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Immunological Labratory Tests

Immunological Labratory Tests



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ANCA Presentation Transcript

  • 1. Prepared by Dr. Anees Al-Saadi April 2008Clinical immunology principles and practice RICH, 2nd editionMethodological update ›,
  • 2.  ANCA auto antibodies related to inflammatory disorders. van der Woude et al. in 1985 showed ANCA related to Wegeners granulomatosis. Methodological update ANCA.mht
  • 3.  Enzymes used in the defense against bacteria found in WBCs granules. Most reactivities were found molecular weights ≈29kD & l4OkD. Methodological update ANCA.mht
  • 4.  Two main enzymes in ANCA take part in the killing of bacteria by:  Proteinase 3 (PR3) showing cANCA pattern.  Myeloperoxidase (MPO) showing pANCA pattern. Methodological update ANCA.mht
  • 5.  Molecular weight of 29kD antigen:  Which is proteinase .  PR3 is a single protein chain that is glycosylated.  Is very similar to other serine proteases like elastase and cathepsin G. Methodological update ANCA.mht
  • 6.  Myeloperoxidase (MPO)  MPO is a dimer molecular weight of l4OkD consisting of one heavy & light chain .  It is glycosylated with mannose oligosaccharide chains.  Is cleaved by heating and has a green color . Methodological update ANCA.mht
  • 7.  Many other antigens have been described to be associated with ANCA,  i.e. elastase,  lactoferrin cathepsin G,  BPI  defensins, HMG1/2, catalase etc. Methodological update ANCA.mht
  • 8. Methodological update ANCA.mht
  • 9.  It is poorly understood how ANCA are developed. Two possible mechanisms of ANCA development are postulated:  Theory of molecular mimicry.  Theory of defective apoptosis. Methodological update ANCA.mht
  • 10.  Theory of molecular mimicry.  Theory of defective apoptosis.  Superantigens have the  ANCA may be developed power to stimulate a strong either via ineffective immune response . THEY apoptosis or ineffective have regions that resemble removal of apoptotic cell self-antigens – this is the fragments, leading to the theory of molecular mimicry. exposure of the immune system to molecules  classical example in post normally sequestered inside group A streptococcal the cells. This theory solves rheumatic heart disease, the paradox of how it could where there is similarity be possible for antibodies to between M proteins of be raised against the Streptococcus pyogenes to intracellular antigenic cardiac myosin and laminin. targets of ANCA.[4] Methodological update ANCA.mht
  • 11. p-ANCA, show a perinuclear staining patternc-ANCAs, show a diffusely granular,cytoplasmic staining patternAtypical that develop against antigens other than MPO orPR3 will occasionally result in patchy staining Methodological update ANCA.mht
  • 12. cANCA disease : pANCA disease association: Atypical association• Primary vasculitis • Primary vasculitis • Primary Microscopic polyangitis sclerosing Churg-Strauss syndrome • Wegeners cholangitis Polyarteritis nodosa granulomatosis • Primary biliary• Collagenosis • Microscopic cirrhosis Feltys syndrome polyangitis SLE • Autoimmune Rheumatiod arthritis • Churg-Strauss hepatitis Sjögrens syndrome syndrome. • SLE• Chronic inflammatory bowel disease • RA• Chronic liver disease Primary sclerosing cholangitis Methodological update ANCA.mht
  • 13. Definition Wegeners granulomatosis is a uncommon type of (vasculitis). It classically involves the lungs, the nasal passages (sinuses), and the kidneys. Nasal or oral inflammation:Clinical Lungs: abnormal chest X-ray .Picture Kidneys: with microhematuria or red cell casts Biopsy: granulomatous inflammation Initial treatment is corticosteroids and oral CYC. On remission treatment is changed to azathioprineTreatment or methotrexate. Duration of therapy should be at least one year.
  • 14. • Renal GN 79%.Definition Features Treatment • daily/ • May progress to irreversible rapid intermittent progressive renal I.v • Microscopic damage If not cyclophosph polyangiitis treated . amide 6- (MPA) is • Weight loss 12months . vasculitis of 73%. small vessels. • Methotraxat • Fever 55%. e or • Pulmonary: azathioprine alveolar in remission stage of the hemorrhage. disease. Methodological update ANCA.mht
  • 15. Definition Features Treatment • Treatment is • 1. A prodromal prednisone for mild• An eosinophil- phase cases , systemic rich form of • Allergic disease. involvement granulomatous cyclophosphamide inflammation • 2. Eosinophilia- to be added. mainly tissue infiltration involving phase: • Clinical remission • Eosinophilia. seen in 90% of the respiratory tract cases and • 3. Vasculitic phase : recurrences seen in• Asthma and 25% • Systemic eosinophilia. necrotizing vasculitis . Methodological update ANCA.mht
  • 16.  The application of ANCA useful in both the diagnosis and monitoring of disease activity . Applications of Antineutrophil Cytoplasmic Antibody.mht
  • 17. Microscopic Wegeners Churg- Polyangiitis Granuloma StraussANCA tosis SyndromePR3-ANCA 40 80% 10%MPO-ANCA 50% 20% 60%Negative 10% 5% 30% Methodological update ANCA.mht
  • 18. Prevalence of ANCA in renal vasculitis Type of renal ANCA test positivity (%) vasculitis P-ANCA C-ANCA Polyarteritis nodosa 10-20% 10-20% Microscopic polyangitis 50-80% 10-20%Wegener`s granulomatosis 10-20% 80-90%Necrotizing and crescentic 50-80% 10-20% GN Clinical immunology principles and practice RICH, 2nd edition
  • 19.  In Juvenile rheumatoid arthritis :  Occur in 10-20% of active conditions.  Showing atypical pattern.  Does not correlate with clinical parameters. Clinical immunology principles and practice RICH, 2nd edition pr
  • 20.  Autoimmune hepatitis :  Showing p-ANCA pattern.  Seen in 65%-96% in AIH-1 not in AIH-2.  Not correlated with disease activity and liver function test. Clinical immunology principles and practice RICH, 2nd edition pr
  • 21.  Inflammatory bowel disease:  Showing p-ANCA pattern more seen in UC than CD.  Not been used for distinguishing the 2 diseases . Clinical immunology principles and practice RICH, 2nd edition pr
  • 22.  Drug-induced ANCA:  Picture of ANCA-associated vasculitis (AAV).  Propylthiouracil is a well-documented cause of drug- induced AAV.  Other drugs: ▪ Hydralazine,sulfasalazine. ▪ minocycline, D-penicillamine. ▪ ciprofloxacin, phenytoin. ▪ clozapine, allopurinol, and pantoprazole. AccessMedicine - ANCA induced by drugs.mht
  • 23.  Usually of p-ANCA pattern. Slow resolving condition. Good responding to low dose of immunosuppressive agents. AccessMedicine - ANCA induced by drugs.mht
  • 24.  Prognostic significance of ANCAs:  Increasing ANCA titers do not reliably predict relapse.  Nevertheless, many clinicians assume that ANCA titers are reliable indicators of disease activity !. ANCAClinical Applications of Antineutrophil Cytoplasmic Antibody.mht
  • 25.