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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Anti-neutrophil cytoplasmic antibodies &#40;ANCA&#41;&#44; mainly directed towards proteinase 3 &#40;PR3&#41; and myeloperoxidase &#40;MPO&#41;&#44; are associated with primary systemic small-vessel vasculitis known as ANCA-associated vasculitis &#40;AAV&#41;&#44; a term which includes microscopic polyangiitis &#40;MPA&#41;&#47;renal limited vasculitis &#40;RLV&#41;&#44; granulomatosis with polyangiitis &#40;GPA or Wegener&#39;s granulomatosis&#41;&#44; and eosinophilic granulomatosis with polyangiitis &#40;EGPA or Churg Strauss syndrome&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;2</span></a> AAV with multi-organ secondary inflammation and necrosis within small blood vessels causes an increase in morbidity and mortality&#46; Screening for the presence of ANCAs is a commonly used diagnostic assay for AAV&#46; A variety of diagnostic assays with different sensitivity and specificity are being used for the screening and confirmation of the specific ANCA antigens viz&#46; MPO and PR3&#46; The assays include but not limited to Immunofluorescence test &#40;IIFT&#41;&#44; Line immunoassay &#40;LIA&#41;&#44; Enzyme-linked immunosorbent assay &#40;ELISA&#41;&#44; and its variants&#44; Immunoblots&#44; and solid-phase bead-based assays&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">As per recommendations of 1999 International Consensus Statement on Testing and Reporting ANCA&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> the combination of both techniques &#40;IIFT and antigen-specific test like LIA&#47;ELISA were used for the detection of ANCA in patients under investigation for ANCA-associated vasculitis&#46; We aimed to determine demographic&#44; clinical features&#44; and laboratory diagnosis of AAV patients presenting to a large tertiary care center in India&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study population and specimen</span><p id="par0015" class="elsevierStylePara elsevierViewall">This retrospective study includes 1289 patients who were tested for ANCA serology at Molecular Genetics laboratory in a large tertiary care center in the National Capital Region &#40;NCR&#41;&#44; India during 2011&#8211;2016&#46; The study protocol conformed to the provisions of the 1975 Declaration of Helsinki &#40;as revised in Seoul&#44; Korea&#44; October 2008&#41;&#46; Samples were mainly received from patients undergoing secondary or tertiary referral to specialists&#44; i&#46;e&#46;&#44; nephrologists&#44; pulmonologists&#44; rheumatologists&#44; gastroenterologists&#44; gynecologists&#44; and general physicians&#46; Whole blood was collected from the patients by venipuncture into plain vacuumed tubes&#44; and separated serum was stored at &#8722;80<span class="elsevierStyleHsp" style=""></span>&#176;C until testing&#46; However&#44; to prevent repeated freezing and thawing&#44; serum aliquots were thawed only once and immediately processed after thawing to prevent discrepancies in results&#46; Based on standardized assays used in our laboratory&#44; screening of ANCA was performed by IIFT and specific antigens &#91;MPO&#44; PR3&#44; and &#40;glomerular basement membrane&#41; GBM&#93; were identified using LIA&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Technology&#44; technique&#44; and equipment</span><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Indirect Immunofluorescence test &#40;IIFT&#41;</span>&#58; Screening of ANCAs was performed using ethanol fixed neutrophils from Immunoconcepts &#40;Cat no&#58; 10070-11&#41;&#46; Serum diluted &#40;1&#58;20&#41; in phosphate-buffered saline was incubated with ethanol fixed neutrophils for 30<span class="elsevierStyleHsp" style=""></span>min at room temperature&#46; Slides were washed twice for five minutes with PBS&#44; incubated for an additional 30<span class="elsevierStyleHsp" style=""></span>min with fluorescent-labeled conjugated antihuman IgG&#46; Subsequently&#44; a cover-slip was placed over the slide and analyzed using a fluorescence microscope at 40&#215; magnification&#46; The fluorescence of each sample was compared with the negative control and the pattern of fluorescence was determined and recorded&#46; While reporting&#44; the results were interpreted as &#40;a&#41; C-ANCA positive&#58; diffuse granular cytoplasmic staining with interlobular accentuation &#40;b&#41; P-ANCA positive&#58; peri-nuclear fluorescence with the nuclear extension &#40;c&#41; Atypical ANCA&#58; peri-nuclear staining without nuclear extension&#44; or diffuse flat cytoplasmic staining&#44; or the combination of both cytoplasmic and nuclear&#47;peri-nuclear staining on neutrophils &#40;d&#41; Atypical ANCA with granulocytes specific ANA&#58; showing atypical staining with ANA interference &#40;e&#41; ANCA negative&#58; shows no fluorescence&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3&#8211;5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Line Immunoassay &#40;LIA&#41;&#58;</span> Imtech ANCA LIA MAXX &#40;Cat No&#58; ITC92005&#41; was used for the qualitative detection of three antigen panels &#40;PR3&#44; MPO&#44; and GBM&#41; according to manufacturer&#39;s instructions&#46; Three antigens&#44; cut-off control&#44; and positive control are