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Simple Summary: This study investigates the autoimmune effects of gold aurothiomalate (AuTM) exposure in genetically different mouse strains to understand how gold triggers autoimmune diseases. We focused on two strains, A.TL and A.SW, which share genetic similarities except for H-2-related genes. Here, we show that A.TL mice, when exposed to AuTM, developed specific immune responses, including increased levels of antinuclear antibodies (ANA) compared to A.SW mice. A.TL mice showed a particularly strong response, especially in females, resembling symptoms of human autoimmune diseases like lupus. These findings suggest that A.TL mice could be a valuable model for studying environment-induced autoimmunity, helping to explore the genetic mechanisms behind these conditions and potentially leading to improved diagnosis and treatment of autoimmune diseases in humans. To demonstrate causation or/and assess pathogenic mechanisms of environment-induced autoimmunity, various animal models that mimic the characteristics of the human autoimmune diseases need to be developed. Experimental studies in mice reveal the genetic factors that contribute to autoimmune diseases. Here, the immune response of two mouse strains congenic for non-H-2 genes, A.TL (H-2tl) and A.SW (H-2s), was evaluated after 15 weeks' exposure to gold aurothiomalate (AuTM). AuTM-treated A.TL mice showed anti-nuclear antibodies (ANA) with homogenous and/or fine speckled staining patterns and serum autoantibodies to ds-DNA, chromatin, histones, and ribonucleoproteins (RNP). Female A.TL mice showed a stronger immune response than males, as well as an increase of B cells in their spleen after 15 weeks of gold exposure. A.SW exposed for AuTM showed the induction of anti-nucleolar antibodies (ANoA) with a clumpy staining pattern, as well as an increase in splenic B and T cells. The serum autoantibodies levels in A.SW mice were limited compared to those of A.TL mice. Overall, A.TL presents a stronger immune response after gold exposure than A.SW. The immune response developed in A.TL presents similarities with the clinical manifestations in human autoimmune diseases. Thus, gold-exposed A.TL could constitute a potential experimental mouse model for the study of autoimmunity. [ABSTRACT FROM AUTHOR]

ObjectiveTo identify the target antigen of an anti-nuclear autoantibody (ANA) from a patient with a suspected systemic autoimmune disease and to study the autoantibody’s clinical association.MethodsThe index patient serum was screened for autoantibodies using indirect immunofluorescence assay (IFA) and line blots (membrane strips coated with parallel lines of different purified antigens). Immunoprecipitation with fixed HEp-2 cells followed by SDS-PAGE and MALDI-TOF mass spectrometry was used to identify the autoantigen, which was verified by competitive inhibition experiments, recombinant HEK293 cell-based IFA, and Western and line blots based on the recombinant antigen. The prevalence of autoantibodies against this antigen was studied in 693 patients with systemic autoimmune rheumatic diseases (SARD) and 150 healthy controls.ResultsThe index patient serum displayed a homogeneous nucleolar staining pattern on HEp-2 cells and monkey liver by IFA but did not react with 27 known nuclear antigens. Nuclear valosin-containing-protein-like (NVL) was identified as the ANA target antigen. Preincubation with recombinant NVL abolished the reactivity of the patient serum with HEp-2 cells in IFA. Additionally, the patient serum reacted with recombinant NVL in cell-based IFA and Western blot analysis, whereas sera from 15 healthy controls were nonreactive. Using line blots coated with recombinant NVL, anti-NVL autoantibodies were exclusively found in four out of 378 patients with systemic sclerosis, but neither in 315 patients with other SARD nor in 150 healthy controls.ConclusionThese findings indicate that autoantibodies against NVL may be a suitable marker to help narrowing the serological gap in systemic sclerosis.

Abstract Psoriasis is a chronic inflammatory disease that sometimes necessitates therapeutic intervention with biologics. Autoantibody production during treatment with tumor necrosis factor (TNF) inhibitors is a recognized phenomenon, however, the production of autoantibodies associated with antiphospholipid syndrome (APS) has not been comprehensively evaluated in patients with psoriasis. This study was conducted to assess the prevalence of APS-associated autoantibodies in patients with psoriasis treated with different biologics and to investigate the potential associations between autoantibody production and clinical or serological parameters. Patients with psoriasis undergoing biologics treatments were enrolled in this study, and were categorized based on the type of biologics administered, TNF, interleukin (IL)-17, or IL-23 inhibitors. Clinical and serological data were collected and analyzed in conjunction with data on APS autoantibodies. TNF inhibitors were associated with a higher frequency of APS autoantibodies compared to IL-17 and IL-23 inhibitors. Notably, the presence of APS autoantibodies correlated with concurrent arthritis and higher disease severity at treatment initiation in patients treated with TNF inhibitors. Elevated Psoriasis Area and Severity Index scores and anti-nuclear antibody titers higher than × 320 were predictors of APS autoantibody production. Despite the higher autoantibody rates, clinical symptoms of APS were absent in these patients. This study provides the first comprehensive evidence of an increased frequency of APS autoantibodies associated with TNF inhibitor treatment in patients with psoriasis. The observed association between APS autoantibody positivity and TNF inhibitor treatment or clinical parameters suggests a potential immunomodulatory interplay between autoimmunity and inflammation in the pathogenesis of psoriasis.

Objective This study aimed to establish a screening model for differentiating anti-synthetase syndrome (ASS) from other ANA-associated rheumatic diseases (AARDs) using a combination of cytoplasmic and non-cytoplasmic ANA (ncANA) patterns. Methods : This retrospective observational study included patients with AARDs such as SLE, SSc, SS, MCTD and PM/DM who underwent ANA screening between April 2012 and December 2021. Variables included age, sex, ANA patterns (Cytoplasmic and ncANA) and titres. Logistic regression analysis of Cytoplasmic and ncANA patterns was performed to differentiate ASS from other AARDs. Result : The 981 diagnosed cases of AARDs consisted of SS (n  = 451), SSc (n  = 264), SLE (n  = 201), PM/DM (n  = 104), MCTD (n  = 52) and ASS, including PM/DM (n  = 64). Of these, 155 patients had ≥2 overlapping diseases; however, there was no overlap between AARDs and ASS. ASS is more likely to occur when the cytoplasmic titre is positive and the ncANA <320. Receiver operating characteristic analysis of the Cytoplasmic and ncANA range revealed an area under the receiver operating characteristic curve of 0.885 (95% CI: 0.844–0.927). Conclusion : It is important to detect cytoplasmic patterns as an ANA screening test for ASS diagnosis, even if the titre is low. Additionally, combining the cytoplasmic and ncANA patterns yields more accurate ASS screening results. [ABSTRACT FROM AUTHOR]

Objective: To determine the rates of simultaneous antinuclear antibodies (ANA) screening and extractable nuclear antigen (ENA) testing that do not follow recommendations. Design, Setting, and Participants: Retrospective cohort study of adult patients (≥18 years) with a HEp-2 ANA or ENA ordered in the Marshfield Clinic Health System. Main Outcome(s) and Measure(s): Counts of patients having simultaneous ANA and ENA laboratory testing or ENA testing without ANA screening. Relevant ENA positivity in ANA negative patients. Secondary measures included relative timing of ANA and ENA ordering, potential cost savings of unnecessary testing, and provider ordering characteristics including specialty and provider type. Results: Of 58,627 cohort patients, 39,155 (66.8%) were women, and the mean (SD) age at first laboratory testing was 48.7 (19.0) years. The negative ANA with positive ENA rate was 2%. Further stratification identified only 23 diagnosed autoimmune connective tissue diseases (AI-CTDs) in this 2%, with a resulting negative ANA with relevant positive ENA rate of 0.37%. Simultaneous ANA and ENA testing occurred in 8.3% of patients, and an ENA only was ordered in 24.2% of patients. The simultaneous or non-sequential ordering of ANA and ENA testing resulted in significant health care costs of $2,293,251.80 over 20,112 unique patients. Conclusions and Relevance: A significant percentage of providers do not follow recommendations to sequentially order ANA and ENA testing on patients with suspected AI-CTDs. Significant saving in health care spending without failure to diagnose AI-CTDs can be achieved if ANA testing is performed first, followed by ENA testing when suspecting AI-CTDs in patients. [ABSTRACT FROM AUTHOR]

