Antinuclear antibodies

Cabiedes, Javier; Núñez-Álvarez, Carlos A.

doi:10.1016/S2173-5743(10)70049-6

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Abstract

Anti-nuclear antibodies (ANA) are immunoglobulin directed against autologous cell nuclear and cytoplasmic components. Besides the autoimmune ANA there are other ANA that can be detected in circulation, like natural and infectious ANA.

Because of its high sensibility, detection of the ANA must be done by indirect immunofluorescence (IIF) as screening test and all of those positive samples are convenient to confirm its specificity by ELISA, western blot or other techniques.

Positive ANA detected by IIF must be evaluated taking in to account the pattern and titer. The following recommended step is the specificity characterization (reactivity against extractable nuclear antigens [ENA], dsDNA, etc.) which is useful for the diagnosis and follow up of patients with autoimmune diseases, and by such reasoning, its detection must be performed in an orderly and reasonable way using guides or strategies focused to the good use and interpretation of the autoantibodies. The objective of this review is to present a compilation of the literature and our experience in the detection and study of the ANA.

Keywords:

Antinuclear antibodies

Indirect immunofluorescence

Autoimmune diseases

Resumen

Los anticuerpos antinucleares son inmunoglobulinas que reconocen componentes celulares autólogos (nucleares y citoplasmáticos). Además de los ANA autoinmunes, pueden estar en circulación ANA infecciosos y naturales.

La detección de ANA debe realizarse mediante inmunofluorescencia indirecta (IFI) en líneas celulares como prueba de tamizado inicial debido a su alta sensibilidad. Una muestra positiva para ANA, detectados mediante IFI, debe confirmarse mediante técnicas más sensibles y específicas, como ELISA, electroinmunotransferencia (Western blot) u otras.

Los ANA detectados por IFI deben ser evaluados según el patrón y el título. La detección específica de diversos autoanticuerpos (anti-ENA, ADNcd, etc.) resulta útil en el diagnóstico y seguimiento de pacientes con enfermedades autoinmunes. Por tal motivo, su detección debe realizarse de manera ordenada y razonable, empleando las guías o estrategias enfocadas al buen uso e interpretación de la presencia de autoanticuerpos. El objetivo de la revisión es presentar una recopilación de la literatura y nuestra experiencia en la detección y estudio de los ANA.

Palabras clave:

Anticuerpos antinucleares

Inmunofluorescencia indirecta

Enfermedades autoinmunes

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