applied as lines on a nitrocellulose membrane&#46; The nitrocellulose membrane was blocked by adding a blocking buffer for 5<span class="elsevierStyleHsp" style=""></span>min to prevent non-specific reactions&#46; Incubation of a strip with diluted patient samples was done for 30<span class="elsevierStyleHsp" style=""></span>min to allow binding of the antigens on the strip with autoantibodies present in the sample&#46; For the detection of the bound antibodies&#44; an alkaline phosphatase labeled anti-human IgG antibody was added to strips for 30<span class="elsevierStyleHsp" style=""></span>min&#46; After the addition of the substrate solution for 30<span class="elsevierStyleHsp" style=""></span>min&#44; the appearance of brown lines indicated the existence of &#40;auto&#41; antibodies against the respective antigens&#46; The intensity of brown lines was measured using Huma-Scan software&#46; The test result is negative&#44; if no band is to be recognized or if the band exhibits a smaller intensity in comparison to the cut-off control&#46; The test is equivocal if the intensity of the band and the intensity of the cut-off control do not significantly differ&#46; The test result is positive if a band exhibits stronger staining in comparison to the cut-off control&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0030" class="elsevierStylePara elsevierViewall">To summarize the data&#44; counts and percentages were used for categorical variables&#46; Percentages were calculated using Microsoft Office Standard 2013&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Ethical approval</span><p id="par0035" class="elsevierStylePara elsevierViewall">Patient consent was obtained for diagnosis and treatment at the hospital&#46; This was an observational study&#59; no personal identifiers like name&#44; addresses were used and no additional sample was drawn for this study&#46; All investigation&#44; treatment&#44; and monitoring were according to the current &#8216;standard-of-care&#8217;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">The incidence of serum ANCA and specific autoantibodies</span><p id="par0040" class="elsevierStylePara elsevierViewall">Upon IIF investigation&#44; ANCA was detected in 13&#46;0&#37; &#40;168 out of 1289&#41; at 1&#58;20 dilution&#44; of which 23&#46;8&#37; &#40;40&#47;168&#41;&#44; 25&#46;0&#37; &#40;42&#47;168&#44; and 47&#46;6&#37; &#40;80&#47;168&#41; were positive with P-ANCA&#44; C-ANCA and atypical pattern respectively&#46; Atypical ANCA with granulocytes specific ANA was observed in 3&#46;6&#37; &#40;6&#47;168&#41; cases &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; On evaluation with a line immunoassay&#44; 6&#46;7&#37; &#40;86&#47;1289&#41; were positive out of which 52&#46;3&#37; &#40;45&#47;86&#41;&#44; 41&#46;9&#37; &#40;36&#47;86&#41;&#44; 8&#46;8&#37; &#40;6&#47;86&#41; were positive for anti-MPO&#44; anti-PR3&#44; and anti-GBM respectively&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Association of ANCA patterns with specific autoantibodies</span><p id="par0045" class="elsevierStylePara elsevierViewall">The association of a specific autoantibody with specific immunofluorescence &#40;IIF&#41; pattern was observed&#46; Out of 40 P-ANCA positive cases&#44; 92&#46;5&#37; &#40;37&#47;40&#41; were positive for anti-MPO and 5&#46;0&#37; &#40;2&#47;40&#41; were positive for anti-PR3&#46; Among 42 C-ANCA cases&#44; 76&#46;2&#37; &#40;32&#47;42&#41; and 16&#46;7&#37; &#40;7&#47;42&#41; were positive for anti-PR3 and anti-MPO respectively &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Images of various ANCA IIF patterns are shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Incidentally&#44; while studying the association of IIF patterns and specific autoantibodies&#44; we found the distribution of anti-MPO and anti-PR3 in AAV &#40;shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Anti-MPO antibody was predominant in 87&#46;5&#37; &#40;7&#47;8&#41; of EGPA and 91&#46;3&#37; &#40;21&#47;23&#41; cases of MPA&#47;RLV&#46; The anti-PR3 antibody was predominant in 87&#46;5&#37; &#40;28&#47;32&#41; cases of GPA&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Clinical features of IIFT positive samples</span><p id="par0055" class="elsevierStylePara elsevierViewall">Out of 168 IIF positive samples 8&#44; 32&#44; and 23 cases were observed as EGPA&#44; GPA&#44; and MPA&#47;RLV respectively&#46; Six cases of rapidly progressive glomerulonephritis &#40;RPGN&#41; were identified as positive for GBM&#46; 105 cases remained unclassifiable&#46; A comparison of demographics among AAV diseases were shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Kidney and chest involvement was observed in most of the diseases&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> indicates the involvement of different organs in AAV diseases&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">ANCAs are important biomarkers to diagnose GPA&#44; MPA&#47;RLV&#44; EGPA&#44; and their limited forms such as pauci immune glomerulonephritis and pulmonary capillaritis and can also be useful in monitoring disease activity&#46; ANCA screening is performed by IIFT on neutrophils to detect predominantly central &#40;C-ANCA&#41; or cytoplasmic &#40;P-ANCA&#41; staining&#46; Antibodies against MPO and PR3 