Abstract
Anti-dsDNA antibodies are a heterogeneous group of antibodies, quite specific for SLE. Their variability is related to the assay used, the immunoglobulin class secondary antibody, and the dsDNA source. The standardization of measuring anti-dsDNA antibodies is still poor and different methods yield different results. Several novel technologies were developed during the last decades that represent viable alternatives to the traditional methods such as the chemiluminescent immunoassay (CIA) and multiplex flow immunoassay (MFI). Additionally, positive results for anti-dsDNA antibodies can be detected in patients with inflammatory arthritis (IA) treated with different biologics reducing its clinical specificity for SLE. Anti-dsDNA antibody levels were evaluated in 246 patient samples: 70 SLE and 176 disease control (including 96 IA during treatment with different biologics), using three enzyme immunoassays (indirect enzyme immunoassay, Bio-Rad Laboratories; chemiluminescent immunoassay, Inova Diagnostics; multiplex flow immunoassay, Bio-Rad Laboratories) and three Crithidia luciliae immunofluorescence tests (CLIFT) (Euroimmun AG, Bio-Rad Laboratories, INOVA Diagnostics). Diagnostic performances were assessed both including and excluding the IA patients. Agreements, measured by the Cohen’s Kappa between all methods, ranged from moderate to substantial (0.47–0.68). The clinical sensitivities for the anti-dsDNA antibody tests varied from 5.7% by CLIFT A up to 33.3% provided by EIA while the clinical specificities varied from 89.8% by MFI to 98.9% provided by CLIFT B and C. Newer technologies, such as MFI and CIA, showed great potential as a diagnostic application. Significant variations among anti-dsDNA antibody assays were observed confirming the lack of standardization.
Similar content being viewed by others
References
Gualtierotti R, Biggioggero M, Penatti AE, Meroni PL. Updating on the pathogenesis of systemic lupus erythematosus. Autoimmun Rev. 2010;10:3–7.
Giles BM, Boackle SA. Linking complement and anti-dsDNA antibodies in the pathogenesis of systemic lupus erythematosus. Immunol Res. 2013;55:10–21.
Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1982;25:1271–7.
Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40:1725.
Petri M, Orbai AM, Alarcón GS, Gordon C, Merrill JT, Fortin PR, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2012;64:2677–86.
Field AK, Davies ME, Tytell AA. Determination of antibodies to double–stranded RNA by enzyme-linked immunosorbent assay (ELISA). Proc Soc Exp Biol Med. 1980;164:524–9.
Eilat D, Hochberg M, Pumphrey J, Rudikoff S. Monoclonal antibodies to DNA and RNA from NZB/NZW F1 mice: antigenic specificities and NH2 terminal amino acid sequences. J Immunol. 1984;133:489–94.
Infantino M, Meacci F, Bentow C, Martis P, Benucci M, Afeltra A, et al. Clinical comparison of QUANTA Flash dsDNA chemiluminescent immunoassay with four current assays for the detection of anti-dsDNA autoantibodies. J Immunol Res. 2015;2015:902821.
Almeida González D, Roces Varela A, Marcelino Rodríguez I, González Vera A, Delgado Sánchez M, Aznar Esquivel A, et al. Anti-dsDNA antibodies in systemic lupus erythematosus: a combination of two quantitative methods and the ANA pattern is the most efficient strategy of detection. J Immunol Methods. 2015;427:30–5.
de Leeuw K, Bungener L, Roozendaal C, Bootsma H, Stegeman CA. Auto-antibodies to double-stranded DNA as biomarker in systemic lupus erythematosus: comparison of different assays during quiescent and active disease. Lupus. 2013;22:1169–73.
Hillebrand JJ, Bernelot Moens HJ, Mulder AH. Changes in Farr radioimmunoassay and EliA fluorescence immunoassay anti-dsDNA in relation to exacerbation of SLE. Lupus. 2013;22:1169–73.
