High incidence of type II autoantibodies in pernicious anaemia.

AIMS: To investigate the incidence of type II autoantibodies to intrinsic factor in pernicious anaemia. METHODS: Three hundred and forty four serum samples submitted for intrinsic factor antibody (IFAB) analysis on clinical or laboratory grounds were tested by an established radioassay and a new enzyme linked immunosorbent assay (ELISA) method for type I and total IFAB, respectively. Sixty of these were found to be positive by ELISA; this method was used to test further, 40 samples of adequate volume for types I and II antibodies. RESULTS: Type II antibodies were detected in 39 of the 40 sera tested. A comparative analysis indicated that seven samples contained pure type II antibody, being positive for total and type II by ELISA, but negative for type I by both the ELISA and radioassay technique. CONCLUSIONS: The occurrence of type II antibody, both alone and in combination with type I, seems to be more common than has previously been recognised, and emphasises the advantage of using a technique which will detect both types of antibody.     

Anomalous reactions in the haemagglutination assay for anti-collagen antibodies: studies on patients with rheumatoid arthritis or chronic low back pain

Sera from 23 patients with chronic low back pain, 20 rheumatoid patients and 16 normal controls were tested for antibodies to collagen types I, II and III, both native and denatured, by haemagglutination. Weak reactions against denatured collagen types I and II were found in 30-40% of the sera. Sera from individuals with rheumatoid arthritis or chronic low back pain behaved similarly, while only one normal serum showed any positive reaction. Reactions to denatured collagen type III and to native collagen of all 3 types were largely negative. Non-antibody serum components were thought to be responsible for these haemagglutination reactions since weakly positive reactions were abolished by cryoprecipitation and could not be confirmed by a solid-phase fluorimetric assay. Using the latter technique sera from 62 rheumatoid patients were screened for antibodies to type II collagen (native and denatured) and only one positive serum found. We conclude that haemagglutination is subject to false positive reactions and that the incidence of anticollagen antibodies in sera from patients with rheumatoid arthritis or chronic low back pain is low.     

Platelet antibody screening by flow cytometry is more sensitive than solid phase red cell adherence assay and lymphocytotoxicity technique: a comparative study in Thai patients

The objective of this study was to compare the sensitivity and specificity of lymphocytotoxicity test (LCT), solid phase red cell adherence assay (SPRCA) and flow cytometry in detecting platelet reactive antibodies against human leukocyte antigens (HLA) class I and human platelet antigens (HPA). Sera from 38 thrombocytopenic patients and 5 mothers of thrombocytopenic newborns were screened for platelet reactive antibodies by these three methods using screening platelets and/or lymphocytes panels derived from six subjects. The sensitivity and specificity of each method and levels of agreement were analysed. HLA antibodies were found in 18, 17 and 19 out of 43 patients' sera tested by LCT, SPRCA and flow cytometry, respectively. Four out of 43 patients' sera were reactive against HPA by flow cytometry, but were reactive to only 2 sera by SPRCA. Using flow cytometry as the reference method, the sensitivities/specificities of SPRCA and LCT in HLA antibody detection were 84.21/95.83% and 94.73/100%, respectively, with a good strength of agreement. SPRCA had 50% sensitivity and 100% specificity in HPA antibody detection compare to flow cytometry. Flow cytometry appeared to be the most sensitive technique compared with SPRCA and LCT for both HPA and HLA antibody screening. SPRCA sensitivity was too low for HPA antibody detection, but this might be because of the small number of samples. There was one serum from the mother of a baby suffering neonatal alloimmune thrombocytopenia (NAIT), in whom SPRCA could not detect HPA antibodies, while flow cytometry came out positive. Therefore, SPRCA should not be used in NAIT investigation and flow cytometry should be employed instead.     