antigens expressed on the surface of neutrophils and monocytes are recognized as the main ANCA targets&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">6&#44;7</span></a> The antigen specific testing for anti-MPO and anti-PR3&#44; in addition to ANCA IIFT&#44; increases the sensitivity and specificity for the diagnosis of AAV&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">In the present study&#44; the PR3 antigen was positive with C-ANCA in 88&#37; of patients with GPA&#46; While P-ANCA and MPO antibodies were positive in 91&#37; patients with MPA&#47;RLV which were compatible with results reported earlier in the literature showing PR3-C-ANCA pairing&#44; is seen in 90&#37; patients with GPA&#44;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">9&#44;10</span></a> while P-ANCA and MPO antibodies result positive in 60&#8211;80&#37; of patients with MPA&#47;RLV&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> GBM positivity was observed in six patients with RPGN&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The other category of atypical ANCA is uncommon&#44; found in 80 cases in the present study&#44; and usually caused by a combination of both cytoplasmic and nuclear&#47;peri-nuclear fluorescence&#46; These sera have multiple antigenic specificities including PR3&#44; MPO&#44; bactericidal permeability-increasing protein&#44; cathepsin G&#44; elastase&#44; lactoferrin&#44; and lysozyme&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3&#44;12</span></a> Atypical ANCA occurs in inflammatory bowel disease&#44; some autoimmune forms of arthritis&#44; and drug-induced vasculitides&#46; Out of 80 cases of atypical ANCA pattern&#44; only one was positive for anti-MPO and 2 were positive for the anti-PR3 antibody&#46; However&#44; these samples were not tested for antigen specificity &#40;other than MPO&#44; PR3&#44; and GBM&#41; in the present study&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">AAVs are small-vessel vasculitides with a broad spectrum of manifestations since almost all organs can be affected&#46; Miscellaneous organ manifestations including the involvement of the cardiovascular and musculoskeletal system&#44; gastrointestinal and urogenital tract&#44; occur in only a minority of patients but may have a profound impact on morbidity and mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> Here&#44; in this study&#44; the organ involvement was observed in 168 ANCA IIF positive cases in which kidney and chest were the major organs involved along with general manifestations&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The primary aim of the study is to provide a single-center report to determine the laboratory diagnosis of AAV&#46; A combination of IIFT and LIA was found to be an optimum testing strategy for the laboratory diagnosis of AAV&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Limitation of the study</span>&#58; This study followed the recommendations of the 1999 International Consensus Statement&#46; However&#44; The international guidelines were updated in 2017<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> which mentions that antigen-specific tests like LIA and ELISA<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> should be used as a first-line test for diagnosis as monitoring is an additional advantage of using antigen-specific assays&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Funding source</span><p id="par0090" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflict of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">All the authors of the manuscript hereby declare that we have no conflict of interest&#46;</p></span></span>"
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              "titulo" => "The incidence of serum ANCA and specific autoantibodies"
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              "titulo" => "Association of ANCA patterns with specific autoantibodies"
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    "fechaRecibido" => "2020-05-12"
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            0 => "ANCA associated vasculitis &#40;AAV&#41;"
            1 => "Anti-neutrophil cytoplasmic antibodies &#40;ANCA&#41;"
            2 => "C-ANCA"
            3 => "P-ANCA&#46; MPO"
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          "palabras" => array:4 [
            0 => "Vasculitis asociada a ANCA &#40;AAV&#41;"
            1 => "Anticuerpos anticitoplasma de neutr&#243;filos &#40;ANCA&#41;"
            2 => "C-ANCA"
            3 => "P-ANCA&#46; MPO"