Shovman O, Gilburd B, Barzilai O, Shinar E, Larida B, Zandman-Goddard G, et al. Evaluation of the BioPlex 2200 ANA screen: analysis of 510 healthy subjects: incidence of natural/predictive autoantibodies. Ann N Y Acad Sci. 2005;1050:380–8.
Shovman O, Gilburd B, Zandman-Goddard G, Yehiely A, Langevitz P, Shoenfeld Y. Multiplexed AtheNA multi-lyte immunoassay for ANA screening in autoimmune diseases. Autoimmunity. 2005;38:105–9.
Mahler M, Radice A, Yang W, Bentow C, Seaman A, Bianchi L, et al. Development and performance evaluation of novel chemiluminescence assays for detection of anti-PR3 and anti-MPO antibodies. Clin Chim Acta. 2012;413:719–26.
Infantino M, Bentow C, Seaman A, Benucci M, Atzeni F, Sarzi-Puttini P, et al. Highlights on novel technologies for the detection of antibodies to Ro60, Ro52, and SS-B. Clin Dev Immunol. 2013;2013:978202.
Antico A, Platzgummer S, Bassetti D, Bizzaro N, Tozzoli R, Villalta D. Diagnosing systemic lupus erythematosus: new-generation immunoassays for measurement of anti-dsDNA antibodies are an effective alternative to the Farr technique and the Crithidia luciliae immunofluorescence test. Lupus. 2010;19:906–12.
Pérez D, Gilburd B, Cabrera-Marante Ó, Martínez-Flores JA, Serrano M, Naranjo L, et al. Predictive autoimmunity using autoantibodies: screening for anti-nuclear antibodies. Clin Chem Lab Med. 2017;
Ghirardello A, Villalta D, Morozzi G, Afeltra A, Galeazzi M, Gerli R, et al. Evaluation of current methods for the measurement of serum anti double-stranded DNA antibodies. Ann N Y Acad Sci. 2007;1109:401–6.
Egner W. The use of laboratory tests in the diagnosis of SLE. J Clin Pathol. 2000;53:424–32.
Rouquette AM, Desgruelles C. Detection of antibodies to dsDNA: an overview of laboratory assays. Lupus. 2006;15:403–7.
Isenberg DA, Manson JJ, Ehrenstein MR, Rahman A. Fifty years of anti-ds DNA antibodies: are we approaching journey’s end? Rheumatology. 2007;46:10526.
Fiegel F, Buhl A, Jaekel HP, Werle E, Schmolke M, Ollert M, et al. Autoantibodies to double-stranded DNA intermethod comparison between four commercial immunoassays and a research biosensor-based device. Lupus. 2010;19:95764.
Smeenk R, van der Lelij G, Aarden L. Measurement of low avidity anti-dsDNA by the Crithidia luciliae test and the PEG assay. Clin Exp Immunol. 1982;49:603–10.
Agmon-Levin N, Damoiseaux J, Kallenberg C, Sack U, Witte T, Herold M, et al. International recommendations for the assessment of autoantibodies to cellular antigens referred to as anti-nuclear antibodies. Ann Rheum Dis. 2014;73:17–23.
Ghirardello A, Villalta D, Morozzi G, Afeltra A, Galeazzi M, Gerli R, et al. Diagnostic accuracy of currently available anti-double-stranded DNA antibody assays. An Italian multicentre study. Clin Exp Rheumatol. 2011;29:50–6.
De Rycke L, Baeten D, Kruithof E, Van den Bosch F, Veys EM, De Keyser F. Infliximab, but not etanercept, induces IgM anti-double-stranded DNA autoantibodies as main antinuclear reactivity: biologic and clinical implications in autoimmune arthritis. Arthritis Rheum. 2005;52:2192–201.
