Fluorescence patterns in indirect immunofluorescence on HEp-2 cells and antigens recognized in blot test in patients supposed to have a connective tissue disease
Journal Title: Dermatologia Kliniczna - Year 2009, Vol 11, Issue 2
Abstract
Introduction: Connective tissue diseases (CTD) are caused by interplay between genetic and environmental factors. Autoantibodies against diverse nuclear antigens (ANA) play an important role in their pathogenesis. Patients suspected of CTD should be examined for serum ANA titer with indirect immunofluorescence (IIF). Further, fluorescence pattern should be evaluated in all ANA-positive patients. To identify antinuclear antibodies to isolated antigens, blot test is performed. Objective: The aim of this study was to define relationship between fluorescence patterns in IIF and antigens recognized in blot test by sera of ANA-positive patients. Material and methods: One hundred thirty nine ANA-positive, CTD-suspected patients from Cutaneous Histopathology and Immunopathology Laboratory of Department of Dermatology of Poznań University of Medical Sciences were examined with blot tests. Fluorescence pattern was assessed on HEp-2 cells with IIF in accordance with American College of Rheumatology guidelines. Results: Significant relationship, with Fisher's exact test, between 9 fluorescence patterns on HEp-2 cell line and 8 antigens recognized in blot test was found. The most frequent fluorescence pattern was speckled (41.73%), subsequently homogenous (16.55%), homogenous plus speckled (10.76%), homogenous plus nucleolar (5.76%), nucleolar (5.04%), cytoplasmic fibrillar (4.32%), fine granular cytoplasmic, granular cytoplasmic plus speckled (respectively 2.16%), cytoplasmic fibrillar plus speckled, nucleolar plus cytoplasmic (1.44% each) and remaining patterns occurred once each and reached 6.48% altogether. In 65 sera (46.76%) of ANA-positive patients, blot test results were negative. Conclusions: Analysis performed shown range of relationships between fluorescence patterns observed with HEp-2 cells and antigens recognized in blot test. Knowing the specificity of the blot tests, the authors find standard ization efforts of IIF for ANA aimless. In immunopathologist’s work, blot test is an important tool for identifying certain ANA due to objectiveness, quickness and simplicity of performing. The result of the blot test presented numerically, graphically and using scale is clear and easy to interpret even for beginner immunopathologist. The authors suggest blot test to be selected as a primary screening test for diagnosing systemic connective tissue diseases in both internal medicine and dermatological practice.
Authors and Affiliations
Anna Lutkowska, Paweł Pietkiewicz, Justyna Gornowicz, Maria Raptis-Bolwach, Marian Dmochowski, Monika Bowszyc-Dmochowska
Keywords
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