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    "resumen" => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Anti-neutrophil cytoplasmic autoantibodies &#40;ANCA&#41; associated vasculitis &#40;AAV&#41; is a small vessel vasculitis with insufficient epidemiological estimates in India&#46; We aimed to determine demographic&#44; clinical features&#44; and laboratory diagnosis of AAV patients presenting to a large tertiary care centre in India&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">1289 patient samples were screened for ANCA by indirect immunofluorescence test &#40;IIFT&#41; and confirmation of ANCA target antigens was done by line immunoassay&#46; Association between IIFT and LIA was determined in AAV&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">By IIFT&#44; ANCA was detected in 13&#46;0&#37; &#40;168 out of 1289&#41;&#44; of which 23&#46;8&#37; &#40;40&#47;168&#41; were positive with P-ANCA pattern&#44; 25&#46;0&#37; &#40;42&#47;168&#41; were positive with C-ANCA and 47&#46;6&#37; &#40;80&#47;168&#41; showed an atypical pattern&#46; On evaluation with a line immunoassay&#44; 6&#46;7&#37; &#40;86&#47;1289&#41; were positive out of which 52&#46;3&#37; &#40;45&#47;86&#41;&#44; 41&#46;9&#37; &#40;36&#47;86&#41;&#44; 8&#46;8&#37; &#40;6&#47;86&#41; were positive for anti-MPO&#44; anti-PR3&#44; and anti-GBM respectively&#46; In eosinophilic granulomatosis with polyangiitis &#40;EGPA&#41; 87&#46;5&#37; &#40;7&#47;8&#41;&#44; and microscopic polyangiitis &#40;MPA&#47;RLV&#41; 91&#46;3&#37; &#40;21&#47;23&#41;&#44; anti-MPO was the predominantly observed antibody&#46; In granulomatosis with polyangiitis &#40;GPA&#41; anti-PR3 antibody was predominant in 87&#46;5&#37; &#40;28&#47;32&#41; cases&#46; Out of 168 IIF positive samples 8&#44; 32&#44; and 23 cases of EGPA&#44; GPA&#44; and MPA&#47;RLV were observed respectively&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The primary aim of the study was to provide single-centre data to determine the laboratory diagnosis of AAV&#46; A combination of IIFT and LIA was found to be an optimum testing strategy for the laboratory diagnosis of AAV&#46;</p></span>"
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            "titulo" => "Material and methods"
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          2 => array:2 [
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            "titulo" => "Results"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La vasculitis asociada a anticuerpos anticitoplasma de neutr&#243;filos &#8211;ANCA&#8211; &#40;VAA&#41; es una vasculitis de peque&#241;os vasos con c&#225;lculos epidemiol&#243;gicos insuficientes en India&#46; Nuestro objetivo fue determinar las caracter&#237;sticas demogr&#225;ficas y cl&#237;nicas&#44; y los diagn&#243;sticos de laboratorio de los pacientes con VAA que se presentaron en un gran centro de cuidados terciarios en India&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un cribado de ANCA en 1&#46;289 pacientes mediante test de inmunofluorescencia directa &#40;IIFT&#41;&#44; realiz&#225;ndose la confirmaci&#243;n de los ant&#237;genos diana de ANCA mediante inmunoensayo lineal&#46; La asociaci&#243;n entre IIFT y LIA fue determinada en VAA&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Mediante IIFT&#44; se detect&#243; ANCA en el 13&#37; de los pacientes &#40;168 de 1&#46;289&#41;&#44; de los cuales&#44; el 23&#44;8&#37; &#40;40&#47;168&#41; fue positivo con el patr&#243;n P-ANCA&#44; el 25&#37; &#40;42&#47;168&#41; fue positivo con C-ANCA y el 47&#44;6&#37; &#40;80&#47;168&#41; reflej&#243; un patr&#243;n at&#237;pico&#46; En la evaluaci&#243;n con inmunoensayo lineal&#44; el 6&#44;7&#37; &#40;86&#47;1&#46;289&#41; fue positivo&#44; de los cuales&#44; el 52&#44;3&#37; &#40;45&#47;86&#41;&#44; 41&#44;9&#37; &#40;36&#47;86&#41; y 8&#44;8&#37; &#40;6&#47;86&#41; fueron positivos para anti-MPO&#44; anti-PR3 y anti-GBM&#44; respectivamente&#46; En la granulomatosis eosinof&#237;lica con poliangitis &#40;EGPA&#41;&#44; en el 87&#44;5&#37; &#40;7&#47;8&#41; de los casos&#44; y en poliangitis microsc&#243;pica &#40;MPA&#47;RLV&#41; en el 91&#44;3&#37; &#40;21&#47;23&#41;&#44; anti-MPO fue el anticuerpo predominantemente observado&#46; En granulomatosis con poliangitis &#40;GPA&#41;&#44; el anticuerpo anti-PR3 fue predominante en el 87&#44;5&#37; &#40;28&#47;32&#41; de los casos&#46; De entre 168 muestras positivas de IIF&#44; se observaron 8&#44; 32&#44; y 23 casos de EGPA&#44; GPA y MPA&#47;RLV&#44; respectivamente&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El objetivo primario del estudio fue aportar los datos de un &#250;nico centro para determinar el diagn&#243;stico de laboratorio de VAA&#46; El resultado fue que la combinaci&#243;n de IIFT y LIA es una estrategia &#243;ptima para el diagn&#243;stico de laboratorio de VAA&#46;</p></span>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">ANCA patterns observed by IIFT in patients included in the study&#58; &#40;a&#41; C-ANCA&#44; &#40;b&#41; P-ANCA&#44; &#40;c&#41; Atypical ANCA&#44; &#40;d&#41; Atypical ANCA with granulocytes specific ANA&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">EGPA &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t">Cardiovascular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Abdominal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Renal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
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Original Article
Laboratory Diagnosis of ANCA-Associated Vasculitis (AAV) Using a Combination of Immunofluorescence Test (IIFT) and Line Immunoassay (LIA): Single-Centre Report From India
Diagnóstico de laboratorio de vasculitis asociada a ANCA (VAA), utilizando conjuntamente test de inmunofluorescencia (IIFT) e inmunoensayo lineal (LIA): Reporte de un único centro de la India
Rajni Chauhana,b, Dharmendra Jaina, Aseem Kumar Tiwaria, Pranav Dorwala, Vimarsh Rainac, Shoma Paul Nandib,
Corresponding author
spaul@amity.edu

Corresponding author.
