Immunology - ANA patterns/ENA antibodies

Anti-SSA/Ro

positive in 10-50% SLE patients; 70% Sjogrens

Must use Hep2 cells (not present on mouse stomach/kidney)

Anti-SSB/La

positive in 10-20% SLE patients (must be pos for SSA); ~ 1/2 Sjogrens

Must use Hep2 cells!!!

Finely Speckled

Anti-SSA/SSB

Anti-Sm (smith)

positive in 1/3 SLE; presence confirms SLE, but a negative cannot rule out SLE

Coarse speckled

Anti-nRNP

high titer —> indicative of mixed connective tissue disease, Sjogrens, systemic sclerosis.

low titer —> SLE

Coarsely speckled

Coarsely Speckled

Anti-Sm, Anti-nRNP

Anti-Scl-70

Diagnostic of Scleroderma (SSc or systemic sclerosis) only seen in 1/5 patients though.

antibody to DNA topoisomerase I nuclear protein

Atypical specks/Nucleolar Pattern

Anti-Jo-1

Positive in 1/3 of patients with Polymyositis

antibody to histidyl-tRNA synthtase

atypical specks/Nucleolar pattern

Nucleolar pattern; Anti-Scl-70, Anti-Jo-1

Anti-dsDNA

Used as criteria for diagnosis of SLE. High titers = high degree of specificity for SLE, BUT only ~ ¾ patients are positive.

Homogenous (Diffuse) pattern

Describe an immunofluorescent test for anti-dsDNA.

One type of assay for anti ds-DNA is an immunofluorescent test using Crithidia luciliae, a hemoflagellate, as the substrate. This organism has ds-DNA in the kinetoplast. This test has a high degree of specificity, because high titers help confirm the diagnosis of SLE, but about one-fourth of patients with SLE do not have this antibody.

Homogenous Pattern; Anti-dsDNA

Homogenous Rim Pattern

PCNA pattern

Speckled and Nucleolar mixed pattern

Centromere and Mitochondrial mixed pattern

Anti-nuclear membrane pattern

Anti-golgi pattern

Anti-cardiolipin

Positive in patients with SLE w/ thrombosis. Elevation may be predictive of risk of thrombosis or recurrent spontaneous abortions of early pregnancy. (with or without SLE) Also called lupus anticoagulants and phospholipid antibodies.

Anti-centromere

Antibodies to chromosomal centromeres. CREST syndrome!! 1/3 Raynaud’s disease and about 10% of patients with systemic sclerosis.

Anti-Centromere

Goodpasture’s Syndrome

the presence of autoantibody to glomerular, renal tubular, and alveolar basement membranes, resulting in injury to the glomerulus that can rapidly progress to renal failure.

Anti-glomerular basement membrane antibody

High titers are suggestive of Goodpasture’s disease or anti-GBM nephritis. Negative results do not rule out Goodpasture’s disease.

Anti-glomerular basement membrane antibody

Anti-mitocondrial

A high titer strongly suggests primary biliary cirrhosis (PBC);

the absence is strong evidenceagainst PBC. Other forms of liver disease often show low mitochondrial antibody titers.

Anti-mitocondrial

Anti-Neutrophil

an autoantibody producing a characteristic granular cytoplasmic staining pattern (c-ANCA) to cytoplasmic constituents of neutrophilic granulocytes. Antineutrophil cytoplasmic antibody has been described as a sensitive and specific marker for active Wegener’s granulomatosis, a systemic vasculitis. Antibody producing a perinuclear staining of neutrophils (p-ANCA) occurs in a wide range of diseases.

C-ANCA

P-ANCA

Anti-Parietal Cell

Pernicious Anemia patients

Anti-reticulin

childhood gluten sensitive enteropathy

Anti-smooth muscle

hepatitis, infectious mono