Journal of Clinical Immunology

, Volume 25, Issue 3, pp 202–208

Evaluation of a New Fluorescent-Enzyme Immuno-Assay for Diagnosis and Follow-up of ANCA-Associated Vasculitis

  • J. G. M. C. Damoiseaux
  • M. C. Slot
  • M. Vaessen
  • C. A. Stegeman
  • P. Van Paassen
  • J. W. Cohen Tervaert
Article

DOI: 10.1007/s10875-005-3863-2

Cite this article as:
Damoiseaux, J.G.M.C., Slot, M.C., Vaessen, M. et al. J Clin Immunol (2005) 25: 202. doi:10.1007/s10875-005-3863-2

Abstract

In this study we have evaluated a new, fully automated fluorescent-enzyme immuno-assay (FEIA) for detection and quantification of anti-PR3 and anti-MPO ANCA in diagnosis and follow-up of ANCA-associated small vessel vasculitis (AAV). PR3- and MPO-ANCA were determined by FEIA technology in (1) sera of 87 consecutive patients with biopsy-proven, pauci-immune necrotizing crescentic glomerulonephritis (NCGN) and 72 controls; (2) 120 sera (60 patients with Wegener’s granulomatosis and 60 controls) that were previously used in a multicentre comparison of direct and capture ELISAs for PR3-ANCA; (3) in samples preceding relapse in 23 PR3-AAV patients with and 23 matched PR3-AAV patients without relapse for prediction of relapses. PR3- and/or MPO-ANCA detection in pauci-immune NCGN by FEIA revealed an overall sensitivity of 82.8%. The FEIA specificity was 96% and 100% for PR3- and MPO-ANCA, respectively. The overall sensitivity of MPO- and PR3-ANCA could be increased to 88.5% by lowering the cut-off values without affecting the specificity (ROC-curve analysis), which is similar to a multistep ANCA procedure that combines indirect immunofluorescence with direct and capture ELISAs. The sensitivity for Wegener’s granulomatosis (WG) of the PR3-ANCA FEIA (60%) was more comparable to direct ELISAs (64%) than to capture ELISAs (74%). A rise of 100% in ANCA level as measured by FEIA appeared optimal (ROC-curve) for prediction of relapses and such a rise was observed in 26 patients. In 18 of these 26 patients the rise was followed by a relapse (PPV 69%), whereas in 15 of the 20 patients without a rise no relapse was observed (NPV 75%). In conclusion, detection of PR3- and MPO-ANCA by FEIA has excellent performance in terms of diagnosis of AAV patients. Furthermore, detection of rises in PR3-ANCA by FEIA for prediction of relapses gives results comparable to other techniques.

Key Words

ANCAfluorescent-enzyme immuno-assaymyeloperoxidaseproteinase 3vasculitis

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • J. G. M. C. Damoiseaux
    • 1
    • 3
  • M. C. Slot
    • 1
  • M. Vaessen
    • 1
  • C. A. Stegeman
    • 2
  • P. Van Paassen
    • 1
  • J. W. Cohen Tervaert
    • 1
  1. 1.Department of Clinical and Experimental ImmunologyUniversity Hospital MaastrichtThe Netherlands
  2. 2.Department of NephrologyUniversity Hospital GroningenThe Netherlands
  3. 3.Department of Clinical and Experimental ImmunologyUniversity Hospital MaastrichtAZ MaastrichtThe Netherlands