a Molecular and Transplant Immunology Laboratory, Department of Transfusion Medicine, Medanta-The Medicity, Gurgaon, India
b Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India
c Chimera Transplant Research Foundation, New Delhi, India
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Anti-neutrophil cytoplasmic antibodies &#40;ANCA&#41;&#44; mainly directed towards proteinase 3 &#40;PR3&#41; and myeloperoxidase &#40;MPO&#41;&#44; are associated with primary systemic small-vessel vasculitis known as ANCA-associated vasculitis &#40;AAV&#41;&#44; a term which includes microscopic polyangiitis &#40;MPA&#41;&#47;renal limited vasculitis &#40;RLV&#41;&#44; granulomatosis with polyangiitis &#40;GPA or Wegener&#39;s granulomatosis&#41;&#44; and eosinophilic granulomatosis with polyangiitis &#40;EGPA or Churg Strauss syndrome&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;2</span></a> AAV with multi-organ secondary inflammation and necrosis within small blood vessels causes an increase in morbidity and mortality&#46; Screening for the presence of ANCAs is a commonly used diagnostic assay for AAV&#46; A variety of diagnostic assays with different sensitivity and specificity are being used for the screening and confirmation of the specific ANCA antigens viz&#46; MPO and PR3&#46; The assays include but not limited to Immunofluorescence test &#40;IIFT&#41;&#44; Line immunoassay &#40;LIA&#41;&#44; Enzyme-linked immunosorbent assay &#40;ELISA&#41;&#44; and its variants&#44; Immunoblots&#44; and solid-phase bead-based assays&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">As per recommendations of 1999 International Consensus Statement on Testing and Reporting ANCA&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> the combination of both techniques &#40;IIFT and antigen-specific test like LIA&#47;ELISA were used for the detection of ANCA in patients under investigation for ANCA-associated vasculitis&#46; We aimed to determine demographic&#44; clinical features&#44; and laboratory diagnosis of AAV patients presenting to a large tertiary care center in India&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study population and specimen</span><p id="par0015" class="elsevierStylePara elsevierViewall">This retrospective study includes 1289 patients who were tested for ANCA serology at Molecular Genetics laboratory in a large tertiary care center in the National Capital Region &#40;NCR&#41;&#44; India during 2011&#8211;2016&#46; The study protocol conformed to the provisions of the 1975 Declaration of Helsinki &#40;as revised in Seoul&#44; Korea&#44; October 2008&#41;&#46; Samples were mainly received from patients undergoing secondary or tertiary referral to specialists&#44; i&#46;e&#46;&#44; nephrologists&#44; pulmonologists&#44; rheumatologists&#44; gastroenterologists&#44; gynecologists&#44; and general physicians&#46; Whole blood was collected from the patients by venipuncture into plain vacuumed tubes&#44; and separated serum was stored at &#8722;80<span class="elsevierStyleHsp" style=""></span>&#176;C until testing&#46; However&#44; to prevent repeated freezing and thawing&#44; serum aliquots were thawed only once and immediately processed after thawing to prevent discrepancies in results&#46; Based on standardized assays used in our laboratory&#44; screening of ANCA was performed by IIFT and specific antigens &#91;MPO&#44; PR3&#44; and &#40;glomerular basement membrane&#41; GBM&#93; were identified using LIA&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Technology&#44; technique&#44; and equipment</span><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Indirect Immunofluorescence test &#40;IIFT&#41;</span>&#58; Screening of ANCAs was performed using ethanol fixed neutrophils from Immunoconcepts &#40;Cat no&#58; 10070-11&#41;&#46; Serum diluted &#40;1&#58;20&#41; in phosphate-buffered saline was incubated with ethanol fixed neutrophils for 30<span class="elsevierStyleHsp" style=""></span>min at room temperature&#46; Slides were washed twice for five minutes with PBS&#44; incubated for an additional 30<span class="elsevierStyleHsp" style=""></span>min with fluorescent-labeled conjugated antihuman IgG&#46; Subsequently&#44; a cover-slip was placed over the slide and analyzed using a fluorescence microscope at 40&#215; magnification&#46; The fluorescence of each sample was compared with the negative control and the pattern of fluorescence was determined and recorded&#46; While reporting&#44; the results were interpreted as &#40;a&#41; C-ANCA positive&#58; diffuse granular cytoplasmic staining with interlobular accentuation &#40;b&#41; P-ANCA positive&#58; peri-nuclear fluorescence with the nuclear extension &#40;c&#41; Atypical ANCA&#58; peri-nuclear staining without nuclear extension&#44; or diffuse flat cytoplasmic staining&#44; or the combination of both cytoplasmic and nuclear&#47;peri-nuclear staining on neutrophils &#40;d&#41; Atypical ANCA with granulocytes specific ANA&#58; showing atypical staining with ANA interference &#40;e&#41; ANCA negative&#58; shows no fluorescence&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3&#8211;5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Line Immunoassay &#40;LIA&#41;&#58;</span> Imtech ANCA LIA MAXX &#40;Cat No&#58; ITC92005&#41; was used for