Diabetes mellitus (DM) is a group of physiological disorders characterized by a prolonged hyperglycemic state caused by insulin secretion and activity. Recently, several study positive correlations between the increase in BMI and T2D. Additionally, the immune system has contributed to the pathogenicity of T2D in obese individuals. The current study sought to investigate the correlation between obesity and inflammation in obese T2D and obese non-T2D individuals and also detected the role of increasing BMI in obese individuals and developing T2D. The finding involved 100 participants (50 obeseT2D and 50 obese without T2D). The serum of all participants underwent the following immunological and biochemistry tests, which include FBS, Insulin, IAA, ANA, BMI, and HOMA-IR. This study revealed that obese males develop T2D more than females (60.0%, 40.0% respectively) Moreover, Obese T2D and obese without T2D individuals were increased concentrations of IgG in serum levels with markers (ANA, HOMA-IR, and IL-6). While IgG levels in IAA serum were considerably greater in obese T2D individuals only. Furthermore, BMI has been positively associated with an increasing level of ANA, HOMA-IR, and IL-6 in both groups. This investigation unveiled a direct correlation between escalating BMI and the incidence of T2D. Additionally, it revealed the active impact of obesity on the immune response and its consequential contribution to the pathogenesis of T2D. [ABSTRACT FROM AUTHOR]

• Psychotic syndromes can have autoimmune-mediated causes in some patients. • Rheumatological screening led to suspicion of an autoimmune psychotic syndrome in 4%. • Antinuclear antibodies were associated with magnetic resonance imaging pathologies. • Rheumatological processes may rarely be associated with psychotic syndromes. Psychotic syndromes can have autoimmune-mediated causes in some patients. Thus, this retrospective work aims to investigate the role of rheumatological markers in the development of psychosis. In total, 224 patients with psychotic syndromes receiving a "rheumatological laboratory screening" (including C-reactive protein [CRP], immunofixation, complement factors, rheumatoid factor [RF], antiphospholipid antibodies [APAs], antineutrophil cytoplasmic antibodies [ANCAs], and antinuclear antibodies [ANAs]) were analyzed. A further diagnostic work-up included investigations of neuronal antibodies and cerebrospinal fluid (CSF), as well as electroencephalography (EEG) and magnetic resonance imaging (MRI) of the brain. ANA testing was routinely performed in all patients using serum on human epithelioma-2 (Hep2) cells, and a subset of patients (N = 73) also underwent tissue-based assays from serum and CSF. The number of cases with autoimmune psychotic syndromes was descriptively collected, and ANA-positive and −negative patients were compared in detail. CRP was elevated in 9 % of patients, immunofixation identified alterations in 8 %, complement factor C3 was decreased in 14 %, RF was elevated in 1 %, APAs were elevated in 7 %, ANCAs were not clearly positive, and ANAs were positive in 19 % (extractable nuclear antigen [ENA] differentiation resulted in positive findings in 14 patients). From the 73 patient samples additionally investigated using tissue-based assays, there were 26 positive results for some kind of ANA (36 %), and overall using both methods, 54 patients (24 %) were considered positive for ANAs. A neuropsychiatric evaluation revealed a possible autoimmune psychotic syndrome in seven patients (3 %) and a probable autoimmune psychotic syndrome in two patients (1 %). ANA-positive patients were more frequently treated with antidepressants (p = 0.040) and had a higher number of somatic comorbidities (p < 0.001). In addition, (chronic) inflammatory MRI lesions (p = 0.008) and focal atrophies (p = 0.012) were found more frequently in ANA-positive than ANA-negative patients. Rheumatological screening led to suspicion of a possible or probable autoimmune psychotic syndrome in 4%. ANAs were associated with MRI pathologies. Therefore, rheumatological processes may contribute to the development of psychotic syndromes in rare cases. [ABSTRACT FROM AUTHOR]

Systemic Lupus Erythematosus (SLE) is a medical condition characterized by an abnormal immune response that affects multiple organs and tissues, resulting in a range of symptoms and potential problems. To confirm or exclude a diagnosis of systemic lupus erythematosus (SLE), it is necessary to conduct tests for anti-nuclear antibody (ANA) and anti-DFS70 antibody. The most widely accepted and reliable approach for detecting antinuclear antibodies (ANA) is the indirect immunofluorescent test (IIFA), which is known for its complexity and high cost. Therefore, it is imperative to create a more cost-effective and simplified test for the detection of ANA and anti)DFS70 antibodies. Our preliminary study aimed to isolate sensitive and specific antigens for the detection of ANA and anti-DFS70 antibodies using the dot blot method. Nuclear antigens were isolated from leukocytes of SLE patients who underwent leukapheresis. DSF70 antigens were obtained from R&D Systems (RH-LEDGF cat.no 3468-LE, Lot: ODX0819071). Nuclear antigens and DFS70 antigen were attached to the nitrocellulose membrane dot blot with a dilution of 0.01 mcg/mL and 0.1 mcg/mL, respectively. Furthermore, the antigens were tested for sensitivity and specificity in 56 SLE patients and 34 healthy controls. As a comparison for ANA and anti)DFS70 antibody tests, the ELISA methods were used. The sensitivity and specificity of dot blot methods using the nuclear antigen were 61.5% and 84.6% and the DSF70 antigen were 45.5% and 82.3%, respectively. There were moderate sensitivity and good specificity dot blot methods using both nuclear and DFS-70 antigens for ANA and anti-DFS70 antibody detection. The method of nuclear antigen preparation still needs to be modified to improve its sensitivity. [ABSTRACT FROM AUTHOR]

Cellular debris resulting from large trauma might overwhelm the scavenger mechanisms and lead to autoimmune reactions. We analysed whether a major well‐defined trauma in humans induces laboratory signs of transient autoimmunity in the months after the insult. We included 50 patients with pertrochanteric femur fracture undergoing intramedullary nail osteosynthesis in a prospective cohort study and followed them at 3–4 days, 6 weeks, 12 weeks and 12 months postoperatively. By standard techniques, we assessed levels of total immunoglobulins, anti‐nuclear antibodies (ANA), anti‐cardiolipin antibodies, anti‐dsDNA antibodies and anti‐C1q antibodies, as well as antibodies against cytomegalovirus (CMV) as a control. Blood leukocyte differential and lymphocyte subpopulations were determined at baseline and in the first two postoperative samples. The mean age of the patients reached 80.1 years, and 23 (46%) completed all visits. Serum concentrations of total IgG, IgM and IgA increased at all follow‐up time points. The ANA fluorescence light intensity units increased at 12 weeks and 12 months postoperatively (p < 0.0001), but the proportion of ANA‐positive patients did not change (35%). The values of anti‐C1q mildly increased at all follow‐up visits, but not the ratio to total IgG. Anti‐dsDNA remained negative in all patients, and anti‐cardiolipin IgG/IgM antibodies did not change. Anti‐CMV IgG antibodies increased significantly at all follow‐up visits, without change in the ratio to total IgG. Flow cytometry showed an increased proportion of B‐cells 3–4 days postoperatively. In conclusion, major musculoskeletal trauma in elderly patients induces a generalized non‐specific increase in immunoglobulin production without laboratory signs for enhanced systemic autoimmunity. [ABSTRACT FROM AUTHOR]

