Antinuclear antibodies: a contemporary nomenclature using HEp-2 cells.

The choice of terms used to describe indirect immunofluorescence (IIF) staining patterns of autoantibodies binding to HEp-2 cells is at present quite varied and disordered because no accurate consensus on names and descriptions exist. The aim of our study was to propose a logical and ordered IIF classification taxonomy based on 29 different selected IIF patterns. In a preliminary project carried out at Statens Serum Institut it was first shown by use of a software programme named DOORS developed by Percepton Ltd, that reading of digitized images of HEp-2 patterns on an LCD monitor could be used instead of traditional microscopy. Digitized images of HEp-2 patterns were then used in the EU supported project named CANTOR (June 1998-July 2000) aiming to reach consensus among three clinical immunology expert centres and collaborating to attain a classification version that could be used to qualitatively and quantitatively test and train image recognitions skills of laboratory technicians against expert consensus. The usability of this classification version was then tested in a course consisting of training and certification. The conclusion was that participants in the training programme clearly increased their perceptive skills using images, terms, descriptions and the graphic and statistic tools in the self-administered DOORS programme and that software-assisted training could achieve a common and accurate level of visual pattern interpretation. All results from this project were reported to the European Commission but have not previously been published in scientific literature. This communication presents the final results of agreed image classifications.

Tissue transglutaminase and endomysial autoantibodies measured in an historical cohort of children and young adults in whom coeliac disease was suspected.

OBJECTIVE: To evaluate whether anti-endomysial and anti-transglutaminase antibodies are relevant important markers of coeliac disease in an historical group of patient sera. DESIGN: Sera from 196 children suspected to suffer from coeliac disease were analysed for these antibodies. METHODS: A total of 233 serum samples were obtained simultaneously with a biopsy. Coeliac disease was confirmed in 37 (19%) patients. Antibodies against guinea pig transglutaminase were determined by enzyme-linked immunosorbent assay (ELISA); endomysial antibodies were determined by immunofluorescence. RESULTS: In 17 samples, immunoglobulin A (IgA) anti-transglutaminase levels were increased; 16 of these came from coeliac patients. High levels correlated with high prediagnostic or challenge-related gluten intake. The additional anti-transglutaminase-positive patient was assumed to suffer from sequelae to gastroenteritis. CONCLUSIONS: Raised IgA anti-transglutaminase levels were correlated with presence of coeliac disease. Negative tests were seen in some coeliac patients when on a gluten-containing diet. The IgA anti-transglutaminase test using guinea pig antigen was less sensitive than anti-endomysial antibodies but rather specific for active coeliac disease. In our study, anti-endomysial antibodies were more specific than anti-transglutaminase antibodies for active coeliac disease.

A combination of cation exchange and ligand-affinity chromatography for purification of two molecular species of the folate binding protein in human milk, one equipped with a hydrophobic glycosyl phosphatidylinositol tail: characterization of hydrophobicity and electrical charge.

Cation exchange chromatography combined with ligand (methotrexate) affinity chromatography on a column desorbed with a pH-gradient was used for separation and large scale purification of two folate binding proteins in human milk. One of the proteins, which had a molecular size of 27 kDa on gel filtration and eluted from the affinity column at pH 5-6 was a cleavage product of a 100 kDa protein eluted at pH 3-4 as evidenced by identical N-terminal amino acid sequences and a reduction in the molecular size of the latter protein to 27 kDa after cleavage of its hydrophobic glycosylphosphatidyl-inositol tail that inserts into Triton X-100 micelles. Chromatofocusing showed that both proteins possessed multiple isoelectric points within the pH range 7-9. The 100 kDa protein exhibited a high affinity to hydrophobic interaction chromatographic gels, whereas this was only the case with unliganded forms of the 27 kDa protein indicative of a decrease in the hydrophobicity of the protein after ligand binding.

Untreated silicone breast implant rupture.

Implant rupture is a well-known complication of breast implant surgery that can pass unnoticed by both patient and physician. To date, no prospective study has addressed the possible health implications of silicone breast implant rupture. The aim of the present study was to evaluate whether untreated ruptures are associated with changes over time in magnetic resonance imaging findings, serologic markers, or self-reported breast symptoms. A baseline magnetic resonance imaging examination was performed in 1999 on 271 women who were randomly chosen from a larger cohort of women having cosmetic breast implants for a median period of 12 years (range, 3 to 25 years). A follow-up magnetic resonance imaging examination was carried out in 2001, excluding women who underwent explantation in the period between the two magnetic resonance imaging examinations (n = 44). On the basis of these examinations, the authors identified 64 women who had at least one ruptured implant at the first magnetic resonance imaging examination and, for comparison, all women who had intact implants at both examinations (n = 98). Magnetic resonance images from the two examinations were compared and changes in rupture configuration were evaluated. Comparisons were also made for self-reported breast symptoms occurring during the study period and for changes in serum values of antinuclear antibodies, rheumatoid factor, and cardiolipin antibodies immunoglobulin G and immunoglobulin M. The majority of the women with implant rupture had no visible magnetic resonance imaging changes of their ruptured implants. For 11 implants (11 percent) in 10 women, the authors observed progression of silicone seepage, either as a conversion from intracapsular into extracapsular rupture (n = 7), as progression of extra-capsular silicone (n = 3), or as increasing herniation of the silicone within the fibrous capsule (n = 1); however, in most cases, these changes were minor. Some changes could be ascribed to trauma, but others seemed spontaneous. There was no increase in levels of autoantibodies during the study period in either study group. Women with untreated implant ruptures reported a significant increase in nonspecific breast changes (odds ratio, 2.1; 95 percent confidence interval, 1.2 to 3.8) compared with women without ruptures. On the basis of this first study of women with untreated silicone breast implant rupture, the authors conclude that implant rupture is a relatively harmless condition, which only rarely progresses and gives rise to notable symptoms. Even so, because of a small risk of silicone spread, the authors suggest that women with implant ruptures be followed clinically, if not operated on. Because implant ruptures often occur asymptomatically, any woman with silicone implants, regardless of rupture status, should be evaluated at regular intervals.

