Antineutrophil cytoplasmic autoantibodies and clinical phenotype in patients with Churg-Strauss syndrome
2012; Elsevier BV; Volume: 130; Issue: 6 Linguagem: Inglês
10.1016/j.jaci.2012.09.031
ISSN1097-6825
AutoresRenato Alberto Sinico, Paolo Bottero, Loı̈c Guillevin,
Tópico(s)Urticaria and Related Conditions
ResumoIn a recent article, Healy et al1Healy B. Bibby S. Steele R. Weatherall M. Nelson H. Beasley R. Antineutrophilcytoplasmic autoantibodies and myeloperoxidase autoantibodies in clinical expression of Churg-Strauss syndrome.J Allergy Clin Immunol. 2012; ([Epub ahead of print])PubMed Google Scholar investigated the relationship between antineutrophil cytoplasmic autoantibody (ANCA) status and clinical expression of Churg-Strauss syndrome (CSS) in a case series derived from the US Food and Drug Administration's adverse events database. There were 38 (40.9%) of 93 cases with positive ANCA results, of which a positive ELISA result was reported in 15 cases, all of which included positive anti-myeloperoxidase (MPO) results. ANCA negativity was associated with an increased proportion of cardiac involvement, gastrointestinal involvement, pulmonary infiltrates, the outcome of a life-threatening event or death, and a decreased proportion of peripheral neuropathy when compared with anti-MPO–positive cases. They concluded that the presence or absence of MPO-ANCA influences the clinical expression and disease severity in patients with CSS. Their findings are in substantial agreement with those reported by Sablé-Fourtassou et al2Sablé-Fourtassou R. Cohen P. Mahr A. Pagnoux C. Mouthon L. Jayne D. et al.Antineutrophil cytoplasmic antibodies and the Churg-Strauss syndrome.Ann Intern Med. 2005; 143: 632-638Crossref PubMed Scopus (586) Google Scholar and Sinico et al3Sinico R.A. Di Toma L. Maggiore U. Bottero P. Radice A. Tosoni C. et al.Prevalence and clinical significance of antineutrophil cytoplasmic antibodies in Churg-Strauss syndrome.Arthritis Rheum. 2005; 52: 2926-2935Crossref PubMed Scopus (564) Google Scholar in terms of ANCA prevalence (40.9% vs 38% and 37.6%, respectively) and of clinical associations. Healy et al1Healy B. Bibby S. Steele R. Weatherall M. Nelson H. Beasley R. Antineutrophilcytoplasmic autoantibodies and myeloperoxidase autoantibodies in clinical expression of Churg-Strauss syndrome.J Allergy Clin Immunol. 2012; ([Epub ahead of print])PubMed Google Scholar recognized that their results are mainly confirmatory of previous reports supporting the hypothesis that ANCA status segregates with clinical phenotype, but outlined that this was the only case series investigating the clinical expression of CSS in relation to ANCA in which a positive indirect immunofluorescence (IIF) assay result required confirmation by ELISA. We cannot agree with this statement. We are well aware that international guidelines recommend that positive IIF ANCA results should be verified by using an ELISA.4Savige J. Gillis D. Benson E. Davies D. Esnault V. Falk R.J. et al.International consensus statement on testing and reporting of antineutrophil cytoplasmic antibodies (ANCA).Am J Clin Pathol. 1999; 111: 507-513Crossref PubMed Scopus (549) Google Scholar, 5Radice A. Bianchi L. Sinico R.A. Anti-neutrophil cytoplasmic autoantibodies: methodological aspects and clinical significance in systemic vasculitis.Autoimmune Rev. 2012; ([Epub ahead of print])Google Scholar Indeed, in the article by Sinico et al,3Sinico R.A. Di Toma L. Maggiore U. Bottero P. Radice A. Tosoni C. et al.Prevalence and clinical significance of antineutrophil cytoplasmic antibodies in Churg-Strauss syndrome.Arthritis Rheum. 2005; 52: 2926-2935Crossref PubMed Scopus (564) Google Scholar the presence of ANCAs was determined in all 93 patients at the time of diagnosis by using IIF on ethanol-fixed granulocytes and antigen-specific proteinase 3 and MPO ELISAs. Antigen-specific ELISAs were performed on all serum samples. Moreover, ANCA serology was tested first in each hospital and rechecked centrally in a laboratory that participated in the European Commission/Community Bureau of Reference study for ANCA assay standardization.3Sinico R.A. Di Toma L. Maggiore U. Bottero P. Radice A. Tosoni C. et al.Prevalence and clinical significance of antineutrophil cytoplasmic antibodies in Churg-Strauss syndrome.Arthritis Rheum. 