Background: The characteristics of autoimmune hepatitis (AIH) in Asia mostly remain elusive. Methods: A cohort study of liver biopsy-proven AIH patients was conducted in a tertiary care cancer of Taiwan. Results: From 1999 to 2022, of 13,766 patients who underwent liver biopsy, 150 patients with AIH were enrolled. The female-to-male ratio was 2.26. At baseline, the mean age was 51.09 years, mean alanine aminotransferase level was 494.11 U/L, and 17 (11.3%) had cirrhosis. All except one patient had AIH type 1. The females were older and had higher baseline cirrhosis rates than did the males. The 23-year cumulative incidences of cirrhosis, hepatocellular carcinoma (HCC), mortality/liver transplantation, autoimmune diseases and extrahepatic cancer were 64.2%, 13.3%, 23.4%, 30.7% and 21.2%, respectively. The 1-year, 2-year, 3-year, 5-year, 10-year and 20-year postimmunosuppressive therapy relapse rates were 60%, 78.2%, 81.8%, 89.1%, 94.5% and 100%, respectively. Baseline associations were as follows: alkaline phosphatase (Alk-p) levels with postimmunosuppressive therapy flare [hazard ratio (HR): 1.003; 95% CI HR: 1.000-1.005]; age with HCC (1.072; 1.010–1.138) and all-cause cancer (1.041;1.005–1.079); cirrhosis with mortality/liver transplantation (11.933;1.984–71.787); and antinuclear antibody (ANA) titers with mortality/liver transplantation (1.001;1.000-1.003), cirrhosis (1.001;1.000-1.002), and autoimmune diseases (1.001; 1.000-1.002). Conclusion: In an Asian country endemic for viral hepatitis, the female-to-male and baseline cirrhosis rates of AIH patients were lower than expected, while over 60% of the patients eventually developed cirrhosis. The high posttherapy relapse rate warrants cautious monitoring, particularly for patients with high baseline Alk-p levels. Baseline age, cirrhosis status and ANA titers are crucial for outcomes. [ABSTRACT FROM AUTHOR]

The immune system's amplified response to SARS-CoV-2 may lead to the production of autoantibodies, but their specific impact on disease severity and outcome remains unclear. This study aims to assess if hospitalized COVID-19 patients face a worse prognosis based on ANA presence, even without autoimmune diseases. We performed a retrospective, single-center, observational cohort study, enrolling 638 COVID-19 patients hospitalized from April 2020 to March 2021 at Hospital "Policlinico Riuniti" of Foggia (Italy). COVID-19 patients with a positive ANA test exhibited a significantly lower 30-day survival rate (64.4% vs. 83.0%) and a higher likelihood of severe respiratory complications during hospitalization than those with negative ANA screening (35.4% vs. 17.0%) (p < 0.001). The association between poor prognosis and ANA status was identified by calculating the HALP score (Hemoglobin-Albumin-Lymphocyte-Platelet), which was lower in COVID-19 patients with a positive ANA test compared to ANA-negative patients (108.1 ± 7.4 vs. 218.6 ± 11.2 AU; p < 0.011). In detail, COVID-19 patients with a low HALP showed a lower 30-day survival rate (99.1% vs. 83.6% vs. 55.2% for high, medium, and low HALP, respectively; p < 0.001) and a higher incidence of adverse respiratory events compared to those with high and medium HALP (13.1% vs. 35.2% vs. 64.6% for high, medium, and low HALP, respectively; p < 0.001). In summary, ANA positivity in COVID-19 patients appears to be linked to a more aggressive disease phenotype with a reduced survival rate. Furthermore, we propose that the HALP score could serve as a valuable parameter to assess prognosis for COVID-19 patients. [ABSTRACT FROM AUTHOR]

Introduction: The anti-idiotype network was introduced in 1974 by Niels Jerne. One of the factors that reduces the effectiveness of the vaccines is the anti-idiotype network. It should be noted that the Anti-idiotype of the antibody has the ability to bind to the receptors of the body cells to which the antigen of the first antibody binds; this causes pathological complications, especially after a longer period of time. In this study, we aim to be the first to study the presence of Anti-idiotype antibodies and ANA in people who have received three doses of the COVID-19 vaccine and check that at least 4 months have passed since the injection of their third dose. Materials and Methods: This study was conducted on 180 people and measuring amount of Anti-RBD Anti-idiotype, Anti-Nuclear Antibody (IgG antibodies against RNP, sm RNP, smSSB/La, SSA/Ro, scl 70, centromere B, Jo1, and dsDNA antigens) and SARS-COV-Anti IgG RBD in serum by ELISA methods. Results: In the measurement of Anti-RBD Anti-idiotype, it was found that 14 people (7.7%) of the studied subjects had Anti-idiotype antibodies and 166 (92.3%) lacked this antibody. It was found that five of the studied subjects (2.7%) had positive values for ANA (above 50 RU/ML; in 175 people (97.3), the ANA value was negative (less than 50 RU/ML). In the examination of the results related to the measurement of the quantitative amount of SARS-COV-Anti IgG RBD, it was found that all 180 people included in the study (100%) had a detectable titer of Anti-RBD antibody. Conclusion: Many studies have shown an association between autoimmune diseases and SARS-COV-2 and MERS-CoV. Nevertheless, no studies have investigated autoantibodies in people who have injected three doses of the COVID-19 vaccine. further studies are warranted to confirm and find the causes of this difference. [ABSTRACT FROM AUTHOR]

En esta investigación se lleva a cabo un análisis de la evolución histórica del derecho de aguas de Perú y se discuten los resultados obtenidos por el Tribunal Nacional de Resolución de Controversias Hídricas (TNRCH) de la Autoridad Nacional del Agua (ANA) durante el periodo 2014-2020. En Perú, el derecho de aguas ha evolucionado desde los tiempos coloniales. En 2008 se inició un importante cambio en la gestión de los recursos hídricos, creando la ANA y promulgando la Ley de Recursos Hídricos en 2009; en esta última se contempla la creación del TNRCH, órgano colegiado que resuelve en segunda y última instancia administrativa. En este trabajo se dan los resultados de dicho órgano colegiado. Se espera que el aporte coadyuve a mejor el desempeño de la institución en la solución de las controversias hídricas incrementando la predictibilidad.

