Antineutrophil cytoplasmic antibodies (ANCA) testing: detection methods and clinical application

摘要

Antineutrophil cytoplasmic antibodies (ANCA) are considered the diagnostic biomarker of some necrotising vascu-litis such as granulomatosis with poly-angiitis (GPA), microscopic polyangiitis (MPA) and, to a lesser extent, eosino-philic granulomatosis with polyangiitis (EGPA).According to the current recommendations, combining indirect immunofluo-rescence and proteinase 3 (PR3) and myeloperoxidase (MPO) antigen specific immunometric assays, in the proper clinical setting, assures the best diagnostic specificity. When such conditions are satisfied, ANCA are detected in up to 90% of patients with active generalised GPA and MPA and in about 40% of patients with EGPA. Cytoplasmic ANCA (C-ANCA) with specificity for PR3 are usually found in patients with GPA whereas perinuclear ANCA (P-ANCA) in patients with MPA and EGPA. However, ANCA antigen specificity is more closely associated with disease phenotype and prognosis than clinical diagnosis. The clinical value of serial ANCA testing in monitoring disease activity is still debated. Recently, new promising developments in methodology and techniques (computer-based image analysis of imuno-fluorescence patterns, novel generation of PR3-/MP0-ANCA immunometric assays and multiplex technology) have been proposed but studies comparing the performances of the different assays are scarce.