Self-reported diseases and symptoms by rupture status among unselected Danish women with cosmetic silicone breast implants.

Epidemiologic evidence does not support an association between silicone breast implants and connective tissue or other rheumatic diseases. However, a recent study has suggested that women with ruptured implants may be at increased risk of developing fibromyalgia. An analysis of adverse health outcomes according to breast implant rupture status was conducted in 238 unselected Danish women with cosmetic silicone breast implants. Ninety-two of the women had definite implant rupture, and 146 had intact implants as determined by magnetic resonance imaging. Before undergoing imaging, the women provided blood samples and completed a self-administered questionnaire. Women with ruptured implants overall, and the subgroup with extracapsular ruptures (n = 23), were compared with women with intact implants regarding a number of self-reported diseases and symptoms and the presence of specific autoantibodies, such as antinuclear antibodies, rheumatoid factor, and cardiolipin immunoglobulin G and M antibodies. Overall, there were no differences in the occurrence of self-reported diseases or symptoms or in the presence of autoantibodies between women with intact implants and women with ruptured implants, including extracapsular rupture. The only exception was capsular contracture, which was reported six times more frequently by women with extracapsular ruptures than by women with intact implants (OR, 6.3; 95 percent CI, 1.7 to 23.5). In conclusion, this study of unselected women with silicone breast implants could establish no association between silicone implant rupture and specific diseases or symptoms related to connective tissue disease or other rheumatic conditions, except for an excess of capsular contracture among women with extracapsular rupture.

alpha Isoforms of soluble and membrane-linked folate-binding protein in human blood.

The high-affinity FBP/FR (folate-binding protein/folate receptor) is expressed in three isoforms. FRalpha and FRbeta are attached to cell membranes by hydrophobic GPI (glycosylphosphatidylinositol) anchors, whereas FBPgamma is a secretory protein. Mature neutrophil granulocytes contain a non-functional FRbeta on the surface, and, in addition, nanomolar concentrations of a secretory functional FBP (29 kDa) can be present in the secondary granules. A statistically significant correlation between the concentrations of functional FBP, probably a gamma isoform, in granulocytes and serum supported the hypothesis that serum FBP (29 kDa) mainly originates from neutrophils. The presence of FBP/FRalpha isoforms were established for the first time in human blood using antibodies specifically directed against human milk FBPalpha. The alpha isoforms identified on erythrocyte membranes, and in granulocytes and serum, only constituted an almost undetectable fraction of the functional FBP. The FBPalpha in neutrophil granulocytes was identified as a cytoplasmic component by indirect immunofluorescence. Gel filtration of serum revealed a peak of FBPalpha (>120 kDa), which could represent receptor fragments from decomposed erythrocytes and granulocytes. The soluble FBPs may exert bacteriostatic effects and protect folates in plasma from biological degradation, whereas FRs on the surface of blood cells could be involved in intracellular folate uptake or serve as signal proteins. The latter receptors have also been used for therapeutic targeting in malignancy.

Determination of rickettsial and antinuclear antibodies in Danish patients with sarcoidosis.

INTRODUCTION: Rickettsia helvetica has been proposed as an aetiological agent in sarcoidosis. OBJECTIVES: To assess the prevalence of plasma anti-Rickettsia antibodies in a Danish population of patients with sarcoidosis and control subjects. In addition, we evaluated the presence of plasma antinuclear antibodies (ANAs). METHODS: Plasma samples from 49 consecutive patients (27 male, 22 female, median age 38 years, interquartile range 32-51 years) were compared with plasma from 51 age- and sex-matched controls (28 male, 23 female, median age 40 years, interquartile range 33-49 years), using a commercially available immunofluorescence assay testing for antibodies towards spotted fever group and typhus group Rickettsia as well as an assay for ANA. We obtained information regarding tick exposure and sarcoid disease manifestations from the medical records. RESULTS: The prevalence of antibodies to Rickettsia in patients with sarcoidosis 1/49 (2%) was not significantly different from the prevalence in the controls 4/51 (8%). The prevalence of ANA was 2/49 (4%) in the patients and 3/51 (6%) in the controls. CONCLUSIONS: The results do not support the hypothesis that Rickettsia or ANAs should be involved in the pathogenesis of sarcoidosis. Seventy-one per cent of the patients were under treatment with prednisolone in the 3 months leading up to the blood sample. We assume that antibody-related serological methods for various reasons could be inadequate to diagnose a chronic rickettsial infection.

