Further, more than 180 different self-antigens were discovered to bind autoantibodies in SLE patients, with high heterogeneity and variable expressions between the patients

Further, more than 180 different self-antigens were discovered to bind autoantibodies in SLE patients, with high heterogeneity and variable expressions between the patients. (anti-dsDNA), complements C3 and C4, rheumatoid factor (RF), anticardiolipin antibodies IgG (ACL IgG) and IgM (ACL IgM), Beta-2 Glycoprotein 1 Antibodies (2-GP) IgG (2-IgM) and IgM (2-IgM), and lupus anticoagulant (LA). Method A comparative cross-sectional study was conducted among 495 SLE patients, who were diagnosed and classified by consultant rheumatologists according to the new European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2019 criteria. SLE immunodiagnostic profiles were analyzed including the following parameters: ANA antibody titers and staining patterns, anti-dsDNA, C3 and C4 levels, aCL, and anti-2-GP and LA. Result The most frequently observed ANA patterns were the speckled (52.1%) and homogeneous (35.2%) patterns, while other patterns were rare representing less than 7% of the patients each. ANA titers were highest in patients with mixed pattern followed by the speckled pattern. Of all the investigated patterns, the peripheral pattern showed the most pathogenic immune profile, namely, highest levels of anti-dsDNA, lowest levels of C4, and highest levels of aCL and 2-GP IgG and IgM. Conclusion This retrospective study showed that speckled followed GSK1324726A (I-BET726) by homogeneous ANA patterns were predominant accounting for 52.1 and 35.2% of the patients. The ANA pattern showed several associations with other immune markers that are documented to have significant clinical implications in SLE. Peripheral, mixed, and speckled patterns were associated with higher profiles of immune markers indicative of a potential prognostic value of these patterns in SLE. Keywords: antinuclear antibodies, ANA, patterns, systemic lupus erythematosus, SlE, immunofluorescence, anti-dsDNA 1 Introduction Systemic lupus erythematosus (SLE) is usually a systemic autoimmune disease characterized by flare up phases and others with low disease activity (1). It affects multiple organs such as serous membranes, renal, nervous, and cardiovascular systems, and joints and skin, resulting in multiorgan damage. Among the challenging aspects of SLE are its enigmatic pathophysiology and extremely variable clinical presentations and manifestations, both between patients and within the same patient over time (2C4). Further, more than 180 different self-antigens were discovered to bind autoantibodies in SLE patients, Rabbit Polyclonal to OR2W3 with high heterogeneity and variable GSK1324726A (I-BET726) expressions between the patients. These autoantibodies mainly target intracellular components in the nucleus, such as single- (ssDNA) and double-stranded (dsDNA) DNA, and histones, and are hence called antinuclear antibodies (ANA) (5C7). Such immunological profile brings an odd complexity in understanding the pathophysiology of the disease. On the other hand, most of these antibodies are not specific for SLE. ANA can be seen in all kinds of rheumatic diseases (8). ANA, anti-dsDNA, phospholipids are included in the 11 criteria to diagnose SLE including the new European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2019 classification criteria which has a sensitivity of 96% and a specificity of 93.4% (9). Because high concentrations of anti-ds-DNA antibodies are almost exclusively present in SLE patients, anti-ds-DNA antibodies are more SLE-specific (10). Besides, ANAs titers and antigenic target are predictive of the disease pathogenicity and prognosis. Most specifically, anti-ds DNAs titers have a diagnostic value in indicating SLE activity along with the level of organ involvement (11C14). Despite being part of the EULAR/ACR criteria, the clinical utility of ANA and anti-DNA assays in SLE patients is highly debated due to their inconsistency and non-resolution of their pathogenic roles (12, 15C18). On the other hand, technical challenges of the assays impact their interpretability, notably concerning the immunofluorescence staining patterns of ANA, whose pathogenic role is highly controversial (19C21). In the present study, we aimed to further explore the pathogenic significance of ANA patterns among patients with SLE, by analyzing their association with ANA titers, complement levels and other pathogenic immune markers, namely, complement C3 and C4, rheumatoid factor (RF), anticardiolipin antibodies IgG (ACL IgG) and IgM (ACL IgM), Beta-2 Glycoprotein 1 Antibodies IgG (2-IgM) and IgM (2-IgM), and lupus anticoagulant (LA). Such correlations would contribute to the pathogenic or prognostic significance of ANA patterns in SLE. 2 Methods 2.1 Design and Participants This was a cross-sectional study conducted at the Immunodiagnostic unit of the Microbiology and Parasitology Department of the King Abdulaziz University Hospital, which is a referral immunodiagnostic center in Jeddah, Saudi Arabia. The study was ethically approved by the institutional review board of the King Abdulziz University (Ref. No. 130-21). 2.2 Participants The study involved patients from all age groups diagnosed and classified SLE by a consultant rheumatologist and followed in the participating center from January 2018 to December 2020. Cases were diagnosed and defined in accordance with the EULAR/ACR criteria 2019 (22). Patients having no results for ANA pattern were excluded. A convenience sampling was used to include all consecutive patients that fulfilled the eligibility criteria. 2.3 Data Collection 2.3.1 Demographic Data of Patients The age, gender and nationality of patients were collected from the electronic files of GSK1324726A (I-BET726) the patient. 2.3.2 Immune Assays SLE immunodiagnostic profiles were analyzed including the.