Charles PJ, Smeenk RJ, De Jong J, Feldmann M, Maini RN. Assessment of antibodies to double-stranded DNA induced in rheumatoid arthritis patients following treatment with infliximab, a monoclonal antibody to tumor necrosis factor alpha: findings in open-label and randomized placebo-controlled trials. Arthritis Rheum. 2000;43:2383–90.
Eriksson C, Engstrand S, Sundqvist KG, Rantapää-Dahlqvist S. Autoantibody formation in patients with rheumatoid arthritis treated with anti-TNF alpha. Ann Rheum Dis. 2005;64:403–7.
Caramaschi P, Bambara LM, Pieropan S, Tinazzi I, Volpe A, Biasi D. Anti-TNFalpha blockers, autoantibodies and autoimmune diseases. Joint Bone Spine. 2009;76:333–42.
Infantino M, Grossi V, Benucci M, Li Gobbi F, Damiani A, Manfredi M. The impact of biological treatments on the anti-dsDNA and anti-nucleosome tests. Lupus. 2017;1:961203317709344.
Visser H, le Cessie S, Vos K, Breedveld FC, Hazes JM. How to diagnose rheumatoid arthritis early: a prediction model for persistent (erosive) arthritis. Arthritis Rheum. 2002;46:357–65.
Borchers AT, Keen CL, Gershwin ME. Drug-induced lupus. Ann N Y Acad Sci. 2007;1108:166–82.
Moder KG, Wener MH, Weisman MH, Ishimori ML, Wallace DJ, Buckeridge DL, et al. Measurement of antinuclear antibodies by multiplex immunoassay: a prospective, multicenter clinical evaluation. J Rheumatol. 2007;34(5):978–86.
Mahler M, Bentow C, Serra J, Fritzler MJ. Detection of autoantibodies using chemiluminescence technologies. Immunopharmacol Immunotoxicol. 2016;38:14–20.
Bentow C, Lakos G, Martis P, Wahl E, Garcia M, Viñas O, et al. International multi-center evaluation of a novel chemiluminescence assay for the detection of anti-dsDNA antibodies. Lupus. 2016;25:864–72.
Bertsias GK, Pamfil C, Fanouriakis A, Boumpas DT. Diagnostic criteria for systemic lupus erythematosus: has the time come? Nat Rev Rheumatol. 2013;9:687–94.
Mahler M, Meroni PL, Bossuyt X, Fritzler MJ. Current concepts and future directions for the assessment of autoantibodies to cellular antigens referred to as anti-nuclear antibodies. J Immunol Res. 2014;2014:315179.
Mahler M, Dervieux T. Comments on recent advances and recommendations for the assessment of autoantibodies to cellular antigens referred as antinuclear antibodies. Ann Rheum Dis. 2014;73:e36.
Enocsson H, Sjöwall C, Wirestam L, Dahle C, Kastbom A, Rönnelid J, et al. Four anti-dsDNA antibody assays in relation to systemic lupus erythematosus disease specificity and activity. J Rheumatol. 2015;42:817–25.
Biesen R, Dähnrich C, Rosemann A, Barkhudarova F, Rose T, Jakob O, et al. Anti-dsDNA-NcX ELISA: dsDNA-loaded nucleosomes improve diagnosis and monitoring of disease activity in systemic lupus erythematosus. Arthritis Res Ther. 2011;13:R26.
Launay D, Schmidt J, Lepers S, Mirault T, Lambert M, Kyndt X, et al. Comparison of the Farr radioimmunoassay, 3 commercial enzyme immunoassays and Crithidia luciliae immunofluorescence test for diagnosis and activity assessment of systemic lupus erythematosus. Clin Chim Acta. 2010;411:959–64.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Infantino, M., Manfredi, M., Merone, M. et al. Analytical variability in the determination of anti-double-stranded DNA antibodies: the strong need of a better definition of the old and new tests. Immunol Res 66, 340–347 (2018). https://doi.org/10.1007/s12026-018-8992-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12026-018-8992-9