Pathogenetikai láncszemek a Sjögren-szindróma és a szisztémás lupus erythematosus társulásában. = Pathogenetical aspects in the association of Sjögren's syndrome and systemic lupus erythematosus

A zsírban-oldódó vitaminok immunmodulans hatását tanulmányoztuk 25 primer Sjögren-szindrómás (SS) betegben. Megállapítottuk, hogy a zsírban-oldódó vitaminoknak immunmodulans hatása van, és szerepük van az autoimmun betegségek patogenezisében.Az A és E vitamin szintje korrelál az immunregulatorikus sejtek számával és befolyásolhatja az autoimmun folyamatot. (Rheumatol 2010;49:211-17.) Megállapítottuk,hogy a Graves-betegség és a Hashimoto thyreoiditis kialakulása megelőzheti, de követheti is az SS jelentkezését. Mivel a SS-val társult autoimmun thyreoiditisek korábbi életkorban alakulnak ki fontos annak a további vizsgálata, hogy a SS valóban perdisponáló faktor-e az autoimmun thyreoiditis kifejlődésében. (Thyroid 2009;19(1):39-45.) Meghatároztuk az Interferon omega (IFN omega) szérumkoncentrációjának korrelációját az APSI és más szisztémás autoimmun betegségekkel.Az AIRE gén egy új mutációja, a c.1344 delC-t tudtuk kimutatni. Úgy tűnik, az anti-IFNomega antitestek a nagyon korai életkorban jelennek meg és segítenek abban, hogy az APSI-et differenciálni tudjuk más szisztémás autoimmun kórképtől. (Clin Endocrinol(Oxf); 2009Oct 26.[Epub ahead of print]) A SS nagyon gyakran társul más autoimmun betegségekkel. Az utóbbi évek kutatásai nagyban hozzájárultak a betegség etiopathogenezisének megértéséhez. Nagy figyelmet fordítottunk az etiopathogenesis kritikus részeinek ismertetésére. (Sjögren's syndrome and associated disorders. Ed.: M.Zeher,P. Szodoray; Transworld Research Network 2009.) | We have investigated the immunomodulating role of fat-soluble vitamins in 25 patients with primary Sjögren's syndrome (SS).We have stated that fat-soluble vitamins possess immunoregulatory properties and have been implicated in the development of autoimmune diseases. The levels of vitamin A and E correlate with immunoregulatory cell counts, and may influence the autoimmune processes. (Rheumatol 2010;49:211-217.) We noted that both Graves disease and Hashimoto-thyroiditis can appear either before or after the onset of SS. Since most cases of SS predate the appearance of autoimmune thyroid diseases it is important to determine if SS is a predisposing factor for the development of autoimmune thyroiditis. (Thyroid 2009; 19(1):39-45.) The correlation of Interferon omega (IFN omega) serum concentration with APSI and other multiorgan autoimmun diseases were measured. A novel c. 1344 delC mutation in AIRE was detected. Anti-IFN-omega antibodies seem to appear very early in life and are helpful to differentiate APSI from other multi-organ autoimmune diseases. (Clinl Endocrinol (Oxf); 2009 Oct 26.[Epub ahead of print]) Sjögren?s syndrome tends to associate with other autoimmune diseases.The intensive research of the past years led to the better understanding of its etiopathogenesis. We put a special emphasis on certain, critical parts of the etiopathogenesis. (Sjögren's syndrome and associated disorders. Ed.: M. Zeher, P. Szodoray; Transworld Research Network 2009.

Novel Clinical and Diagnostic Aspects of Antineutrophil Cytoplasmic Antibodies

Antineutrophil cytoplasmic antibodies (ANCA) are the serological hallmark of some idiopathic systemic vasculitides. Besides the investigation of ANCA-associated vasculitis (AAV) and constant effort for a standardized nomenclature and classification of the AAV, amain focus of research during the last few years has been to constantly improve the performance of enzyme immunoassays. With the latest so called third generation ELISA, this goal seemed to be fulfilled. The International Consensus Statement on Testing and Reporting of ANCA gave recommendations for standardized strategies for the serological diagnosis of ANCA. New developments now target the system immanent drawbacks of the respective diagnosticmethods, be it the need for batching and the long time to result for ELISA, or the high likelihood of error and subjectivity of indirect immunofluorescence (IIF). Randomaccess technology andmultiplexing for solid phase assays aswell as digital imaging for IIF are toolswhichmay help to expedite and simplify routine diagnostics in the lab and in emergency settings. Recent findings indicate that PR3-ANCA have clinical utility beyond the diagnosis of AAV. PR3-ANCA can also serve as an aid for the differentiation between ulcerative colitis (UC) and Crohn’s disease (CrD) and the stratification of UC patients. This review provides a detailed review of what is known about ANCA and highlights the latest research and state-of-the-art developments in this area

