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Laboratory and clinical practices in antinuclear antibody detection and related antigens: recommendations from a Spanish multicentre survey

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Abstract

Antinuclear antibodies (ANA) are the most widely used immunological test for the diagnosis of autoimmune diseases. Despite the recommendations of experts, there is some variability in performing and interpreting this test in routine practice. In this context, the Spanish Group on Autoimmune Diseases (GEAI) of the Spanish Society of Immunology (SEI) conducted a national survey of 50 autoimmunity laboratories. Here we report the survey results on ANA testing, detection of related antigens, and our recommendations. The survey showed that most of the participating laboratories use a similar approach for most key practices: 84% perform ANA by indirect immunofluorescence (IIF) on HEp-2 cells as the screening methodology while the other laboratories use IIF to confirm positive screens; 90% report ANA test results as either negative or positive with titer and pattern; 86% indicated that the ANA pattern conditioned follow-up testing for specific antigen-related antibodies; and 70% confirm positive anti-dsDNA. However, testing practices were highly heterogeneous for certain items, such as sera dilutions and the minimum time period for repeating ANA and related antigen determinations. Overall, this survey shows that most autoimmune laboratories in Spain use a similar approach but that further standardization of testing and reporting protocols is needed.

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Data Availability

The data presented in this study are available on request from the corresponding author.

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Acknowledgements

We would like to thank the survey participants: Cristina Abad Molina (H. Clínico Univ. de Valladolid, Valladolid); Aránzazu Alfranca (H. de La Princesa, Madrid); Delia Almeida (H. Univ. Nuestra Señora de Candelaria, Santa Cruz de Tenerife); Mª José Amengual (Corporació Sanitàra Parc Taulí, Sabadell); Belén Aparicio (Comp. Asist. Univ. de Salamanca, Salamanca); Rosario Caro Narros (Comp. Asist. de Segovia, Segovia); Clara Esteve Cols (CLILAB Diagnòstics, Vilafranca del Penedés); Mireia Fonolleda Ramboux (CATLAB, Viladecavalls); Concepción González (H. Univ. Virgen Macarena, Sevilla); Nicolás Adolfo Guerrero Navarrete (Comp. Asist. de Zamora, Zamora); Carlos Hierro Delgado (Comp. Asist. de Ávila, Ávila); María Imaz (H. Univ. de Basurto, Bilbao); Laura Jaimez (H. Univ. Virgen de las Nieves, Granada); Montaña Jiménez (H. Virgen del Puerto de Plasencia, Plasencia); Rosa Julià (H. Univ. Son Espases, Palma de Mallorca); Nallibe Lanio (H. Juaneda Miramar de Palma, Palma de Mallorca); Marcos López Hoyos (H. Univ. Marqués de Valdecilla, Santander); Isabel Lorenzo Romo (H. Univ. Rio Hortega, Valladolid); Mª José Martínez Becerra (Fundación Jiménez Díaz, Madrid); Alba Martínez Chamorro (H. Univ. de Jaén, Jaén); Anaís Mariscal (H. Santa Creu i Sant Pau, Barcelona); Pedro Martínez (H. Univ. Virgen de la Arrixaca, Murcia); Juana María Merino Roncal (Clínica Univ. de Navarra, Navarra); Francisco Morandeira Rego (H. Univ. de Bellvitge, Hospitalet de Llobregat); Lourdes Mozo (H. Univ. Central de Asturias, Oviedo); M. José Muñoz- Delgado Mérida (Comp. Asist. de Soria, Soria); Pilar Nozal (H. Univ. la Paz, Madrid); Juliana Lucía Ochoa Grullón (H. Clínico San Carlos, Madrid); Jesún Ontañón (Complejo H. Univ. de Albacete, Albacete); Mª Aránzazu Pacho de Lucas (H. Univ. Cruces, Baracaldo); Jaume Pérez (H. Clínico de Valencia, Valencia); Aresio Plaza (H. Puerta de Hierro, Madrid); Enriqueta Preciado San Miguel (H. Univ. Araba, Vitoria); Bibiana Quirant (H. Germans Trial y Pujol, Badalona); Carmen Rodríguez (H. Univ. Puerta del Mar, Cádiz); Beatriz Sacristán (H. de Mérida, Mérida); Mª Teresa Sanz (H. Univ. Vall d' Hebron, Barcelona); Antonio Serrano (H. Univ. 12 Octubre, Madrid); Pilar Timoneda (Consorci H. General Univ. de València, València); Vicente Villamandos Nica (H.l Univ. de Burgos, Burgos); and Mª José Zaro (H. Don Benito- Villanueva, Don Benito).