Abstract Background To evaluate long-term outcomes and prognostic factors in patients with juvenile idiopathic arthritis (JIA), presenting as oligoarthritis, who received IAC as the first treatment for their disease. Methods We conducted retrospective study at the University Children’s Hospital Ljubljana, Slovenia, from January 2015 to May 2023 in children with JIA, clinically presenting as oligoarthritis receiving intra-articular corticosteroid injection (IAC) as the initial treatment. Patient and treatment data were collected, and the outcomes were categorized into three groups based on the later need for therapy: no therapy needed, only additional IAC needed and systemic therapy needed. The last group was further divided based on the requirement of bDMARD. Log-rank (Mantel-Cox) survival analyses compared different outcome groups. Results We included 109 patients with JIA, presenting as oligoarthritis (63% female), who were first treated with IAC. The mean age at IAC was 8.0 years, with a 4.3-year follow-up. Notably, 38.5% of patients did not require additional therapy post-IAC, whereas 15.5% required only additional IAC. Systemic therapy, mainly methotrexate (MTX), was necessary for 45.9% of patients, initiated in average 7.8 months post-IAC. Biologic therapy was initiated in 22% in average 2.2 years post-IAC. Number of injected joints correlated with the need for biologics. At the last follow-up, 88.9% had inactive disease. ANA positivity (P = 0.049, chi square 3.89) and HLA B27 antigen presence (P = 0.050, chi square 3.85) were associated with the need for systemic therapy. A subgroup of children older than 8 years, ANA and HLA B27 negative required significantly less systemic (25.8%) and biologic therapy (9.6%) compared to other patients (p = 0.050, chi square 3.77). Conclusion Almost 40% of children with oligoarticular JIA requiring IAC did not progress to chronic disease. Younger age, ANA positivity, and HLA B27 presence were predictive factors for systemic therapy, while the number of injected joints predicted the future need for biologic therapy.

Abstract Objectives This study describes clinical, biochemical, and histological features and long-term outcomes in pediatric patients diagnosed with autoimmune hepatitis (AIH) at King Abdullah University Hospital, Jordan. Design Retrospective, single-center study. Setting King Abdullah University Hospital, Jordan. Participants Inclusion of all pediatric patients with AIH diagnosed at our hospital from 2015 to 2023. Exclusion criteria was patients aged over 18 at time of diagnosis and those diagnosed elsewhere. Outcome measures Understanding clinical, biochemical, and histological AIH features in children, evaluating treatment responses, and reporting short- and long-term complications, including mortality. Results Sixteen pediatric cases were diagnosed, with an average age of 9.84 ± 4.13 years. Females comprised 75% of patients, and 31.3% presented with acute liver failure. Jaundice was the most common symptom, and hepatosplenomegaly was observed in 18% of cases. Most patients had elevated transaminase levels, along with positive anti-smooth muscle antibody (ASMA) and antinuclear antibodies (ANA). Common hematological abnormalities included anemia (56.3%) and thrombocytopenia (37.5%). All patients underwent liver biopsy, with interface hepatitis present in 81.3% of cases. Treatment mainly involved prednisone and azathioprine. Three patients died, one discontinued therapy, two patients were lost to follow-up, and 10 remained on treatment. Conclusion Autoimmune hepatitis affects Jordanian children, primarily female children. Jaundice is the most common presenting symptoms. Only Type I AIH occurred in our cohort. Although of good response to conventional treatment with steroids and immunosuppression, mortality reached 18.8%.

IntroductionViral infections have been implicated in the initiation of the autoimmune diseases. Recent reports suggest that a proportion of patients with COVID-19 develop severe disease with multiple organ injuries. We evaluated the relationship between COVID-19 severity, prevalence and persistence of antinuclear and other systemic and organ specific autoantibodies as well as SARS-CoV-2 infection specific anti-nucleocapsid (N) IgG antibodies and protective neutralizing antibody (Nab) levels.MethodsSamples from 119 COVID-19 patients categorized based on their level of care and 284 healthy subjects were tested for the presence and persistence of antinuclear and other systemic and organ specific autoantibodies as well as SARS-CoV-2 and neutralizing antibody levels.ResultsThe data shows significantly increased levels of anti RNP-A, anti-nucleocapsid and neutralizing antibody among patients receiving ICU care compared to non-ICU care. Furthermore, subjects receiving ICU care demonstrated significantly higher nucleocapsid IgG levels among the RNP-A positive cohort compared to RNP-A negative cohort. Notably, the expression of anti RNP-A antibodies is transient that reverts to non-reactive status between 20 and 60 days post symptom onset.ConclusionsCOVID-19 patients in ICU care exhibit significantly higher levels of transient RNP-A autoantibodies, anti-nucleocapsid, and SARS-CoV-2 neutralizing antibodies compared to patients in non-ICU care.

The diagnosis of systemic autoimmune rheumatic disease (SARD) or its exclusion is carried out taking into account the results of immunological studies, primarily antinuclear antibodies (ANA) and specific autoantibodies. Often, during ANA analysis via indirect immunofluorescence reaction on cellular and tissue substrates, a dense fine speckled 70 (DFS70) fluorescence pattern is observed. Studies on the diagnostic significance of antibodies to anti-DFS70 allow for optimizing the stepwise diagnosis of SARD. Currently, a two-step strategy for laboratory diagnostic investigation is recommended: in the first step, ANA screening is performed, and in the second step, patients with positive results undergo confirmatory tests to detect specific antibodies against individual nuclear antigens. The detection of anti-DFS70 in ANA-seropositive patients without clinical and/or other specific serological markers characteristic of a particular disease within the SARD group may be considered a negative prognostic marker. Also, in the process of decision making in clinical practice, we should remember that anti-DFS70 can be found in the blood of patients with a different, non-SARD pathology and that most people showing anti-DFS70 are healthy individuals.

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Background: Nearly half of the Systemic lupus erythematosus (SLE) patients develop lung involvement. The study assessed the extent of pulmonary involvement among SLE patients and to identify the associated factors in the population. Methodology: This retrospective cohort study was conducted at Aseer Hospital and Khamis Myshat Hospital in the Southern region of Saudi Arabia. The study spanned from January 1, 2016, to June 3, 2023. Patient inclusion criteria encompassed individuals who received a definitive diagnosis and classification as per American College of Rheumatology criteria, while patients under 18 years of age and those with mixed connective tissue diseases were exclude. Results: A total of 247 participants were included. 41.7% (n=103) aged 41 years and older, 95.1% (n = 235) were females. Around 10.10% had diabetes mellitus and 17.00% had hypertension and hypothyroidism. Lupus Nephritis was in 15.40%. Chest involvement was reported in 21.9%, in the form of pleuritis (6.10%), pleural effusion (4.00%), and lupus pneumonitis (4.00%), interstitial lung disease (4.00%), pulmonary embolism (3.60%) of individuals, and pulmonary hemorrhage (2.80%). The respiratory symptoms reported by SLE were; dyspnea, cough, and chest pain each having a prevalence of around 18.0%. Palpitations have a relatively high occurrence at 13.80%. Meanwhile, hemoptysis (blood coughing) has a lower prevalence of 1.20%, and fever is reported at 2.80%. Having chronic kidney disease and hypertension were significantly associated with having pulmonary involvement; (χ 2=3.308, p=0.027) and (χ 2=7.782, Fisher's p=0.002) respectively. The seropositivity for antiphospholipid Abs, anti-CCP, and antids-DNA were significantly associated with pulmonary involvement (χ 2=3.239, =p=0.049), (χ 2=4.621, Fisher's p=0.023), and (χ 2=8.248, p=0.010) respectively. Conclusion: The study found that 21.9% of SLE patients experience chest involvement, with varying degrees of pulmonary symptoms. Factors such as chronic kidney disease, hypertension, antiphospholipid antibodies, Anti-CCP positivity, and seropositivity for Anti-dsDNA were found to be significant associations with lung involvement, contributing to our understanding of SLE. [ABSTRACT FROM AUTHOR]

