Autoimmunity and lymphoproliferation markers in naïve HCV-RNA positive patients without clinical evidences of autoimmune/lymphoproliferative disorders.
BACKGROUND
HCV can lead to both chronic liver disease and B-cell lymphoproliferative disorders. A strong association exists between HCV and mixed cryoglobulinaemia (MC).


METHODS
Anti-nuclear antibodies (ANA), rheumatoid factor Ig-G (RF-IgG), free light chain κ and λ (FLC-κ, FLC-λ) levels and κ/λ ratio were evaluated in 50/420 subjects unexpectedly resulted anti-HCV positive after routine screenings for non-hepathological procedures.


RESULTS
Three/fifty patients had HCV-RNA undetectable in the serum and were excluded from the analysis. Thirty-nine/fifty patients had laboratory evidence of circulating cryoglobulins without liver disease and MC-related symptoms. Among them, 17 resulted ANA-positive. The mean cryocrit was higher in ANA-positive patients, while no other demographic/clinical differences were observed between the groups. Significantly higher levels of RF-IgG were observed in ANA-positive vs ANA-negative patients. κ and λ FLC were higher in ANA-positive patients. A ROC analysis, based on ANA-positivity vs ANA-negativity, confirmed a high sensitivity and specificity of RF-IgG test.


CONCLUSIONS
Published data concerning MC come mostly from symptomatic vasculitis. We analyzed HCV-patients without MC symptoms, founding cryoglobulins in the majority of them. The increased levels of FR-IgG and FLC in CGs-ANA-positive patients, suggest these test could be used to identify a state of silent autoimmune and/or lymphoproliferative condition before the transition to a frank disease in naïve HCV-patients without symptoms of extrahepatic manifestations.
Department of Laboratory Medicine of the Catholic University of the Sacred Heart, Rome, Italy.
Francesca
F
Gulli
Department of Laboratory Medicine of the Catholic University of the Sacred Heart, Rome, Italy.
Umberto
U
Basile
Center for Systemic Manifestations of Hepatitis Viruses (MaSVE), Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. Electronic address: laura.gragnani@unifi.it.
Laura
L
Gragnani
Center for Systemic Manifestations of Hepatitis Viruses (MaSVE), Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Elisa
E
Fognani
Department of Laboratory Medicine of the Catholic University of the Sacred Heart, Rome, Italy.
Cecilia
C
Napodano
Department of Laboratory Medicine of the Catholic University of the Sacred Heart, Rome, Italy.
Luigi
L
Colacicco
Institute of Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy.
Luca
L
Miele
Institute of Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy.
Nicoletta
N
De Matthaeis
Institute of Microbiology, Catholic University of the Sacred Heart, Rome, Italy.
Paola
P
Cattani
Center for Systemic Manifestations of Hepatitis Viruses (MaSVE), Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Anna Linda
AL
Zignego
Institute of Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy.
Gian Ludovico
GL
Rapaccini
D000465:Algorithms; D000974:Antibodies, Antinuclear / Q000097:blood*; D015551:Autoimmunity; D015415:Biomarkers / Q000097:blood; D003449:Cryoglobulinemia / Q000097:blood*; D003450:Cryoglobulins / Q000145:classification; D005260:Female; D016174:Hepacivirus / Q000302:isolation & purification; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007147:Immunoglobulin Light Chains / Q000097:blood*; D008232:Lymphoproliferative Disorders / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012217:Rheumatoid Factor / Q000097:blood*
D000974:Antibodies, Antinuclear; D015415:Biomarkers; D003450:Cryoglobulins; D007074:Immunoglobulin G; D007147:Immunoglobulin Light Chains; D012217:Rheumatoid Factor
Antinuclear antibodies (ANA); Cryoglobulins (CGs); Hepatitis C virus (HCV); Rheumatoid factor (RF)