2005; 52: 2926-2935Crossref PubMed Scopus (564) Google Scholar ANCAs were present, as determined by using IIF, in 35 (37.6%) of 93 patients; of those, 30 had positive anti-MPO and 3 had positive anti–proteinase 3 results, with only 2 with negative results by means of ELISA.3Sinico R.A. Di Toma L. Maggiore U. Bottero P. Radice A. Tosoni C. et al.Prevalence and clinical significance of antineutrophil cytoplasmic antibodies in Churg-Strauss syndrome.Arthritis Rheum. 2005; 52: 2926-2935Crossref PubMed Scopus (564) Google Scholar In the article by Sablé-Fourtassou et al,3Sinico R.A. Di Toma L. Maggiore U. Bottero P. Radice A. Tosoni C. et al.Prevalence and clinical significance of antineutrophil cytoplasmic antibodies in Churg-Strauss syndrome.Arthritis Rheum. 2005; 52: 2926-2935Crossref PubMed Scopus (564) Google Scholar “ELISA assay showed that serum specimens of 34 of 39 patients with perinuclear ANCA (5 patients’ specimens were not tested) had anti-MPO specificity.”2Sablé-Fourtassou R. Cohen P. Mahr A. Pagnoux C. Mouthon L. Jayne D. et al.Antineutrophil cytoplasmic antibodies and the Churg-Strauss syndrome.Ann Intern Med. 2005; 143: 632-638Crossref PubMed Scopus (586) Google Scholar More recently, similar results were obtained by Baldini et al6Baldini C. Della Rossa A. Grossi S. Catarsi E. Talarico R. d'Ascanio A. et al.Churg-Strauss syndrome: outcome and long-term follow-up of 38 patients from a single Italian centre.Reumatismo. 2009; 61: 118-124PubMed Google Scholar and Oka et al,7Oka N. Kawasaki T. Matsui M. Shigematsu K. Unuma T. Sugiyama H. Two subtypes of Churg-Strauss syndrome with neuropathy: the roles of eosinophils and ANCA.Mod Rheumatol. 2011; 21: 290-295PubMed Google Scholar who found anti-MPO antibodies in 15 (39%) of 38 and 8 (36.4%) of 22 patients, respectively. Concerning peripheral neuropathy, it is true that it is less prevalent in patients with negative ANCA results,2Sablé-Fourtassou R. Cohen P. Mahr A. Pagnoux C. Mouthon L. Jayne D. et al.Antineutrophil cytoplasmic antibodies and the Churg-Strauss syndrome.Ann Intern Med. 2005; 143: 632-638Crossref PubMed Scopus (586) Google Scholar, 3Sinico R.A. Di Toma L. Maggiore U. Bottero P. Radice A. Tosoni C. et al.Prevalence and clinical significance of antineutrophil cytoplasmic antibodies in Churg-Strauss syndrome.Arthritis Rheum. 2005; 52: 2926-2935Crossref PubMed Scopus (564) Google Scholar, 6Baldini C. Della Rossa A. Grossi S. Catarsi E. Talarico R. d'Ascanio A. et al.Churg-Strauss syndrome: outcome and long-term follow-up of 38 patients from a single Italian centre.Reumatismo. 2009; 61: 118-124PubMed Google Scholar but more importantly, the pathogenetic mechanisms seem different in the 2 subgroups: possibly ANCA-related vascular fibrinoid necrosis and a toxic eosinophilic effect on nerve fibers that is independent of ANCA.7Oka N. Kawasaki T. Matsui M. Shigematsu K. Unuma T. Sugiyama H. Two subtypes of Churg-Strauss syndrome with neuropathy: the roles of eosinophils and ANCA.Mod Rheumatol. 2011; 21: 290-295PubMed Google Scholar In conclusion, Healy et al1Healy B. Bibby S. Steele R. Weatherall M. Nelson H. Beasley R. Antineutrophilcytoplasmic autoantibodies and myeloperoxidase autoantibodies in clinical expression of Churg-Strauss syndrome.J Allergy Clin Immunol. 2012; ([Epub ahead of print])PubMed Google Scholar confirm that ANCAs (mainly with specificity for MPO) are present in approximately 40% of patients with CSS and that ANCA status correlates with organ involvement, even though some associations should be verified in more numerous case series. Antineutrophil cytoplasmic autoantibodies and myeloperoxidase autoantibodies in clinical expression of Churg-Strauss syndromeJournal of Allergy and Clinical ImmunologyVol. 131Issue 2PreviewThe clinical significance of antineutrophil cytoplasmic antibodies (ANCAs) in the phenotypic expression of Churg-Strauss syndrome (CSS) is uncertain. Full-Text PDF ReplyJournal of Allergy and Clinical ImmunologyVol. 130Issue 6PreviewWe appreciate the feedback from Sinico et al1 regarding our recent article on the relationship between antineutrophil cytoplasmic autoantibody (ANCA) status and the clinical phenotypes of Churg-Strauss syndrome (CSS).2 We would like to acknowledge at the outset the contribution of Sinico et al1 in this area of research. Full-Text PDF
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