Objectives: This study describes clinical, biochemical, and histological features and long-term outcomes in pediatric patients diagnosed with autoimmune hepatitis (AIH) at King Abdullah University Hospital, Jordan. Design: Retrospective, single-center study. Setting: King Abdullah University Hospital, Jordan. Participants: Inclusion of all pediatric patients with AIH diagnosed at our hospital from 2015 to 2023. Exclusion criteria was patients aged over 18 at time of diagnosis and those diagnosed elsewhere. Outcome measures: Understanding clinical, biochemical, and histological AIH features in children, evaluating treatment responses, and reporting short- and long-term complications, including mortality. Results: Sixteen pediatric cases were diagnosed, with an average age of 9.84 ± 4.13 years. Females comprised 75% of patients, and 31.3% presented with acute liver failure. Jaundice was the most common symptom, and hepatosplenomegaly was observed in 18% of cases. Most patients had elevated transaminase levels, along with positive anti-smooth muscle antibody (ASMA) and antinuclear antibodies (ANA). Common hematological abnormalities included anemia (56.3%) and thrombocytopenia (37.5%). All patients underwent liver biopsy, with interface hepatitis present in 81.3% of cases. Treatment mainly involved prednisone and azathioprine. Three patients died, one discontinued therapy, two patients were lost to follow-up, and 10 remained on treatment. Conclusion: Autoimmune hepatitis affects Jordanian children, primarily female children. Jaundice is the most common presenting symptoms. Only Type I AIH occurred in our cohort. Although of good response to conventional treatment with steroids and immunosuppression, mortality reached 18.8%. [ABSTRACT FROM AUTHOR]

Background: Hypoparathyroidism is the destruction of the parathyroid gland by the immune system, as part of a multiple endocrine insufficiency syndrome. Tissue resistance to PTH's activities can occur in rare cases, resulting in hypoparathyroidism with increased PTH levels. Hypothyroidism is more common in females than males. 1,25-dihydroxyvitamin D3 (active vitamin D) levels must be evaluated to rule out vitamin D deficiency as a contributor to or cause of hypocalcemia. Hypocalcemia and phosphatemia are common symptoms of hypoparathyroidism. Antinuclear antibodies (ANA) and double strand DNA (DsDNA) are the important biomarkers for diagnosis and prognosis of patients with autoimmune diseases. ANA and DsDNA occur in different endocrine disorders including thyroid disorders like hypoparathyroidism. Methods: Thirty Hypoparathyroidism patients with age range 21-74 years with (20 female and 10 male) were attending international Baghdad Medical Hospital, during the period from December 2019 to February 2021 and thirty apparently healthy were chosen as healthy control groups respectively. For these two study groups, the blood samples were collected to evaluate the serum level of serum phosphorus, calcitonin, Calcium, Vitamin D3, DsDNA and ANA. The type of kits used for serum DsDNA and ANA in humans were an indirect enzyme immunoassay (ELISA) and the kits for serum level of serum Vitamin D3 and calcitonins were a sandwich ELISA. Finally, these kits for the calcium and phosphorus inorganic Colorimetric method were used. Results: Using Student's t-test, the present study's data revealed a statistically significant difference in the mean of age group cases and controls (P=0.005), as well as a statistically significant difference in serum mean values of each Serum phosphorus (P=0.005), calcitonin (P=0.005), calcium (P=0.002), and vitamin D3 centration (P=0.005) between these two groups. By using Chi-square test sex was not significant between hypoparathyroid and control (P=0.787) and DsDNA was not significantly more positive in hypoparathyroid subjects than control (P=0.112); while ANA was significant (P=0.024). Conclusion: The study sheds light on the necessity to screen the hypo parathyroid patients for vitamin D, calcium and phosphorous levels and calcitonin for better prognosis of patients and for each of antinuclear antibodies (ANA) and double strand DNA (DsDNA). [ABSTRACT FROM AUTHOR]

This study included the detection of the spread of the Rubella virus and some causes of abortion among women of childbearing age in the city of Samarra. Ninety samples were collected from women with recurrent abortions for the period from the beginning of October 2019 to the end of January 2020. Their ages ranged between (16-45) years. Anti-rubella IgG, IgM, antiphospholipid (APL), anticardiolipin (ACL), and antinuclear antibody (ANA) were investigated for (60) samples of women who were infected with the rubella virus, and (30) samples from no infected women. The results showed that 86.7% of the women infected with German measles had anti-rubella IgG and 35% had anti-rubella IgM. While the other group had 38.4% of IgG and 0% of IgM anti-rubella antibodies. The results showed that 71.7%, 78.3%, and 11.7% of patients with rubella infection gave positive results for APL, ACL, and ANA antibodies, respectively. 16.6%, 6.7%, and 3.4% of the cases that were suffering from repeated miscarriages and without rubella gave a positive result for APL, ACL, and ANA antibodies, respectively. [ABSTRACT FROM AUTHOR]

Objective: To study the predictive value of a positive anti-nuclear antibody (ANA) for a rheumatological diagnosis in an outpatient setting. Methods: Individuals who were referred to the rheumatology outpatient clinics because of a positive ANA between July 2014 and June 2015 were retrospectively reviewed. Presenting symptoms in addition to a positive ANA and whether a final rheumatological diagnosis was made were recorded. The positive predictive value of a positive ANA and its titer for a rheumatological diagnosis, with and without accompanying symptoms was evaluated. Results: A total of 230 patients were included (82% women, age 47.7 ± 14.1 years [range 18-84]). Family medicine and the general outpatient clinic were the main sources of referral (32.2%), followed by ophthalmology (13.0%) and otorhinolaryngology (11.7%). A final rheumatological diagnosis was made in 54 (23.5%) patients, with rheumatoid arthritis being the commonest diagnosis (40.7%). In the absence of any associated symptoms, the predictive value of a positive ANA was 0%. The presence of Raynaud’s phenomenon (100%), joint swelling (59.5%), and joint stiffness (48.9%) predicted a better final rheumatological diagnosis along with a positive ANA. ANA titers of 1:80 or less had a low sensitivity for rheumatic diseases. A receiver operating characteristic (ROC) curve analysis showed that an ANA titer of [Formula: see text]1:128 best predicted a rheumatological diagnosis (AUC 0.78 [0.71–0.85]; sensitivity 0.78; specificity 0.64). Conclusions: To improve the prediction for a rheumatological diagnosis, referral for a positive ANA test should be more appropriately done with compatible symptoms.

Objectives: Virus infection closely associated with autoimmune disease. The study aimed to explore the autoantibody profiles and the correlation of autoantibodies with the disease severity and the prognosis of the coronavirus disease 2019 (COVID-19) patients. Methods: Three hundred thirty-seven hospitalized COVID-19 patients from 6th to 23rd January 2023 were enrolled. Logistic and Cox regression analyses were used to analyze the risk factors for the patient's disease severity and outcome. The association between Anti-extractable nuclear antigen antibody (ENA) positivity and the prognosis of COVID-19 patients was analyzed using Kaplan-Meier survival curves. Results: 137 of COVID-19 patients were detected positive for antinuclear antibody (ANA), 61 had positive results for ENA, and 38 were positive for ANA and ENA. ANA positivity rate was higher in non-severe illness group (p = 0.032). COVID-19 patients who died during hospitalization had a high rate of ENA positivity than convalescent patients (p = 0.002). Multivariate logistic regression showed that ANA positivity was a protective factor for the disease severity of COVID-19. Multivariate Cox regression analysis revealed that ENA positivity, white blood cells count (WBC), aspartate aminotransferase (AST), Creatinine (CREA), and CRP were independent risk factors for the outcome of COVID-19 patients, and that COVID-19 patients with ENA positivity had a lower cumulative survival rate (p = 0.002). Conclusion: A spectrum of autoantibodies were expressed in COVID-19 patients, among which ANA and ENA positivity was associated with the severity and prognosis of COVID-19. Therefore, autoantibodies may help to assess the disease severity and prognosis of COVID-19 patients. [ABSTRACT FROM AUTHOR]