Studies on the neutralizing antibody to herpes simplex virus

Summary A quantitative analysis was carried out on type specific antibody developed in rabbits primed with three doses of one type of herpes simplex virus at two week intervals, followed by administration of another type of virus. Complement-requiring neutralizing antibody assay and mutual absorbing methods were used. The homotype specific antibody produced against the type of virus used for priming persisted at a constant level for a long period, despite the lack of antigenic stimuli by the same type after priming. The homotype specific antibody was not affected by the heterotypic antigenic stimuli. On the other hand, the heterotype specific antibody developed after the first or second injection of heterotypic virus, and the titer tended to decline, reaching undetectable levels at 9 months. However, the heterotype specific antibody was produced rapidly after the third injection of virus at 9 months and the titers exceeded or closed to those of the homotype specific antibody. The homotype specific antibodies were mainly distributed in the IgG fraction, while the IgM fraction contained mainly the heterotype specific antibodies. In the relationship between type specific antibody response and the values of II/I index, the coexistence of both type specific antibodies was apparent in sera with the values of 91 to 117 of II/I index and in the IgG fraction with the values of 90 to 115, respectively.With 2 Figures     

Efficiency of various serological techniques for diagnosing Coxiella burnetii infection

An indirect immunofluorescence assay (IFA) using a recently developed commercial kit for detecting antibodies against Coxiella burnetii (C.b.), the etiological agent of Q fever, has been evaluated using human field serum samples. The IFA was compared with an ELISA and a complement fixation test (CFT). The IFA was based on the corpuscular C.b. phase I and phase II antigens specific to anti-C.b. phase I and II antibodies, respectively. Fifty sera from persons with symptoms of Q fever were examined in this study. The IFA compared with the ELISA showed the sensitivities of 97.7% and 87.2% for IgG and 66.7% and 60.0% for IgM phase II and I antibodies, respectively and the specificities of 100% and 90.0% for IgG and 75.9% and 64.7% for IgM phase II and phase I antibodies, respectively. Due to a limited number of sera positive in the IgA antibody testing, the data presented should be considered with caution. It appears that the IFA strikes a very good balance between high specificity and sensitivity with phase II and phase I IgG antibodies and a less satisfactory one with IgM antibodies. The CFT failed in one of the above aspects showing a good specificity but a poor sensitivity, especially for phase I antibodies. The study demonstrated that the IFA is suitable for diagnosing Q fever and its therapeutic follow-up and is a good candidate for screening sera in large numbers. A certain limitation, especially in testing early stages of the chronic disease, could be a low fluorescence intensity of the IgA positive control in comparison with the IgA negative one.     

Comparison between indirect immunofluorescence and microneutralization for detection of antibodies to polioviruses.

Indirect immunofluorescence and microneutralization methods for the detection of antibodies to poliovirus serotypes 1, 2, and 3 were compared. Of the 41 sera tested for poliovirus type 1 antibody, 40% were in complete agreement, 55% differed by one dilution, and 5% differed by two dilutions. For poliovirus type 2, 37 sera were tested; 56% completely agreed, and 44% differed by only one dilution. For poliovirus type 3, complete agreement occurred in 59% of 33 sera, while 41% differed by one dilution. No false-negative results were obtained. These findings suggest that indirect immunofluorescence for poliovirus types 1, 2, and 3 is as sensitive as the microneutralization method and could represent a less cumbersome alternative.     

Enzyme-linked immunosorbent assay for titration of Haemophilus influenzae capsular and O antigen antibodies.

The enzyme-linked immunosorbent assay (ELISA) was elaborated for the detection of immunoglobulin M (IgM) and IgG antibodies against capsular and O antigens of Haemophilus influenzae. Purified capsular polysaccharide and lipopolysaccharide were used as antigens, with optimal coating concentrations being about 50 and 100 micrograms/ml, respectively. The antibody content was expressed as the highest serum dilution (-log10) showing an absorbance of 0.2 above the background level. The titers of hyperimmune sera (reference sera) ranged between 5 and 7 -log10. The sensitivity of the method was about 80 ng/ml with regard to anticapsular antibodies and 3 to 5 ng/ml with regard to anti-lipopolysaccharide antibodies. For detection of antibodies against capsular polysaccharide in sera obtained after primary immunization, ELISA was about 100-fold more sensitive than the indirect hemagglutination assay, whereas in hyperimmune sera, ELISA was about 10-fold more sensitive than the indirect hemagglutination assay. The sensitivity of ELISA for detecting anticapsular antibodies after primary and booster immunizations was 50-fold higher than that of the bactericidal assay using capsulated bacteria, whereas the sensitivity of the two methods was the same when hyperimmune sera were tested. ELISA performed with lipopolysaccharide as the antigen was about 50- and 150-fold more sensitive than the complement fixation and bactericidal assays tested with noncapsulated variants after primary injection and hyperimmunization, respectively.     