A Clinical Approach for Defining the Threshold between Low and Medium Anti-Cardiolipin Antibody Levels for QUANTA Flash Assays

The threshold between low and medium antibody levels for anticardiolipin (aCL) and anti-β2 glycoprotein I antibodies (aβ2GPI) for the diagnosis of antiphospholipid syndrome (APS) remains a matter of discussion. Our goal was to create a protocol for determining the low/medium antibody cut-off for aCL antibody methods based on a clinical approach, and utilize it to establish the clinically-relevant low/medium threshold for QUANTA Flash aCL chemiluminescent immunoassay (CIA) results. The study included 288 samples from patients with primary APS (n = 70), secondary APS (n = 42), suspected APS (n = 36), systemic lupus erythematosus (SLE) without APS (n = 96) and other connective tissue diseases (n = 44). All samples were tested for IgG and IgM aCL antibodies with QUANTA Flash CIA, along with traditional enzyme-linked immunosorbent assays (ELISAs) (QUANTA Lite). The assay specific low/medium threshold for QUANTA Flash aCL IgG and IgM assays (i.e., the equivalent of 40 GPL and MPL units) was established as 95 and 31 chemiluminescent units (CU), respectively, based on clinical performance and comparison to QUANTA Lite ELISAs. Agreement between CIA and ELISA assay results improved substantially when the platform-specific low/medium antibody threshold was used, as compared to agreement obtained on results generated with the assay cutoff: Cohen’s kappa increased from 0.85 to 0.91 for IgG aCL, and from 0.59 to 0.75 for IgM aCL results. This study describes a clinical approach for establishing the low/medium antibody threshold for aPL antibody assays, and successfully employs it to define 95 and 31 CU, respectively, as the low/medium cut point for QUANTA Flash aCL IgG and IgM results. This study can serve as a model for labs wishing to establish the appropriate low/medium aPL antibody threshold when implementing new aPL antibody assays

A Clinical Approach for Defining the Threshold between Low and Medium Anti-Cardiolipin Antibody Levels for QUANTA Flash Assays

The threshold between low and medium antibody levels for anticardiolipin (aCL) and anti-β2 glycoprotein I antibodies (aβ2GPI) for the diagnosis of antiphospholipid syndrome (APS) remains a matter of discussion. Our goal was to create a protocol for determining the low/medium antibody cut-off for aCL antibody methods based on a clinical approach, and utilize it to establish the clinically-relevant low/medium threshold for QUANTA Flash aCL chemiluminescent immunoassay (CIA) results. The study included 288 samples from patients with primary APS (n = 70), secondary APS (n = 42), suspected APS (n = 36), systemic lupus erythematosus (SLE) without APS (n = 96) and other connective tissue diseases (n = 44). All samples were tested for IgG and IgM aCL antibodies with QUANTA Flash CIA, along with traditional enzyme-linked immunosorbent assays (ELISAs) (QUANTA Lite). The assay specific low/medium threshold for QUANTA Flash aCL IgG and IgM assays (i.e., the equivalent of 40 GPL and MPL units) was established as 95 and 31 chemiluminescent units (CU), respectively, based on clinical performance and comparison to QUANTA Lite ELISAs. Agreement between CIA and ELISA assay results improved substantially when the platform-specific low/medium antibody threshold was used, as compared to agreement obtained on results generated with the assay cutoff: Cohen’s kappa increased from 0.85 to 0.91 for IgG aCL, and from 0.59 to 0.75 for IgM aCL results. This study describes a clinical approach for establishing the low/medium antibody threshold for aPL antibody assays, and successfully employs it to define 95 and 31 CU, respectively, as the low/medium cut point for QUANTA Flash aCL IgG and IgM results. This study can serve as a model for labs wishing to establish the appropriate low/medium aPL antibody threshold when implementing new aPL antibody assays