The diagnosis of systemic autoimmune rheumatic disease (SARD) or its exclusion is carried out taking into account the results of immunological studies, primarily antinuclear antibodies (ANA) and specific autoantibodies. Often, during ANA analysis via indirect immunofluorescence reaction on cellular and tissue substrates, a dense fine speckled 70 (DFS70) fluorescence pattern is observed. Studies on the diagnostic significance of antibodies to anti-DFS70 allow for optimizing the stepwise diagnosis of SARD. Currently, a two-step strategy for laboratory diagnostic investigation is recommended: in the first step, ANA screening is performed, and in the second step, patients with positive results undergo confirmatory tests to detect specific antibodies against individual nuclear antigens. The detection of anti-DFS70 in ANA-seropositive patients without clinical and/or other specific serological markers characteristic of a particular disease within the SARD group may be considered a negative prognostic marker. Also, in the process of decision making in clinical practice, we should remember that anti-DFS70 can be found in the blood of patients with a different, non-SARD pathology and that most people showing anti-DFS70 are healthy individuals. [ABSTRACT FROM AUTHOR]

Autoimmune hepatitis (AIH) is often complicated with immune diseases, which greatly affected the course and clinical outcome of AIH. We aimed to systematically assess clinical characteristics, prognosis in autoimmune hepatitis accompanied by immune diseases. Clinical records of 358 patients with AIH from Beijing Ditan Hospital in China were retrospectively reviewed. The clinical features of AIH with immune diseases were compared retrospectively, including clinical characteristics, prognosis and outcome. Prevalence of immune diseases in patients with AIH was 26.5%. Connective tissue disease (CTD) was the commonest immune diseases associated with AIH (33/358, 9.2%), and the incidence of primary biliary cholangitis (PBC) and thyroid dysfunction (TD) was low (4.7% and 8.5%, respectively). At diagnosis, AIH-PBC patients had higher IgM and ALP, lower weight, Hgb, ALT and AFP (P < 0.05). Meanwhile, AIH-CTD patients had lower mean platelet volume, serum K and triglyceride (P < 0.05). AIH-TD patients had a lower proportion of ANA positive (P < 0.05). The overall survival time of AIH-TD was significantly shorter than AIH patients (P = 0.0011), but there were no differences in AIH-PBC and AIH-CTD. Furthermore, ANA negative (HR: 0.21, 95%CI 0.13–0.35, P < 0.001) can be a factor to predict the poor prognosis of AIH, and also in AIH-TD patients. About 26.5% of AIH patients had at least one immune disease, and TD coexisted with AIH impaired patients' survival. ANA negative can be used as an independent indicator to predict the poor prognosis of AIH and AIH-TD. [ABSTRACT FROM AUTHOR]

Antinuclear antibodies (ANAs) are essential diagnostic markers in systemic autoimmune rheumatic diseases. Among the 30 ANA patterns, homogeneous (AC-1) and dense fine speckled (AC-2) should be focused on owing to their somewhat indistinct presentation in immunofluorescence imaging and distinct correlation with clinical conditions. This study aimed to develop a flowchart to guide discrimination between AC-1 and AC-2 patterns and to re-evaluate ANA samples according to this flowchart to verify its detection ability. We re-evaluated immunofluorescence imaging of 62 ANA blood samples simultaneously subjected to solid-phase assays for autoantibodies against dsDNA, nucleosomes, histones, and DFS70. The results showed statistically significant odd ratios (ORs) of detection of anti-DFS70 using AC-2 after re-evaluation of total samples (OR 101.9, 95% CI 11.7–886.4, p-value < 0.001) and subgroup analysis of patients' samples (OR 53.8, 95% CI 5.9–493.6, p-value < 0.001). The OR of anti-nucleosome/histone/dsDNA detection using AC-1 in re-evaluated data increased to 5.43 (95% CI 1.00–29.61, p-value = 0.05). In the analysis of specific autoantibodies, more than half of the samples with an AC-2 pattern (54.2%) had specific autoantibodies other than anti-DFS70. We conclude that the flowchart for discriminating between AC-1 and AC-2 ANA patterns in this study is a viable practical guide for other laboratories when encountering equivocal ANA results. [ABSTRACT FROM AUTHOR]

Background: Noonan syndrome (NS) represents a fairly common genetic disorder with a highly variable phenotype. Its features include inherited heart defects, characteristic facial features, short stature, and mild retardation of motor skills. Case presentation: A 16-year-old Caucasian girl with NS reported visual deterioration, photophobia, and pain in the right eye (RE). The initial best-corrected visual acuity (BCVA) was 0.3 in the RE. An examination demonstrated conjunctival and ciliary body hyperemia, keratic precipitates, and flare in the anterior chamber. In addition, post-hemorrhagic floaters, tortuous vessels, and an epiretinal membrane in the RE were present. Diagnosis of unilateral anterior uveitis was made, and this resolved after the use of topical steroids and cycloplegic drops. Due to the presence of retinal telangiectasias and extraocular exudates (consistent with Coats' disease (CD) stage 2A) in the RE, laser therapy was performed. The patient remains under constant follow-up, and after one year, the BCVA in the RE was 0.7. Conclusions: Here, we report the clinical characteristics, genetic findings, and retinal imaging results of a patient with NS. To our knowledge, this is, to date, the first report of an association of NS with a PTPN11 mutation with anterior uveitis and CD. [ABSTRACT FROM AUTHOR]

[Propósito] O presente artigo busca analisar as perspectivas regulatórias do setor de saneamento básico diante da atribuição de competência à Agência Nacional de Águas e Saneamento Básico - ANA, pela Lei Federal nº 14.026/2020, para editar norma de referência de governança regulatória a ser observada pelas agências infranacionais em sua atuação. [Metodologia/abordagem/design] O artigo meditará acerca dos desafios para implementação prática de tal norma de referência. [Resultados] São suscitadas algumas proposições sobre as linhas gerais da futura norma de referência sobre o tema, a ser elaborada pela ANA no ano de 2022, conforme sua agenda regulatória.

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by autoantibody's presence in the circulation and involvement of many systems. The current study aims to study the role of some immunological and non-immunological parameters in SLE development and to illustrate the correlations between these parameters. The current study included 50 blood samples collected from SLE patients and apparently healthy control. The methods of work included Complete Blood Count (CBC) analysis to assess blood components, you mean to analyse Hb, WBC, ESR, ELISA technique to measure serum levels of TLR-7, IL-17, and TNF-γ, antinuclear antibody test (ANA) and double-strand DNA antibody (anti ds DNA). The study results showed a significant increase in serum levels of each WBC (p< 0.005), ESR (p< 0.001), IL17(p< 0.004), TLR7(p< 0.005), IFN-γ (p< 0.001), ANA (p< 0.001), and anti dsDNA (p< 0.001) in SLE patients compared to apparently healthy control but the Hb is decreasing level was low in the SLE patients compared with control. In conclusion, the low hemoglobin, WBC, and ESR are non-specific parameters associated with SLE pathogenesis. ANA, Anti-ds-DNA as excellent biomarkers for the diagnosis of SLE and serum level of TLR-7, TNF-γ, and IL-17 were evaluated in SLE patients compared to healthy people and they may be suggested as a prognostic tool in SLE patients.