the qualitative detection of three antigen panels &#40;PR3&#44; MPO&#44; and GBM&#41; according to manufacturer&#39;s instructions&#46; Three antigens&#44; cut-off control&#44; and positive control are applied as lines on a nitrocellulose membrane&#46; The nitrocellulose membrane was blocked by adding a blocking buffer for 5<span class="elsevierStyleHsp" style=""></span>min to prevent non-specific reactions&#46; Incubation of a strip with diluted patient samples was done for 30<span class="elsevierStyleHsp" style=""></span>min to allow binding of the antigens on the strip with autoantibodies present in the sample&#46; For the detection of the bound antibodies&#44; an alkaline phosphatase labeled anti-human IgG antibody was added to strips for 30<span class="elsevierStyleHsp" style=""></span>min&#46; After the addition of the substrate solution for 30<span class="elsevierStyleHsp" style=""></span>min&#44; the appearance of brown lines indicated the existence of &#40;auto&#41; antibodies against the respective antigens&#46; The intensity of brown lines was measured using Huma-Scan software&#46; The test result is negative&#44; if no band is to be recognized or if the band exhibits a smaller intensity in comparison to the cut-off control&#46; The test is equivocal if the intensity of the band and the intensity of the cut-off control do not significantly differ&#46; The test result is positive if a band exhibits stronger staining in comparison to the cut-off control&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0030" class="elsevierStylePara elsevierViewall">To summarize the data&#44; counts and percentages were used for categorical variables&#46; Percentages were calculated using Microsoft Office Standard 2013&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Ethical approval</span><p id="par0035" class="elsevierStylePara elsevierViewall">Patient consent was obtained for diagnosis and treatment at the hospital&#46; This was an observational study&#59; no personal identifiers like name&#44; addresses were used and no additional sample was drawn for this study&#46; All investigation&#44; treatment&#44; and monitoring were according to the current &#8216;standard-of-care&#8217;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">The incidence of serum ANCA and specific autoantibodies</span><p id="par0040" class="elsevierStylePara elsevierViewall">Upon IIF investigation&#44; ANCA was detected in 13&#46;0&#37; &#40;168 out of 1289&#41; at 1&#58;20 dilution&#44; of which 23&#46;8&#37; &#40;40&#47;168&#41;&#44; 25&#46;0&#37; &#40;42&#47;168&#44; and 47&#46;6&#37; &#40;80&#47;168&#41; were positive with P-ANCA&#44; C-ANCA and atypical pattern respectively&#46; Atypical ANCA with granulocytes specific ANA was observed in 3&#46;6&#37; &#40;6&#47;168&#41; cases &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; On evaluation with a line immunoassay&#44; 6&#46;7&#37; &#40;86&#47;1289&#41; were positive out of which 52&#46;3&#37; &#40;45&#47;86&#41;&#44; 41&#46;9&#37; &#40;36&#47;86&#41;&#44; 8&#46;8&#37; &#40;6&#47;86&#41; were positive for anti-MPO&#44; anti-PR3&#44; and anti-GBM respectively&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Association of ANCA patterns with specific autoantibodies</span><p id="par0045" class="elsevierStylePara elsevierViewall">The association of a specific autoantibody with specific immunofluorescence &#40;IIF&#41; pattern was observed&#46; Out of 40 P-ANCA positive cases&#44; 92&#46;5&#37; &#40;37&#47;40&#41; were positive for anti-MPO and 5&#46;0&#37; &#40;2&#47;40&#41; were positive for anti-PR3&#46; Among 42 C-ANCA cases&#44; 76&#46;2&#37; &#40;32&#47;42&#41; and 16&#46;7&#37; &#40;7&#47;42&#41; were positive for anti-PR3 and anti-MPO respectively &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Images of various ANCA IIF patterns are shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Incidentally&#44; while studying the association of IIF patterns and specific autoantibodies&#44; we found the distribution of anti-MPO and anti-PR3 in AAV &#40;shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Anti-MPO antibody was predominant in 87&#46;5&#37; &#40;7&#47;8&#41; of EGPA and 91&#46;3&#37; &#40;21&#47;23&#41; cases of MPA&#47;RLV&#46; The anti-PR3 antibody was predominant in 87&#46;5&#37; &#40;28&#47;32&#41; cases of GPA&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Clinical features of IIFT positive samples</span><p id="par0055" class="elsevierStylePara elsevierViewall">Out of 168 IIF positive samples 8&#44; 32&#44; and 23 cases were observed as EGPA&#44; GPA&#44; and MPA&#47;RLV respectively&#46; Six cases of rapidly progressive glomerulonephritis &#40;RPGN&#41; were identified as positive for GBM&#46; 105 cases remained unclassifiable&#46; A comparison of demographics among AAV diseases were shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Kidney and chest involvement was observed in most of the diseases&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> indicates the involvement of different organs in AAV diseases&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">ANCAs are important biomarkers to diagnose GPA&#44; MPA&#47;RLV&#44; EGPA&#44; and their limited forms such as pauci immune glomerulonephritis and pulmonary capillaritis and can also be