A radioimmunoassay for serum and gingival crevicular fluid antibodies to a purified protein of Streptococcus mutans.

A solid-phase radioimmunoassay was developed to measure serum IgG antibodies to a purified protein antigen I/II prepared from Streptococcus mutans. The assay was specific to this antigen and significant binding of 125I-radiolabelled antiserum was found only in sera from rhesus monkeys immunized with the antigen I/II but not in sham-immunized monkeys or those immunized with streptococcal antigen III. A very significant correlation was found in serum IgG antibodies tested by the radioimmunoassay and an immunofluorescent technique (r = 0.88, P less than 0.001). The sensitivity of the double-layer radioimmunoassay was increased 10 times by the addition of a third antibody layer and this enabled gingival crevicular fluid antibodies to be measured. Comparison of paired samples of serum and crevicular fluid revealed a very significant correlation between IgG antibodies to streptococcal antigen I/II in the the two fluids (P less than 0.001). These findings suggest that serum antibodies can reach the tooth surface via gingival crevicular fluid.     

Comparison of various serological methods and diagnostic kits for the detection of acute, recent, and previous rubella infection, vaccination, and congenital infections

The antibody development after natural rubella infection and rubella vaccination has been followed in 802 sera from 493 patients and 71 sera from 22 vaccinees. Also examined were 67 sera from 28 infants with rubella embryopathy and sera from 50 children with presumed prenatal infection. In addition, 777 sera from 641 patients tested for routine rubella diagnosis were studied. Anamnestic information was available from all these patients. These sera were assayed for IgM antibody detection by sucrose density gradient (SDG), the commercial ELISAs (Enzygnost IgM and Rubazyme M), and the non-commercial anti-my-hemadsorption immunosorbent technique (HIT). For the determination of IgG antibodies the hemagglutination inhibition test (HAI), the commercial ELISAs (Enzygnost IgG, Rubazyme), and a single radial hemolysis test (SRH) were used. The SDG and HIT were less sensitive for IgM antibody detection than the two ELISAs, particularly when IgM concentrations were low. In total 26.5% of the IgM results with the newer tests were discordant with SDG, but only 0.5-1.3% of these results were not explicable when the clinical data was considered. Problems were encountered with all IgM assay systems used. For the detection of rubella antibodies after acute infection and vaccination the ELISA Enzygnost IgG was as sensitive as the HAI whereas the ELISA Rubazyme and SRH detected antibodies with some delay. Corresponding results with all tests were found more than 25 days after acute infection and more than 50 days after vaccination. All methods can be used for detection of antibodies in infants with rubella embryopathy. The results of this study suggest that certain combinations of tests can be used for the reliable detection of rubella infection.     

Techniques for typing Herpesvirus hominis antibody: a comparison of inhibition of peroxidase-labelled antibody staining with inhibition of indirect haemagglutination and with microneutralisation.

A new technique based upon the inhibition of the peroxidase-labelled antibody staining (PLAS) has been used to type Herpesvirus hominis (HVH) antibodies in four groups of human sera taken from patients with one or both types of HVH infection and in mixtures of different proportions of type 1 and type 2 antisera. The results were compared with those of the microneutralisation (MN) test and the indirect haemagglutination (IHA) inhibition test. The sensitivity and specificity of the three methods were identical for sera containing only one type of HVH antibody. The MN test was slightly more sensitive than the other tests for detecting small amounts of HVH-1 antibody mixed with large amounts of HVH-2 antibody. Nevertheless, the PLAS inhibition technique was far more rapid and it would seem a satisfactory alternative to the IHA inhibition test for HVH antibody typing.     

Detection of cytomegalovirus antibodies by an enzyme-linked immunosorbent assay using recombinant polypeptides of the large phosphorylated tegument protein pp150.