A minor fraction of a high-affinity folate binding protein from the epididymis is associated with membranous vesicles and spermatozoa in human semen.

A glycolipid linked high-affinity folate binding protein (FBP) is present in human semen at a concentration of 1-2 nmol/L. The association between FBP and seminal components as well as the cellular source of FBP was analysed. Immunoblotting of human seminal plasma, with and without prostasomes, prostasomal fractions and spermatozoa with antibodies against human FBP revealed a single distinct band similar to that observed with purified human FBP. Flow cytometry identified FBP on the surface of ejaculated spermatozoa. Immunohistochemistry showed positive immunostaining of epididymal epithelium, vas deferens and ejaculated spermatozoa, whereas the prostate gland, seminal vesicles, testicular spermatozoa and seminiferous tubules of testis stained negatively. Electron microscopy immunocytochemistry with antibodies against rat FBP showed labelling located to luminal microvilli and intracellular vesicles of rat epididymal epithelial cells and the surface of spermatozoa in the epididymal duct. High-affinity binding of picomolar amounts of tritiated folate to fractions of human prostasomes or prostasome-like vesicles was completely depressed by excess amounts of unlabelled folate. The study indicates that FBP is secreted from the epithelia of epididymis and vas deferens, and that a small fraction of FBP is associated with prostasome-like vesicles which adhere to spermatozoa in the epididymal duct. FBP could have a bacteriostatic function by depriving folate-requiring bacteria of folate and/or ascertain a normal DNA replication subsequent to fertilization by vectorial transfer of folate to the inner compartment of the spermatozoa.

Detection of antinuclear antibodies by solid-phase immunoassays and immunofluorescence analysis.

BACKGROUND: Antinuclear antibodies (ANAs) are associated with several inflammatory rheumatic diseases. The aim of the present work was to evaluate enzyme immunoassays (EIAs) and compare them with classic immunofluorescent analysis (IFA) for the detection of ANA. METHODS: Seven enzyme immunoassays were used in this study. All assays were applied as described by the manufacturers. Three populations were included in the study: (a) a population of patients with well-established autoimmune inflammatory disease (n = 102); (b) a population in which a rheumatic disease was diagnosed up to 5 years after an IFA was performed (n = 164); and (c) a population of consecutive outpatients suspected to have a rheumatic disease (n = 101). The current clinical diagnoses of the patients served as the standard against which performance of the assays was evaluated. RESULTS: In patients with well-established rheumatic disorders, the newly developed EIA in which HEp-2 extracts were included had sensitivities and specificities comparable to or in some instances better than the IFA. The assays without HEp-2 extracts included had significantly lower sensitivities and specificities. In the outpatient population, up to 51% of patients had positive ANA tests that did not correspond to classic ANA-associated disease. However, in the assays in which the HEp-2 extracts were not included, the false-positive rate was <10%. The false-negative rate judged against IFA differed from assay to assay and disease to disease and was mostly <10%. CONCLUSIONS: In this study, the sensitivities of EIAs and IFA were largely comparable. However, EIAs without HEp-2 extracts included had a low sensitivity but a high specificity, particularly in nonselected populations. The choice of test is highly dependent on the clinical setting in which the ANA test is to be used and on laboratory policy.

Self-reported musculoskeletal symptoms among Danish women with cosmetic breast implants.

BACKGROUND: No epidemiological evidence of an association between silicone breast implants and connective tissue disease has been found. Based on case reports, it has been hypothesized that silicone breast implants may be associated with a unique rheumatic symptom cluster termed "atypical connective tissue disease." MATERIAL AND METHODS: We have evaluated self-reported rheumatic symptoms among women who received breast implants between 1977 and 1997 at 2 private plastic surgery clinics in Denmark. Women with other cosmetic surgery, including breast reduction, as well as women from the general population, were identified as controls. RESULTS: No statistically significant differences in mild (odds ratio [OR] = 0.9; 95% confidence interval [CI] = 0.6-1.3), moderate (OR = 0.7; 95% CI = 0.4-1.2), or severe (OR = 1.1; 95% CI = 0.6-2.1) musculoskeletal symptoms were observed when women with breast implants were compared with women with other cosmetic surgery. Compared with women from the general population, women with breast implants were statistically significantly less likely to have mild or moderate musculoskeletal symptoms (OR = 0.5; 95% CI = 0.3-0.7 and OR = 0.3; 95% CI = 0.2-0.5, respectively); for severe symptoms the deficit was not statistically significant (OR = 0.7; 95% CI = 0.3-1.3). For individual symptom groups, there was no consistent pattern of reporting among women with implants. CONCLUSION: We did not find an excess of rheumatic symptoms or symptom clusters among women with breast implants. In fact, the occurrence of mild, moderate, and severe musculoskeletal symptoms was generally lower among women with implants compared with women with other cosmetic surgery and women in the general population.