gauge the dilution of the conjugate that will reproduce the expected titer for that sample.
Example of report of the IIF-ANA test.
Example of report of the IIF-ANA test.
Panel of relevant IIF-ANA patterns. (A) Nuclear homogeneous pattern; (B) nuclear dense fine speckled pattern; (C) nuclear coarse speckled pattern; (D) nuclear SS-A/Ro pattern; (E) nuclear fine speckled pattern; (F) centromere pattern; (G) nuclear pleomorphic pattern; (H) ribosomal-P cytoplasmic pattern. Double arrows, cells in interphase; single arrow, cells in metaphase; arrowheads, cell nuclei with pleomorphic pattern and variable intensity. Indirect immunofluorescence using HEp-2 cells.
Panel of relevant IIF-ANA patterns. (A) Nuclear homogeneous pattern; (B) nuclear dense fine speckled pattern; (C) nuclear coarse speckled pattern; (D) nuclear SS-A/Ro pattern; (E) nuclear fine speckled pattern; (F) centromere pattern; (G) nuclear pleomorphic pattern; (H) ribosomal-P cytoplasmic pattern. Double arrows, cells in interphase; single arrow, cells in metaphase; arrowheads, cell nuclei with pleomorphic pattern and variable intensity. Indirect immunofluorescence using HEp-2 cells.
Pretest probability influences the diagnostic performance of tests. Anti-X antibody is a biomarker for the rare hypothetical disease Z and occurs in 1% of the general population. Indiscriminate testing for anti-X yields poor positive predictive value. Enrichment of the population sample to be tested according to clinical judgment restores the good performance of the anti-X antibody test.
Pretest probability influences the diagnostic performance of tests. Anti-X antibody is a biomarker for the rare hypothetical disease Z and occurs in 1% of the general population. Indiscriminate testing for anti-X yields poor positive predictive value. Enrichment of the population sample to be tested according to clinical judgment restores the good performance of the anti-X antibody test.
Decision-tree algorithm for classification of IIF-ANA patterns proposed by the IV Brazilian Consensus on ANA. MCP, metaphase chromatin plate.
Decision-tree algorithm for classification of IIF-ANA patterns proposed by the IV Brazilian Consensus on ANA. MCP, metaphase chromatin plate.
Advantages of the ANA assay on HEp-2 cells
Advantages of the ANA assay on HEp-2 cells
Ability of the ANA-HEp-2 test to detect clinically relevant autoantibodies a
Ability of the ANA-HEp-2 test to detect clinically relevant autoantibodies a
Specific composite IIF-ANA patterns
Specific composite IIF-ANA patterns
IIF-ANA patterns, targeted autoantigen, and disease associations a
IIF-ANA patterns, targeted autoantigen, and disease associations a