Parts of the large phosphorylated tegument protein, pp150, of human cytomegalovirus (HCMV) were expressed in bacteria. The resulting fusion proteins were tested in a Western blot (immunoblot) assay for reactivity with a monoclonal antibody against pp150, with a polyspecific rabbit antiserum, and with human reconvalescent-phase sera. Those fusion proteins that performed well in the Western blot assay were used as antigens in enzyme-linked immunosorbent assays (ELISAs) for the detection of antibodies against HCMV. Five different recombinant beta-galactosidase fusion proteins were evaluated by ELISA using 62 seropositive and 38 seronegative human serum samples. Of all the proteins tested, one peptide representing 162 amino acids of pp150 was superior to the others with regard to sensitivity and specificity. All sera known to be positive for antibodies against HCMV were identified by combining the results of the ELISAs with the different pp150 fusion proteins. Therefore, it appears that peptides from a single protein of HCMV might be sufficient to identify HCMV-seropositive individuals by recombinant ELISA.     

Enzyme-linked immunosorbent assay for group B streptococcal antibodies.

We report here on the development of enzyme-linked immunosorbent assays (ELISAs) for antibodies to types II and III group B streptococci. Streptococcal antigens were prepared by trichloroacetic acid extraction and fractional alcohol precipitation. Microtiter wells were coated with antigen in 0.1 M carbonate buffer at pH 9.6. Lyophilization was found to be an essential step for efficient binding of the streptococcal antigens. After incubation with antibody-containing rabbit serum, bound antibody was detected with peroxidase-labeled goat anti-rabbit immunoglobulin G. Optimal antigen concentrations were 200 micrograms/ml for type II and 100 micrograms/ml for type III. An ELISA is also described that uses intact bacteria as antigen. Hyperimmune rabbit serum reacted at a titer in excess of 512 against trichloroacetic acid-soluble antigen and 4,096 against whole bacteria. Sera from human subjects were also tested. Most human sera contained antibody which bound to intact bacteria but not to trichloroacetic acid-solubilized streptococcal antigens. Antibody titers in human sera against intact bacteria correlated very well with opsonic antibody activity measured in a chemiluminescence assay.     

Determination of anti-neutrophil cytoplasm antibodies (ANCA) specificity by immunofluorescence on chronic myelocytic leukemia cells.

ANCA positive sera, detected by the standard immunofluorescence method, derived from 37 patients with vasculitis were studied using formalin-acetone fixed chronic myelocytic leukemia cells (CML). All 37 sera were positive on CML cell smears. Furthermore formalin-actone fixation selectively impaired antinuclear antibody binding without reducing ANCA staining and thus facilitated differentiation of these autoantibodies which is often difficult with the standard immunofluorescence method. Two unequivocal and mutually exclusive ANCA binding patterns were identified using the CML smears: (1) type I with diffuse granular binding confined to the polymorphonuclear (PMN) cell lineage and preferentially staining immature cells; (2) type II with similar binding to the PMN cell lineage and, in addition, granular staining of the basophils. All type I antibodies were associated with a c-ANCA pattern suggesting that the major antigen recognized by these antibodies, recently identified as proteinase 3, is not detectable in basophils. The type II pattern was detected in both p-ANCA (84%) and c-ANCA (16%) positive sera. The type I sera remained positive on PMN cells from a myeloperoxidase (MPO) deficient subject and anti-MPO antibodies could not be detected in this group by ELISA. Conversely the type II pattern occurred in the presence of anti-MPO antibodies identified by immunofluorescence, ELISA and dot-blot with the exception of a single serum with antilactoferrin antibody. Type I binding only was observed in Wegener's granulomatosis (WG) but both patterns were found in microscopic polyarteritis (MPA) and rapidly progressive glomerulonephritis (RPGN).     

Anti-idiotypic antibody against anti-DNA in sera of laboratory personnel exposed to lupus sera or nucleic acids.

