Abstract
Autoantibodies are a hallmark of autoimmunity and, specifically, antinuclear antibodies (ANAs) are the most relevant autoantibodies present in systemic autoimmune rheumatic diseases (SARDs). Over the years, different methods from LE cell to HEp-2 indirect immunofluorescence (IIF), solid-phase assays (SPAs), and finally multianalyte technologies have been developed to study ANA-associated SARDs. All of them provide complementary information that is important to provide the most clinically valuable information. The identification of new biomarkers together with multianalyte platforms will help close the so-called “seronegative gap” and to correctly classify and diagnose patients with SARDs. Finally, artificial intelligence and machine learning is an area still to be exploited but in a next future will help to extract patterns within patient data, and exploit these patterns to predict patient outcomes for improved clinical management.
Highlights
Autoantibodies are a hallmark of autoimmunity and, antinuclear antibodies (ANAs) are the most relevant autoantibodies present in systemic autoimmune rheumatic diseases (SARDs)
If we focus on the EULAR/American College of Rheumatology (ACR) 2019 classification criteria for systemic lupus erythematosus (SLE) we can observe that the presence of ANAs has been included as an entry criterion for SLE classification
The existence of different techniques that allow us to evaluate the presence of the same parameter, ANAs in this case, should not be used as a limitation but as an advantage, since a test result with a high sensitivity, such as when using a HEp-2 indirect immunofluorescence (IIF) with a
Summary
The first evidence of the existence of ANAs was the description of the LE-cell phenomenon by Hargraves et al in 1948 [1]. Diagnostics 2022, 12, 647 being the main substrate used for many years [2,7–9] It was not until the mid-1970s when it was discovered that human tissue culture cells, such as human epithelial type-2 cells (HEp-2 cells), derived from laryngeal carcinoma, were better than primary organ secwere developed [5]. It was not until the mid-1970s when it was discovered that the mid-1970shuman could tissue be considered thesuch beginning the ANA-detection explosion using from culture cells, as humanofepithelial type-2 cells (HEp-2 cells), derived as substrate HEp-2 cellscarcinoma, in SARDs. laryngeal were better than primary organ sections, since the production of this type of cell in large number was easier and they had bigger nuclei and expressed antigens in various stages of the cell cycle [10,11].
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