Professional Insights from a Pioneer in Autoimmune Disease Testing: The Future of Antinuclear/Anticellular Antibody Testing.

Abstract

Almost half a century has lapsed since I embarked on a career-long study of systemic autoimmune rheumatic diseases (SARDs)2 with a focus on their autoantibodies directed against an astounding spectrum of cellular antigens (1). The discovery of the lupus erythematosus cell and the development of the lupus erythematosus cell test serves as a historic reference point for the study of antinuclear antibodies (ANAs), or what today international consensus advocated should more correctly be referred to as anticellular antibodies (ACAs) (2, 3). Paralleling the explosion of the spectrum of ACAs was a remarkable transition in the technologies used to detect autoantibodies (1). Although some of the “octogenarian” assays such as double immunodiffusion, hemagglutination, complement fixation, and counterimmunoelectrophoresis are fading into oblivion, the ACA indirect immunofluorescence (IIF) test is increasingly used as a screening test and entry criterion for SARD. However, the emergence of newer multianalyte array technologies that have higher throughput, sensitivity, and specificity and detect a broader range of autoantibodies in comparatively miniscule serum samples may eventually replace the ACA …