Current and emerging techniques for ANCA detection in vasculitis

@article{Csernok2014CurrentAE,
  title={Current and emerging techniques for ANCA detection in vasculitis},
  author={Elena Csernok and Frank Moosig},
  journal={Nature Reviews Rheumatology},
  year={2014},
  volume={10},
  pages={494-501}
}
Detection of antineutrophil cytoplasmic antibodies (ANCAs) is a well-established diagnostic test used to evaluate suspected necrotizing vasculitis of small blood vessels. Conditions associated with these antibodies, collectively referred to as ANCA-associated vasculitides, include granulomatosis with polyangiitis (formerly known as Wegener granulomatosis), microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis (formerly known as Churg–Strauss syndrome). The diagnostic… 

ANCA: Methods and Clinical Significance

The clinical utility of serial ANCA measurements for predicting and assessing clinical relapses is under discussion, but may be informative in subsets of patients, such as patients with renal involvement or alveolar hemorrhage and in patients treated with rituximab.

Usefulness of antineutrophil cytoplasmic autoantibodies in diagnosing and managing systemic vasculitis.

  • C. Kallenberg
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  • 2016
New developments in the methodology of testing, the pitfalls in using these tests as diagnostic tools, and the value of serial ANCA testing for the follow-up of patients with ANCA-associated vasculitis including treatment decisions are discussed.

New concepts in ANCA detection and disease classification in small vessel vasculitis: the role of ANCA antigen specificity

  • E. Csernok
  • Medicine, Biology
    Mediterranean journal of rheumatology
  • 2018
New guidelines for ANCA testing have been developed based on a recent European multicentre study, and according to the revised 2017 international consensus recommendations, testing for AnCA in small vessel vasculitis can be done by PR3- and MPO-ANCA immunoassays, without the categorical need for IIF.

Position paper: Revised 2017 international consensus on testing of ANCAs in granulomatosis with polyangiitis and microscopic polyangiitis

It is proposed that high-quality immunoassays can be used as the primary screening method for patients suspected of having the ANCA-associated vaculitides GPA and MPA without the categorical need for IIF, and evidence is presented to support this recommendation.

Search for Autoantibodies in Systemic Vasculitis: Is It Useful?

Antineutrophil cytoplasmic antibodies (ANCA) are biomarkers of ANCA-associated vasculitis and are detected by indirect immunofluorescence (IIF) with three main patterns described as follows: cytopolasmic (C-ANCA), perinuclear (P-ANca) and atypical (A-AN CA).

The Diagnostic and Clinical Utility of Autoantibodies in Systemic Vasculitis

The revised 2017 international consensus recommendations for ANCA detection support the primary use PR3- and MPO-ANCA immunoassays without the categorical need for additional indirect immunofluorescence (IIF).

Detection of antineutrophil cytoplasmic antibodies (ANCAs): a multicentre European Vasculitis Study Group (EUVAS) evaluation of the value of indirect immunofluorescence (IIF) versus antigen-specific immunoassays

The authors' comparison of various ANCA detection methods showed large variability between the two IIF methods tested and a high diagnostic performance of PR3-ANCA and MPO-AN CA by immunoassay to discriminate AAV from disease controls, indicating that the current international consensus on ANCA testing for AAV needs revision.

AB0963 Inteference of ANAs in ANCa Analysis and Comparison To Clinical Outcome of Vasculitis

Indirect immunofluorescence (IIF) is an excellent technique for screening the presence of ANCAs while other methods such as anti-PR3 and anti- MPO by ELISA or microparticles assays are required for confirmation.
...

References

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Any report of positive neutrophil fluorescence issued before the ELISA results are available should indicate that positive fluorescence alone is not specific for the diagnosis of Wegener granulomatosis or microscopic polyangiitis and that decisions about treatment should not be based solely on the ANCA results.

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Issues of ANCA detection are reviewed, areas of uncertainty are identified, and practical guidelines where possible are provided where possible.

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While maintaining maximal diagnostic accuracy, significant labor savings are achieved by screening for WG/MPA by ELISA followed by confirmatory IIF, which has the highest sensitivity and specificity.

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It is postulate that ANCA as detected by these newer ANCA tests may replace the need to perform indirect immunofluorescence-based assays and classify patients according to their clinical subtype, since genetics, clinical manifestations and response to therapy are more related to ANCA serotype than to clinical sub type.

Using antineutrophil cytoplasmic antibody testing to diagnose vasculitis: can test-ordering guidelines improve diagnostic accuracy?

A positive result on an enzyme-linked immunosorbent assay ANCA test is not a definitive diagnostic indicator of AAV, but compliance with guidelines for ANCA testing would decrease the number of false-positive results and has the potential to reduce total test expenditures.

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  • Medicine, Biology
    Cleveland Clinic Journal of Medicine
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Overall, ANCA is an important diagnostic and prognostic marker for small-vessel vasculitis and warrants further investigation.

Automated interpretation of ANCA patterns - a new approach in the serology of ANCA-associated vasculitis

Pattern recognition algorithms can assist in the automated interpretation of ANCA IIF, and automated reading of ethN and formN IIF patterns demonstrated high consistency with visual ANCA assessment.

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A divergence in the disease spectrum between PR3- and MPO-ANCA-positive patients is found, characterized by higher DEI and extrarenal manifestations in the PR3 -ANCA group.
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