We tested for anti-DNA, anti-idiotypic, antinuclear, and lymphocytotoxic antibodies in the sera of three groups of normals: volunteers never exposed to lupus sera or nucleic acids (group I), research personnel handling nucleic acids (group II), and laboratory personnel handling lupus sera (group III). There was no significant differences among the groups with respect to levels of either single stranded or double stranded anti-DNA. Group I showed no significant differences in binding to F(ab')2 fragments of lupus anti-DNA, lupus non-anti-DNA or normal IgG. Compared to group I, groups II and III bound significantly higher to anti-DNA F(ab')2 fragments compared to non-anti-DNA F(ab')2 or normal F(ab')2 fragments. Sera from the three groups were negative for antibodies and all but one individual from group III had normal antinuclear antibody titres. These results indicate that sera of normals exposed to lupus sera or to nucleic acids contain an anti-idiotype directed against anti-DNA antibody. The possible role of these anti-idiotypes in regulating the anti-DNA antibody is discussed.     

Low prevalence of GAD and IA2 antibodies in schoolchildren from a village in the southwestern section of the Netherlands

Glutamic acid decarboxylase (GAD) and insulinoma antigen 2 (IA2) antibodies are increasingly used as a tool to predict type I diabetes in children and as a differential diagnostic tool to distinguish type I and type II diabetes in adults. However, the background frequency of these antibodies in the general population has not been extensively studied and may differ between countries. The current study aims to establish the frequency of GAD and IA2 antibodies in an unselected population of schoolchildren and confirm the previously reported low prevalence of islet cell antibodies (ICA) in the general Dutch population. The study population consisted of 1403 unselected schoolchildren. All children were tested for GAD antibodies, and 1085 children were analyzed for IA2 antibodies by radiobinding assay. Development of diabetes was recorded during a 7-year follow-up. Five children (0.4%) were positive for GAD antibodies, one child (0.1%) was positive for IA2 antibodies. Two children developed diabetes during follow-up, one was positive for GAD antibodies only, the second was positive for both GAD and IA2 antibodies. The frequency of GAD and IA2 antibodies in the southwestern part of The Netherlands is low. This observation is in concordance with earlier studies on ICA in Dutch schoolchildren. For future diabetes prediction and intervention trials it is important to establish the background frequencies and predictive power of antibody screening in different populations.     

Relationship between type specific antibodies to herpes simplex virus and type specificity in human sera

A quantitative analysis was carried out on the relationship between type specific neutralizing antibodies to herpes simplex virus and the type specificity, using a mutual absorbing procedure. Forty-two samples were selected among human sera, on the basis of type specificity expressed by the value of II/I index. All sera with values of less than 90 of II/I index contained only type 1 specific antibody, while those with values over 111 contained only type 2 specific antibody. When the values were between 90 and 110, type 1 specific antibody was present in all, and type 2 specific antibody was present in some serum samples.     

Comparison of immunoperoxidase staining with indirect immunofluorescence, ELISA, and Western blotting assays for detecting anti-HTLV-I antibodies in systemic lupus erythematosus.

Serum antibodies against human T cell leukaemia virus type I (HTLV-I) were investigated in 12 patients by four methods: indirect immunoperoxidase staining, indirect immunofluorescence, enzyme linked immunosorbent assay (ELISA), and strip radioimmunoassay based on the Western blotting assay. Seven patients had systemic lupus erythematosus (SLE) and five various autoimmune diseases with one or more circulating autoantibodies. Serum samples from three patients were found to be HTLV-I-positive by the ELISA assay and sera from five patients showed a non-specific reaction by indirect immunofluorescence. These sera were negative when tested by indirect immunoperoxidase staining and Western blotting assay. All four methods gave positive results when tested with samples from 19 HTLV-I carriers and 16 patients with adult T cell leukaemia. Indirect immunoperoxidase staining and Western blotting assay are probably useful and more specific assays for the detection of anti-HTLV-I antibodies in samples from patients with autoimmune diseases.     