Previous reports on association of autoantibodies with histological severity in nonalcoholic fatty liver disease (NAFLD) have revealed inconsistent results. Therefore, this study was undertaken to find the impact of autoantibodies on histological severity of NAFLD. All cases with histological diagnosis of NAFLD during January 2016 to January 2021 were included in the study. Laboratory parameters were recorded, and histological assessment was done. The positivity of autoimmune markers was defined as presence of either antinuclear antibody (ANA; titer >1:80), anti-smooth muscle antibodies (ASMA), or anti-liver-kidney-microsomal antibodies (LKM-1; titer >1:40). Serum levels of CK18 - M30 and PIIINP were evaluated to assess the subtle changes in necroinflammatory activity and fibrosis in the liver. Autoantibodies were present in 281/683 (41.1%, 95% CI 37.4–44.9) patients. ANA, ASMA, ANA + ASMA was seen in 20.9% (95% CI 17.9–24.2); 14.5% (95% CI 11.9–17.4); and 5.7% (95% CI 4.1–7.7) cases, respectively. No significant difference was noted between the two groups in terms of age and metabolic tests. No significant difference was noted in the histological parameters between groups with autoantibodies positivity and no-positivity. Mean value of CK18-M30 between cases with negative autoantibody; ANA positivity; ASMA positivity; and combined positivity of autoantibody were 178.2 ± 81.8, 161.6 ± 63.7, 153.2 ± 70.3 and 169.8 ± 42.9, respectively (P = 0.57). However, CK18-M30 and PIIINP showed a rising trend with NAFL, NASH, NASH + AIH (P < 0.001). Autoantibodies noted in 41% NAFLD cases. No significant necroinflammatory activity or fibrosis associated with presence of antibodies in NAFLD cases. However, CK-18-M30 showed a rising trend from NAFL to NASH to NASH + AIH. [ABSTRACT FROM AUTHOR]

Copyright of Mersin University School of Medicine Lokman Hekim Journal of History of Medicine & Folk Medicine is the property of Mersin University School of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Al-Mustansiriyah Journal of Science is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We present the case of a 30-year-old woman who presented with 8-month history of intermittent fever, joint pains with morning stiffness, recurrent oral ulcers, photosensitivity, weight loss and hair fall. For the last 2 months, she had developed a dry cough with progressive shortening of breath. On examination, a cachexic lady with malar hyperpigmentation, alopecia, pallor, nail dystrophy and erythema over her hands and feet were noted. There were multiple punched-out skin ulcers of variable size over legs, arms and abdomen usually round in shape with well-defined even wound margins and scant serous discharge. Musculoskeletal examination revealed synovitis of both elbows and a few metacarpophalangeal and proximal interphalangeal joints. Chest X-ray and HRCT showed bilateral ground-glass opacification. Anti-Nuclear Antibody (ANA) was positive, 1:320, homogenous nuclear pattern. Anti-Ro antibody was highly positive and serum complement (C3, C4) levels were reduced. She was diagnosed with Lupus Vasculitis and started on steroids, mycophenolate mofetil and hydroxychloroquine. [ABSTRACT FROM AUTHOR]

The immune system’s amplified response to SARS-CoV-2 may lead to the production of autoantibodies, but their specific impact on disease severity and outcome remains unclear. This study aims to assess if hospitalized COVID-19 patients face a worse prognosis based on ANA presence, even without autoimmune diseases. We performed a retrospective, single-center, observational cohort study, enrolling 638 COVID-19 patients hospitalized from April 2020 to March 2021 at Hospital “Policlinico Riuniti” of Foggia (Italy). COVID-19 patients with a positive ANA test exhibited a significantly lower 30-day survival rate (64.4% vs. 83.0%) and a higher likelihood of severe respiratory complications during hospitalization than those with negative ANA screening (35.4% vs. 17.0%) (p < 0.001). The association between poor prognosis and ANA status was identified by calculating the HALP score (Hemoglobin-Albumin-Lymphocyte-Platelet), which was lower in COVID-19 patients with a positive ANA test compared to ANA-negative patients (108.1 ± 7.4 vs. 218.6 ± 11.2 AU; p < 0.011). In detail, COVID-19 patients with a low HALP showed a lower 30-day survival rate (99.1% vs. 83.6% vs. 55.2% for high, medium, and low HALP, respectively; p < 0.001) and a higher incidence of adverse respiratory events compared to those with high and medium HALP (13.1% vs. 35.2% vs. 64.6% for high, medium, and low HALP, respectively; p < 0.001). In summary, ANA positivity in COVID-19 patients appears to be linked to a more aggressive disease phenotype with a reduced survival rate. Furthermore, we propose that the HALP score could serve as a valuable parameter to assess prognosis for COVID-19 patients.

Ziryab Imad Taha,1– 4 Israa Abdelghani Awad Ibrahim,3,4 Salih Boushra Hamza,4,5 Yassin A Abdalla,4,5 Elnour M Elagib,3,4,6 Husam A M Ali,4,7 Sara Joseph,8 Jimmy William4,9 1Medical and Cancer Research Institute (MCRI), Department of Clinical Medicine, Nyala, Sudan; 2University of Bahri, Department of Internal Medicine, Khartoum, Sudan; 3Sudan Medical Specialization Board, Department of Internal Medicine, Khartoum, Sudan; 4Rheumatology Department, Ziryab Research Group, Khartoum, Sudan; 5Omdurman Islamic University, Department of Internal Medicine, Khartoum, Sudan; 6Omdurman Military Hospital, Department of Rheumatology, Omdurman, Sudan; 7Fedail Hospital, Department of Neurology, Khartoum, Sudan; 8University of Medical Sciences and Technology, Department of Pharmacy, Khartoum, Sudan; 9Sligo University Hospital, Department of Haematology, Sligo, IrelandCorrespondence: Jimmy William, Sligo University Hospital, The Mall, Rathquarter, Sligo, F91 H684, Ireland, Tel +353851173213, Email Jimgw20@gmail.comPurpose: To assess and establish the relationship between neuropsychiatric systemic lupus erythematosus (NPSLE) involvement and serological biomarkers like antiribosomal-P antibodies.Patients and Methods: This is an analytical cross-sectional hospital-based study conducted on patients attending Omdurman Military Hospital from July 2019 to December 2019. A total of 90 patients were enrolled, 30 of whom had NPSLE compared with 60 SLE patients without NPSLE. SLE diagnosis was established based on the revised SLICC criteria (presence of at least 4 criteria) for SLE classification, with neuropsychiatric manifestations defined based on the ACR nomenclature. The immunological examination results have been performed by (ELISA immune-enzymatic method, immunofluorescence, and Western immunoblotting test). SPSS v 21.0 software was utilised for data analysis.Results: NPSLE patients exhibited +ve ANA in 96.7% vs 75% in non-NPSLE (P-value = 0.008), antiribosomal-P antibodies (46.7% vs 20%; P-value = 0.0001), anti-nucleosome antibodies (26.7% vs 5%; P-value = 0.005), and anti-histones antibodies (40% vs 20%; P-value = 0.04). ANA antibodies were significantly associated with neurological manifestations as ANA antibodies were common in epilepsy (n = 9; 91%) and stroke (n = 8; 27.6%) (P-value < 0.001).Conclusion: Neuropsychiatric manifestation of systemic lupus erythematosus exhibits variable clinical manifestations. Neuropsychiatric manifestations of SLE are strongly associated with the anti-ribosomal P antibody presence and can be employed as a powerful diagnostic tool.Keywords: SLE, neuropsychiatric, ANA, anti-ribosomal-P antibodies, anti-histone antibodies