Author information

Authors and Affiliations

  1. Immunology Department, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, C/Sant Antoni M Claret 167, 08025, Barcelona, Spain

    Laura Martinez-Martinez

  2. Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain

    Laura Martinez-Martinez

  3. Immunology Department, University Hospital Marqués de Valdecilla, Santander, Spain

    Juan Irure-Ventura

  4. Transplantation and Autoimmunity Laboratory, Research Institute “Marqués de Valdecilla” (IDIVAL), Santander, Spain

    Juan Irure-Ventura

  5. UGC Inmunología-Alergología, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital of Cordoba, Córdoba, Spain

    Aurora Jurado

  6. Immunology Department, Hospital Universitario Ramón Y Cajal, IRYCIS, Madrid, Spain

    Garbiñe Roy

  7. Immunology Department, Hospital Universitario Virgen del Rocío (IBiS, CSIC, US), Seville, Spain

    Marco Antonio Montes & Beatriz Rodríguez-Bayona

  8. Immunology Laboratory, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain

    Yvelise Barrios

  9. Immunology and Genetics Unit, Complejo Hospitalario Universitario de Cáceres, Cáceres, Spain

    Esther Vergara

  10. Immunology Laboratory, Hospital Universitario Donostia, Donostia, San Sebastián, Spain

    Álvaro Prada

  11. Immunology Unit, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain

    Ricardo Rojo

  12. Immunology and Genetics Department, Hospital Universitario de Badajoz, Badajoz, Spain

    María Luisa Vargas

Authors
  1. Laura Martinez-Martinez
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  2. Juan Irure-Ventura
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  3. Aurora Jurado
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  4. Garbiñe Roy
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  5. Marco Antonio Montes
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  6. Yvelise Barrios
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  7. Beatriz Rodríguez-Bayona
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  8. Esther Vergara
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  9. Álvaro Prada
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Consortia

on behalf of the GEAI-SEI

  • Cristina Abad Molina
  • , Aránzazu Alfranca
  • , Delia Almeida
  • , Mª José Amengual
  • , Belén Aparicio
  • , Rosario Caro Narros
  • , Clara Esteve Cols
  • , Mireia Fonolleda Ramboux
  • , Concepción González
  • , Nicolás Adolfo Guerrero Navarrete
  • , Carlos Hierro Delgado
  • , María Imaz
  • , Laura Jaimez
  • , Montaña Jiménez
  • , Rosa Julià
  • , Nallibe Lanio
  • , Marcos López Hoyos
  • , Isabel Lorenzo Romo
  • , Mª José Martínez Becerra
  • , Alba Martínez Chamorro
  • , Anaís Mariscal
  • , Pedro Martínez
  • , Juana María Merino Roncal
  • , Francisco Morandeira Rego
  • , Lourdes Mozo
  • , M. José Muñoz- Delgado Mérida
  • , Pilar Nozal
  • , Juliana Lucía Ochoa Grullón
  • , Jesún Ontañón
  • , Mª Aránzazu Pacho de Lucas
  • , Jaume Pérez
  • , Aresio Plaza
  • , Enriqueta Preciado San Miguel
  • , Bibiana Quirant
  • , Carmen Rodríguez
  • , Beatriz Sacristán
  • , Mª Teresa Sanz
  • , Antonio Serrano
  • , Pilar Timoneda
  • , Vicente Villamandos Nica
  •  & Mª José Zaro

Contributions

All authors were involved in revising intellectual content, and all authors approved the final version to be published. Study conceptualization, L.M.-M., A.J., G.R., M.A.M., E.V., A.P., R.R. and M.L.V.; Data curation, L.M.-M., J.I.-V., A.J., G.R., M.A.M., Y.B., B.R.B. and M.L.V.; Formal analysis, M.L.V.; Writing of original draft, L.M.-M., J.I.-V. and M.L.V.; writing review and editing, L.M.-M., J.I.-V., A.J., G.R., M.A.M., Y.B., B.R.B and M.L.V.

Corresponding author

Correspondence to Laura Martinez-Martinez.

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The authors declare no competing interests.

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Collaborating members of the GEAI-SEI group are listed in the Acknowledgements.

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Martinez-Martinez, L., Irure-Ventura, J., Jurado, A. et al. Laboratory and clinical practices in antinuclear antibody detection and related antigens: recommendations from a Spanish multicentre survey. Immunol Res 71, 749–759 (2023). https://doi.org/10.1007/s12026-023-09389-x

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