title: Routine immunofluorescence detection of Ro/SS-A autoantibody using HEp-2 cells transfected with human 60 kDa Ro/SS-A.
abstract: BACKGROUND
  Ro/SS-A autoantibodies associated with systemic lupus erythematosus (SLE) and Sjögren syndrome may be missed during routine screening for antinuclear autoantibodies (ANA) by immunofluorescence using HEp-2 cells.
  
  
  OBJECTIVE
  To investigate the use of HEp-2 cells transfected with human 60 kDa Ro/SS-A for routine detection of these antibodies.
  
  
  METHODS
  10,500 sera were screened at a dilution of 1:200 for Ro/SS-A antibodies, identified by intense immunofluorescence staining in 10-15% of hyperexpressing cells of either the nucleus and nucleolus combined or the nucleus alone.
  
  
  RESULTS
  Ro/SS-A antibodies were identified in 160/2100 ANA positive sera (8%), of which seven were ANA negative (titre < 200) and 33 had weak ANA titres (200) in 85-90% of non-hyperexpressing "background" cells. Enzyme linked immunosorbent assay (ELISA) confirmed the presence of Ro/SS-A antibodies in 110 newly diagnosed Ro/SS-A positive sera. Of these, 50 reacted with Ro/SS-A, 51 with Ro/SS-A and La/SS-B, and nine with Ro/SS-A and other extractable nuclear antigen (ENA) specificities. Fifteen sera which did not show Ro/SS-A antibodies by immunofluorescence tested positive for Ro/SS-A by immunodiffusion, counter-immunoelectrophesis, or ELISA; of these, 14 had ANA titres > 200. Clinical data from 95 Ro/SS-A positive patients showed that 52% had SLE, 24% Sjögren syndrome, 8% rheumatoid arthritis, and 16% other diseases.
  
  
  CONCLUSIONS
  (1) HEp-2 cells transfected with human 60 kDa Ro/SSA are useful for routine immunofluorescence detection for Ro/SS-A antibodies with a positive predictive value of 100%; (2) sera positive for Ro/SS-A antibodies by immunofluorescence should be tested for ENA by other methods because > 50% of these sera will have another ENA reactivity in addition to Ro/SS-A; (3) detection of Ro/SS-A by immunofluorescence may be missed in the presence of high titre ANAs; (4) with a detection sensitivity of 91%, a negative immunofluorescence results for Ro/SS-A does not exclude the presence of this autoantibody.
authors.affiliation: Department of Pathology and Immunology, Monash University Medical School, Prahran, Victoria, Australia.
authors.forename: W
authors.initials: W
authors.lastname: Pollock
authors.forename: B H
authors.initials: BH
authors.lastname: Toh
mesh_terms: D000974:Antibodies, Antinuclear / Q000097:blood*; D001324:Autoantigens / Q000276:immunology*; D001327:Autoimmune Diseases / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D002460:Cell Line; D004797:Enzyme-Linked Immunosorbent Assay; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis*; D020733:RNA, Small Cytoplasmic; D012261:Ribonucleoproteins / Q000276:immunology*; D012680:Sensitivity and Specificity; D012859:Sjogren's Syndrome / Q000175:diagnosis*; D014162:Transfection; D000099207:SS-A Antigen
chemical_list: D000974:Antibodies, Antinuclear; D001324:Autoantigens; D015415:Biomarkers; D020733:RNA, Small Cytoplasmic; D012261:Ribonucleoproteins; D000099207:SS-A Antigen; C116006:RO60 protein, human