Donor-specific HLA class I and CREG antibodies in complement-dependent cytotoxicity-negative renal transplants

Development of a solid-phase, single antigen panel reactive antibody test (SA-PRA) permits the analysis of antibody specificities. This study determined the impact of donor-specific antibodies (DSA) against class I HLA private antigens (DS-HLA) or HLA-A and -B cross-reactive group (DS-CREG) in kidney transplantation. Pre- and post-transplant sera of 133 renal allograft patients who had negative pretransplant complement-dependent cytotoxicity were tested for HLA class I antibody specificities by SA-PRA. Clinical relevance of the flow cytometric crossmatch test (FCXM) for the detection of class I DS-HLA or DS-CREG was analyzed. The sensitivity of FCXM to detect SA-PRA-defined class I DSA was 50% (5/10) and the specificity was 98.4% (121/123). Of 133 renal allograft recipients, including 26 patients with biopsy-proven acute antibody-mediated rejection (AMR), pretransplant DS-HLA or DS-CREG were detected in 10 patients. Pretransplant DSA were associated with AMR (p = 0.012) and a low calculated glomerular filtration rate (p = 0.036). In the analysis of post-transplant sera, the presence of either type of HLA antibodies and the de novo development of DSA were correlated with AMR (p <0.001). This study demonstrates that detection of DSA, including DS-HLA and DS-CREG, using the SA-PRA assay is useful to identify the renal allograft recipients with poor transplant outcome.     

A simple and rapid immunochromatographic strip test for detecting antibody to porcine reproductive and respiratory syndrome virus

Porcine reproductive and respiratory syndrome is rapidly gaining worldwide importance as one of the most economically significant diseases of swine. The antibody of Porcine reproductive and respiratory syndrome virus (PRRSV) is detected currently by the combined use of an enzyme-linked immunosorbent assay, serum neutralization test, immunoperoxidase monolayer assay, indirect immunofluorescent antibody test. These methods are time-consuming and require specialized equipment operated by trained technicians. The purpose of this study was to evaluate a simple strip assay (based on a chromatographic and immunogold system) for specific detection of PRRSV antibody in swine sera. This "immunochromatographic strip" test uses Escherichia coli-expressed viral recombinant membrane protein antigen in combination with recombinant nucleocapsid protein as capture protein for detecting antibodies against PRRSV. In this study, the performance of this assay was evaluated with sera from both clinical samples and experimentally infected piglets. Detection by immunochromatographic strip test was compared with detection by a standard, available commercially, indirect enzyme-linked immunosorbent assay and an immunoperoxidase monolayer assay. The immunochromatographic test strip detected antibodies in sera known to contain antibodies to PRRSV in 95.7% sensitivity of samples from pigs infected experimentally and 98.6% sensitivity of clinical serum samples. For sera that did not contain antibodies to PRRSV, the specificity was 97.8% and 98.2% for clinical and experimental serum samples, respectively.     

Use of immunoblotting to characterize the mitochondrial antigens recognized by anti-mitochondrial autoantibodies

Sera with anti-mitochondrial autoantibodies detected by indirect immunofluorescence and/or enzyme-linked immunosorbent assay (ELISA) were examined by immunoblotting against pig heart mitochondria. Seven types of reactions were defined, according to the pattern of the labelled bands. Type I sera reacted with 12 bands located within four zones. The most intensively labelled bands were located at 70, 67, 58, 63 and 43 kDa. Other types gave decreasing band numbers. When beef heart mitochondria were used, sera belonging to each of the above types had a profile of labelled bands which sometimes differed from those obtained with pig heart mitochondria. When the chloroform extracted F1-ATPase from beef heart mitochondria was used to prepare the immunoblots, primary biliary cirrhosis (PBC) sera with anti-mitochondria antibodies reacted with all the bands although zone A bands were less labelled. Rat liver mitochondria gave seven bands with type I sera among which the 57 and 35 kDa bands were specific for rat liver mitochondria, as shown by absorption tests. Sera of PBC patients were also tested in immunoblotting against rat liver subcellular fractions including mitoplasts, submitochondrial particles, inner membrane, outer membrane, matrix proteins and inter-membrane proteins. Antigenic bands of A and B zones were localized in the inner membrane and/or in the matrix proteins and the 35 kDa band in inter-membrane proteins. The outer membrane gave no reaction. The most frequent anti-mitochondrial autoantibody types in PBC were type II, then I, whilst for chronic active hepatitis type III was the most common. Type V was only seen in a patient suffering from a typical PBC. Some sera from patients with syphilis, collagenous colitis or progressive systemic sclerosis labelled one or two bands distinct from those labelled by the PBC sera. Sera from patients with drug-induced hepatitis with endoplasmic reticulum antibodies and with systemic lupus erythematosus were generally found negative by immunoblotting.