useful in monitoring disease activity&#46; ANCA screening is performed by IIFT on neutrophils to detect predominantly central &#40;C-ANCA&#41; or cytoplasmic &#40;P-ANCA&#41; staining&#46; Antibodies against MPO and PR3 antigens expressed on the surface of neutrophils and monocytes are recognized as the main ANCA targets&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">6&#44;7</span></a> The antigen specific testing for anti-MPO and anti-PR3&#44; in addition to ANCA IIFT&#44; increases the sensitivity and specificity for the diagnosis of AAV&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">In the present study&#44; the PR3 antigen was positive with C-ANCA in 88&#37; of patients with GPA&#46; While P-ANCA and MPO antibodies were positive in 91&#37; patients with MPA&#47;RLV which were compatible with results reported earlier in the literature showing PR3-C-ANCA pairing&#44; is seen in 90&#37; patients with GPA&#44;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">9&#44;10</span></a> while P-ANCA and MPO antibodies result positive in 60&#8211;80&#37; of patients with MPA&#47;RLV&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> GBM positivity was observed in six patients with RPGN&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The other category of atypical ANCA is uncommon&#44; found in 80 cases in the present study&#44; and usually caused by a combination of both cytoplasmic and nuclear&#47;peri-nuclear fluorescence&#46; These sera have multiple antigenic specificities including PR3&#44; MPO&#44; bactericidal permeability-increasing protein&#44; cathepsin G&#44; elastase&#44; lactoferrin&#44; and lysozyme&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3&#44;12</span></a> Atypical ANCA occurs in inflammatory bowel disease&#44; some autoimmune forms of arthritis&#44; and drug-induced vasculitides&#46; Out of 80 cases of atypical ANCA pattern&#44; only one was positive for anti-MPO and 2 were positive for the anti-PR3 antibody&#46; However&#44; these samples were not tested for antigen specificity &#40;other than MPO&#44; PR3&#44; and GBM&#41; in the present study&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">AAVs are small-vessel vasculitides with a broad spectrum of manifestations since almost all organs can be affected&#46; Miscellaneous organ manifestations including the involvement of the cardiovascular and musculoskeletal system&#44; gastrointestinal and urogenital tract&#44; occur in only a minority of patients but may have a profound impact on morbidity and mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> Here&#44; in this study&#44; the organ involvement was observed in 168 ANCA IIF positive cases in which kidney and chest were the major organs involved along with general manifestations&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The primary aim of the study is to provide a single-center report to determine the laboratory diagnosis of AAV&#46; A combination of IIFT and LIA was found to be an optimum testing strategy for the laboratory diagnosis of AAV&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Limitation of the study</span>&#58; This study followed the recommendations of the 1999 International Consensus Statement&#46; However&#44; The international guidelines were updated in 2017<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> which mentions that antigen-specific tests like LIA and ELISA<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> should be used as a first-line test for diagnosis as monitoring is an additional advantage of using antigen-specific assays&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Funding source</span><p id="par0090" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflict of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">All the authors of the manuscript hereby declare that we have no conflict of interest&#46;</p></span></span>"
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              "titulo" => "The incidence of serum ANCA and specific autoantibodies"
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              "titulo" => "Association of ANCA patterns with specific autoantibodies"
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    "fechaRecibido" => "2020-05-12"
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            0 => "ANCA associated vasculitis &#40;AAV&#41;"
            1 => "Anti-neutrophil cytoplasmic antibodies &#40;ANCA&#41;"
            2 => "C-ANCA"
            3 => "P-ANCA&#46; MPO"
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          "palabras" => array:4 [
            0 => "Vasculitis asociada a ANCA &#40;AAV&#41;"
            1 => "Anticuerpos anticitoplasma de neutr&#243;filos &#40;ANCA&#41;"
            2 => "C-ANCA"
            3 => "P-ANCA&#46; MPO"
