Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


Quasi-homogeneous ANA-HEp-2 Pattern Reflects An Autoantibody Profile Intermediate to the Homogeneous and Dense Fine Speckled Nuclear Patterns.

Franca1,  Natália R., Dellavance2,  Alessandra, Rodrigues3,  Sílvia H., Perazzio4,  Sandro F., Silva5,  Neusa P., Andrade3,  Luis Eduardo C.

Federal University, Sao Paulo, Brazil
Universidade Federal de São Paulo and Fleury Health and Medicine Laboratories, Sao Paulo, Brazil
Universidade Federal de São Paulo and Fleury Health and Medicine Laboratories, Sao Paulo Brazil, Sao Paulo, Brazil
Federal University of Sao Paulo, Sao Paulo, Brazil
Escola Paulista de Medicina - Universidade Federal de São Paulo, Sao Paulo, Brazil

Background/Purpose:

The indirect immunofluorescence assay on HEp-2 cells (ANA-HEp-2) yields different morphological patterns that reflect the distribution of the autoantigens recognized by a given sample. Thus the ANA-HEp-2 pattern may reflect the autoantibody profile present in the sample. We have recently observed a novel ANA-HEp-2 pattern, herein designated Quasi-Homogeneous (QH) pattern, which presents intermediary morphological features between the previously characterized nuclear homogeneous (Ho) and nuclear dense fine speckled (DFS) patterns. These three patterns have a common feature of staining the mitotic chromosome plates, what may induce misinterpretation. This study aimed to perform the clinical and immunological characterization of the QH pattern.

Methods:

Serum samples were consecutively selected from the ANA-HEp-2 routine as follows: 60 samples displaying the QH pattern, 30 samples displaying Ho pattern, and 30 samples displaying the DFS pattern. All samples were tested for the presence of antibodies against native DNA, nucleosome, histones, cardiolipin, and extractable nuclear antigens (ENA). QH samples were processed in four different ANA-HEp-2 slide brands, in home-made slides with HEp-2 cells fixed with either methanol/acetone or paraformaldehyde, and tested in western blot against MOLT-4 cell total extract. Systemic autoimmune rheumatic diseases (SARD) were defined according to ACR criteria after clinical chart review and interview with clinicians.

Results:

The QH pattern was reproducible in the four ANA-HEp-2 slide brands and in home-made HEp-2 cell slides fixed with the two different protocols. QH samples showed an intermediate frequency of antibodies against native DNA (7%), ENA (5%), nucleosome (35%) and histones (16.7%), in contrast with Ho samples, which showed high frequency of these autoantibodies (36.7%, 23.3%, 96.7% and 60%, respectively), and DFS samples in which these autoantibodies were consistently absent. In western blot, QH samples depicted heterogeneous reactivity with no apparent common band. QH serum samples were associated with heterogeneous clinical conditions, including SARD, non-inflammatory diseases, non-specific complaints, and even apparently healthy subjects. Association with SARD was higher for QH samples (87.5%) than QH samples (41.6%) (p=0.004). The latter samples were more frequently associated with SARD than DFS samples (4%) (p=0.009). Therefore, QH samples held an intermediate position between the two other patterns in that the Ho pattern was strongly associated with SARD and the DFS pattern that held no association with SARD.

Conclusion:

The QH ANA-HEp-2 pattern reflects a heterogeneous profile of autoantibodies and clinical manifestations intermediate to those represented by the Ho and DFS patterns, respectively. The distinction among these patterns is important for the appropriate interpretation of the ANA-HEp-2 results.

To cite this abstract, please use the following information:
Franca, Natália R., Dellavance, Alessandra, Rodrigues, Sílvia H., Perazzio, Sandro F., Silva, Neusa P., Andrade, Luis Eduardo C.; Quasi-homogeneous ANA-HEp-2 Pattern Reflects An Autoantibody Profile Intermediate to the Homogeneous and Dense Fine Speckled Nuclear Patterns. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :2307
DOI:

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