Background: Some autistic children may have an imbalance of the T-helper (Th)1/Th2 lymphocytes toward Th2. Th2 cells are responsible for the allergic response and the production of antibodies. Aim: We were motivated to investigate the frequency of the brain specific antibodies anti-myelin oligodendrocyte glycoprotein and anti-myelin associated glycoprotein (anti-MoG) and systemic antibodies Anti-Nuclear Antibody (ANA) in the serum of a group of Egyptian autistic children. Patients and Methods: This pilot case-control study was conducted at the Department of Pediatrics, Children's Hospital, Faculty of Medicine, Ain Shams University over a period of 6 months, from May 2022 to November 2022. Twenty five autistic children aged 4 to 16 years and twenty five age- and sexmatched healthy children were included after excluding children with any chronic, allergic or autoimmune disease. Diagnosis of autism was settled according to 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Serum levels of brain specific antibodies (anti-MoG) and systemic antibodies (ANA) were assessed for the patients and healthy children using Enzyme-linked immunosorbent assay (ELISA) technique. Results: Male to female ratio was 3.17:1. Family history of Autism spectrum disorder (ASD) was positive in 2 patients. True seizures were detected in 3/25 (12%) of the studied children. Mild ASD was found among 64% and severe illness was detected among the other 36% of the studied patients using Childhood Autism Rating Scale (CARS). According to anti-ANA 23 healthy control children had negative ANA and the other two had positive ANA. However 23 autistic children had negative ANA and two had borderline level. Anti-ANA not detected among autistic children. According to Anti-MOG 25 healthy control children had negative anti-MOG. However 24 autistic children had negative anti-MOG and one had positive anti-MOG. P-Value of anti-MOG was 1.00 and P-Value of anti-ANA was 0.135. Conclusion: Specific brain antibodies, anti-MOG, and systemic antibodies, ANA were not detected in higher levels among autistic children compared to healthy control. The study was limited by the small sample size. ASD patients and healthy children showed comparable serum levels of ANA. One autistic child had positive anti-MOG. Compared to healthy control group, the difference of results of brain antibodies was statistically non-significant. [ABSTRACT FROM AUTHOR]

Antinuclear autoantibodies (ANA) are heterogeneous self-reactive antibodies that target the chromatin network, the speckled, the nucleoli, and other nuclear regions. The immunological aberration for ANA production remains partially understood, but ANA are known to be pathogenic, especially, in systemic lupus erythematosus (SLE). Most SLE patients exhibit a highly polygenic disease involving multiple organs, but in rare complement C1q, C1r, or C1s deficiencies, the disease can become largely monogenic. Increasing evidence point to intrinsic autoimmunogenicity of the nuclei. Necrotic cells release fragmented chromatins as nucleosomes and the alarmin HMGB1 is associated with the nucleosomes to activate TLRs and confer anti-chromatin autoimmunogenecity. In speckled regions, the major ANA targets Sm/RNP and SSA/Ro contain snRNAs that confer autoimmunogenecity to Sm/RNP and SSA/Ro antigens. Recently, three GAR/RGG-containing alarmins have been identified in the nucleolus that helps explain its high autoimmunogenicity. Interestingly, C1q binds to the nucleoli exposed by necrotic cells to cause protease C1r and C1s activation. C1s cleaves HMGB1 to inactive its alarmin activity. C1 proteases also degrade many nucleolar autoantigens including nucleolin, a major GAR/RGG-containing autoantigen and alarmin. It appears that the different nuclear regions are intrinsically autoimmunogenic by containing autoantigens and alarmins. However, the extracellular complement C1 complex function to dampen nuclear autoimmunogenecity by degrading these nuclear proteins. [ABSTRACT FROM AUTHOR]

Abstract Background Hepatitis C virus (HCV) infection is a serious public health concern due to its high prevalence and mortality rate. In chronic infection, HCV may induce autoimmune responses through the production of autoantibodies, including antinuclear antibodies (ANA). Methods We assessed the presence of ANA by indirect immunofluorescence using HEp-2 cells in 89 patients with chronic hepatitis C. We also collected data on epidemiological variables; clinical characteristics; and biochemical, hematological, molecular, and histopathological information from the patients to assess the impact of the presence of ANA in those patients. Results The prevalence of ANA in the patients was 20.2%, which was significantly higher than that found in healthy controls (2%). However, there was no association of this marker with epidemiological, clinical-laboratory, molecular or histopathological characteristics of hepatitis C, although a slightly higher prevalence of ANA was detected in women and in patients infected with subgenotype 1a. In a specific analysis, chronic HCV patients with the “rods and rings” cytoplasmic pattern had higher degrees of hepatic fibrosis than did ANA-negative patients. Conclusions The results confirm a greater predisposition to the presence of ANA in patients with HCV, which may be associated with a worse prognosis, especially in the presence of the “rods and rings” cytoplasmic pattern.

This article reported a 38-year-old female patient who was misdiagnosed as Sjögren’s syndrome complicated with type I distal renal tubular acidosis （dRTA） due to recurrent hypokalemia, alkaline urine, elevated urinary potassium, positive antinuclear body（ANA）, and positive anti-SSA antibody. The diagnosis of Sjögren’s syndrome was then excluded because the patient had no obvious dry mouth or dry eyes, and the results of unstimulating saliva flow rate, corneal fluorescence staining, Schirmer secretion test, or labial gland biopsy were all negative. The clinical manifestations, such as metabolic alkalosis, hypochloremia, hypomagnesemia and low urinary calcium,could not support the diagnosis of dRTA. The patient presented with severe hypomagnesemia and a Trousseau sign, then Gitelman syndrome was finally confirmed based on genetic testing. Therefore, the diagnosis and treatment of this case prompted that for patients with recurrent hypokalemia and positive anti-SSA antibody, clinicians should make differential diagnosis based on the acid-base imbalance and the electrolyte disturbance at first, instead of paying too much attention to autoantibodies and Sjögren’s syndrome, to avoid being misled by the ANA and anti-SSA antibody.

• AIH shows a predominance of AC1 pattern, while PBC is associated with AC6-AC7 and AC11-AC12 nuclear dots, and AC21 patterns. • AC21 pattern strongly correlates with PBC and CCH and may be a marker for distinguishing hepatic pathologies. • Increased ALP and GGT levels in AILD patients exhibiting AC11, AC12, and AC21 ANA patterns could provide prognistic information. This study aims to explore the clinical significance of antinuclear antibodies (ANA) patterns in liver diseases. We included 396 patients with a request for ANA testing for suspected autoimmune liver disease (AILD). For each patient, we collected demographical, clinical, and laboratory data. Among the patients, 33% had AILD, predominantly aiutoimmune hepatitis (AIH). The AC1 pattern was significantly more prevalent in AIH patients, while the AC21 pattern was strongly associated with primary biliary cholangitis (PBC). AC4-AC5 patterns were less frequent in AIH and PBC patients but more common in non-alcoholic hepatitis. Elevated alkaline phosphatase and gamma-glutamyl transferase levels were observed in AILD patients with AC11, AC12, and AC21 patterns. These findings highlight the different distribution of ANA patterns in liver diseases, with specific patterns showing strong associations with distinct liver conditions. [ABSTRACT FROM AUTHOR]