The Clinical Relevance of Anti-DFS70 Autoantibodies

• Published in: Clinical Reviews in Allergy & Immunology Vol. 52; no. 2; pp. 202 - 216
• Main Authors: Conrad, Karsten, Röber, Nadja, Andrade, Luis E. C., Mahler, Michael
• Format: Journal Article Book Review
• Language: English
• Published: New York Springer US 01-04-2017; Springer; Springer Nature B.V
• Subjects: Adaptor Proteins, Signal Transducing - immunology; Allergology; Antibodies, Antinuclear - immunology; Autoantibodies; Autoantibodies - immunology; Autoantigens - immunology; Autoimmune Diseases - diagnosis; Autoimmune Diseases - immunology; Autoimmunity; Biomarkers - analysis; Fluorescent antibody technique; Humans; Immunology; Internal Medicine; Medicine; Medicine & Public Health; Transcription Factors - immunology; Anti-DFS70 antibodies; Diagnostics; ANA-associated rheumatic diseases; Antinuclear antibodies
• ISSN: 1080-0549; 1559-0267
• DOI: 10.1007/s12016-016-8564-5

Despite all the progress in the establishment of specific autoantibody assays, screening for antinuclear antibodies (ANA) by indirect immunofluorescence on HEp-2 cells for quality-oriented laboratory diagnosis of ANA associated rheumatic diseases (AARD) remains indispensable but is not without limitations. Recent data on the relevance of the dense fine speckled (DFS) pattern and anti-DFS70 antibodies disclosed novel possibilities to optimize the serological stepwise diagnostics of AARD. The DFS pattern on HEp-2 cells is well differentiated from the classic “homogeneous” ANA pattern associated with dsDNA antibodies. This is the most frequent pattern in high titer ANA-positive healthy persons. The most characteristic ANA specificity associated with DFS pattern is the anti-DFS70 antibody (synonym LEDGF antibody). The prevalence of anti-DFS70 antibodies in AARD patients is significantly lower compared with the prevalence in ANA-positive healthy persons. There is a negative association between anti-DFS70 antibodies and AARD, especially if no concomitant AARD-specific autoantibodies are found. Isolated anti-DFS70 antibodies are detectable in less than 1 % of AARD but are detectable in 2–22 % of healthy persons. In the presence of an isolated anti-DFS70 antibody, the posttest probability for AARD is reduced significantly. The significance of anti-DFS70 antibodies as a criterion that helps to exclude AARD is also confirmed by follow-up studies on anti-DFS70 antibodies of positive, healthy individuals, who did not develop any AARD during a 4 year observation period. Consequently, anti-DFS70 antibodies are valuable novel biomarkers for better interpretation of positive ANA in cases of negative AARD-associated autoantibodies and should be integrated in modified test algorithms to avoid unnecessary referrals and examinations of ANA-positive persons.