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    "resumen" => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Anti-neutrophil cytoplasmic autoantibodies &#40;ANCA&#41; associated vasculitis &#40;AAV&#41; is a small vessel vasculitis with insufficient epidemiological estimates in India&#46; We aimed to determine demographic&#44; clinical features&#44; and laboratory diagnosis of AAV patients presenting to a large tertiary care centre in India&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">1289 patient samples were screened for ANCA by indirect immunofluorescence test &#40;IIFT&#41; and confirmation of ANCA target antigens was done by line immunoassay&#46; Association between IIFT and LIA was determined in AAV&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">By IIFT&#44; ANCA was detected in 13&#46;0&#37; &#40;168 out of 1289&#41;&#44; of which 23&#46;8&#37; &#40;40&#47;168&#41; were positive with P-ANCA pattern&#44; 25&#46;0&#37; &#40;42&#47;168&#41; were positive with C-ANCA and 47&#46;6&#37; &#40;80&#47;168&#41; showed an atypical pattern&#46; On evaluation with a line immunoassay&#44; 6&#46;7&#37; &#40;86&#47;1289&#41; were positive out of which 52&#46;3&#37; &#40;45&#47;86&#41;&#44; 41&#46;9&#37; &#40;36&#47;86&#41;&#44; 8&#46;8&#37; &#40;6&#47;86&#41; were positive for anti-MPO&#44; anti-PR3&#44; and anti-GBM respectively&#46; In eosinophilic granulomatosis with polyangiitis &#40;EGPA&#41; 87&#46;5&#37; &#40;7&#47;8&#41;&#44; and microscopic polyangiitis &#40;MPA&#47;RLV&#41; 91&#46;3&#37; &#40;21&#47;23&#41;&#44; anti-MPO was the predominantly observed antibody&#46; In granulomatosis with polyangiitis &#40;GPA&#41; anti-PR3 antibody was predominant in 87&#46;5&#37; &#40;28&#47;32&#41; cases&#46; Out of 168 IIF positive samples 8&#44; 32&#44; and 23 cases of EGPA&#44; GPA&#44; and MPA&#47;RLV were observed respectively&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The primary aim of the study was to provide single-centre data to determine the laboratory diagnosis of AAV&#46; A combination of IIFT and LIA was found to be an optimum testing strategy for the laboratory diagnosis of AAV&#46;</p></span>"
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            "titulo" => "Material and methods"
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          2 => array:2 [
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La vasculitis asociada a anticuerpos anticitoplasma de neutr&#243;filos &#8211;ANCA&#8211; &#40;VAA&#41; es una vasculitis de peque&#241;os vasos con c&#225;lculos epidemiol&#243;gicos insuficientes en India&#46; Nuestro objetivo fue determinar las caracter&#237;sticas demogr&#225;ficas y cl&#237;nicas&#44; y los diagn&#243;sticos de laboratorio de los pacientes con VAA que se presentaron en un gran centro de cuidados terciarios en India&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un cribado de ANCA en 1&#46;289 pacientes mediante test de inmunofluorescencia directa &#40;IIFT&#41;&#44; realiz&#225;ndose la confirmaci&#243;n de los ant&#237;genos diana de ANCA mediante inmunoensayo lineal&#46; La asociaci&#243;n entre IIFT y LIA fue determinada en VAA&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Mediante IIFT&#44; se detect&#243; ANCA en el 13&#37; de los pacientes &#40;168 de 1&#46;289&#41;&#44; de los cuales&#44; el 23&#44;8&#37; &#40;40&#47;168&#41; fue positivo con el patr&#243;n P-ANCA&#44; el 25&#37; &#40;42&#47;168&#41; fue positivo con C-ANCA y el 47&#44;6&#37; &#40;80&#47;168&#41; reflej&#243; un patr&#243;n at&#237;pico&#46; En la evaluaci&#243;n con inmunoensayo lineal&#44; el 6&#44;7&#37; &#40;86&#47;1&#46;289&#41; fue positivo&#44; de los cuales&#44; el 52&#44;3&#37; &#40;45&#47;86&#41;&#44; 41&#44;9&#37; &#40;36&#47;86&#41; y 8&#44;8&#37; &#40;6&#47;86&#41; fueron positivos para anti-MPO&#44; anti-PR3 y anti-GBM&#44; respectivamente&#46; En la granulomatosis eosinof&#237;lica con poliangitis &#40;EGPA&#41;&#44; en el 87&#44;5&#37; &#40;7&#47;8&#41; de los casos&#44; y en poliangitis microsc&#243;pica &#40;MPA&#47;RLV&#41; en el 91&#44;3&#37; &#40;21&#47;23&#41;&#44; anti-MPO fue el anticuerpo predominantemente observado&#46; En granulomatosis con poliangitis &#40;GPA&#41;&#44; el anticuerpo anti-PR3 fue predominante en el 87&#44;5&#37; &#40;28&#47;32&#41; de los casos&#46; De entre 168 muestras positivas de IIF&#44; se observaron 8&#44; 32&#44; y 23 casos de EGPA&#44; GPA y MPA&#47;RLV&#44; respectivamente&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El objetivo primario del estudio fue aportar los datos de un &#250;nico centro para determinar el diagn&#243;stico de laboratorio de VAA&#46; El resultado fue que la combinaci&#243;n de IIFT y LIA es una estrategia &#243;ptima para el diagn&#243;stico de laboratorio de VAA&#46;</p></span>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">ANCA patterns observed by IIFT in patients included in the study&#58; &#40;a&#41; C-ANCA&#44; &#40;b&#41; P-ANCA&#44; &#40;c&#41; Atypical ANCA&#44; &#40;d&#41; Atypical ANCA with granulocytes specific ANA&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">EGPA &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">GPA &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MPA &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  """
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                  \t\t\t\t">Cardiovascular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Abdominal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Renal&nbsp;\t\t\t\t\t\t\n
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Article information
ISSN: 21735743
Original language: English
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Idiomas
Reumatología Clínica (English Edition)
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