Abstract
Identification of antinuclear antibodies has been used for the diagnosis of connective tissue diseases for more than fifty years. Indirect immunofluorescence on human epithelial (HEp-2) cells is considered the gold standard screening method for the detection of antinuclear autoantibodies. As the demand of ANA testing increased, the need for automation and standardization has also come forth. A high level of false positive and false negative cases is seen in various populations making it difficult to take clinical decisions. Newer technologies were introduced for the antibody detection to ensure high sensitivity and specificity. This article intends to provide an overview of the concepts on ANA testing, the different diagnostic methods available, the various patterns and clinical utility, the clinical guidelines to be followed, the drawbacks and what lies ahead in the future of ANA testing.Journal of Pathology of Nepal (2015) Vol. 5, 766-773
Highlights
Autoantibodies are the hallmark of autoimmunity, of which anti-nuclear antibody (ANA) have taken the centre stage for the past 60 years
Homogenous/diffuse, rim/peripheral, nucleolar, or centromere) in addition to titers for positive ANA test results. Using laboratory techniques such as immunodiffusion, immunoprecipitation, radioimmunoassay (RIA), hemagglutination, and enzyme immunoassay (EIA), it has been shown that ANA-positive sera react with several different nuclear antigens
The bead suspension consists of polystyrene microspheres that are conjugated with different antigens and nuclear extract of HEp-2 cells
Summary
Very useful Somewhat useful Very useful Not useful Not useful Not useful Not useful, or utility not established Useful. Homogenous/diffuse, rim/peripheral, nucleolar, or centromere) in addition to titers for positive ANA test results Using laboratory techniques such as immunodiffusion, immunoprecipitation, radioimmunoassay (RIA), hemagglutination, and enzyme immunoassay (EIA), it has been shown that ANA-positive sera react with several different nuclear antigens. Reactivity with these antigens is more disease specific than the above-mentioned patterns and may provide clinically useful prognostic information.[3] Over the past decade, most laboratories worldwide have come to use a human tumor cell line substrate (the HEp-2 cell line) for routine ANA testing.[8] The HEp-2 substrate has largely replaced rodent tissue and has become the standard substrate for performing the ANA test.
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