ANTI-Ro/SSA 52 ANTIBODIES IN

AUTOIMMUNE DISEASES

Coordinator: Monica Copotoiu MD,PhD First author: Gabriela Mihai Coauthors: Isabela Micu, Mihaela Budianu, Andrea

Lőrincz

Defining criteria for autoimmune diseases

Witebsky's postulatesˡ:

1. An autoimmune reaction is identified in the form of autoantibody or cell-mediated immune reaction

2. The corresponding antigen is known3. An analogous response causes a similar disease

in experimental animals

ˡ Rose, N. R., C. Bona. 1993. Defining criteria for autoimmune diseases (Witebsky’s postulates revisited). Immunol. Today

Anti-Ro/SSA 52 antibodies(aSSA52)

• aSSA52 are one of the most frequently detected antibodies against Extractable Nuclear Antigen(ENA)ˡ

• Clinically,the presence of aSSA52 has been reported in various rheumatic diseases but also in other autoimmune diseases.

ˡ Ryusule Yoshimi et al. Clinical and Pathological Roles of Ro/SSA Autoantibody System. Clinical and Developmental Immunology Volume 2012

1

aSSA52 and Autoimmune diseases association

aSSA52 and AD association according to the literatureˡ

Polymyositis/Dermatomyositis (PM/DM)

Systemic Lupus Erythematosus (SLE)

Sjogren syndrome (SjS)

Undifferentiated connective tissue disease (UCTD)

Systemic Sclerosis (SSc)

Rheumatoid Arthritis (RA)

Neonatal Lupus Erythematosus (NLE)

Primary biliary cirrhosis (PBC)

Autoimmune Hepatitis I (AIH I)

ˡDefendenti C et al. Clinical and laboratory aspects of Ro/SSA-52 autoantibodies.Autoimmune Rev 2011 Jan

aSSA52 detection.Extractable Nuclear Antigen (ENA) panel

Anti-Rnp/Sm Anti-Cenp B

Anti-Sm Anti-PCNA

Anti-SSA(Ro) Anti-DsDNA

Anti-SSA-Ro52 Anti-Nucleosome

Anti-SSB(La) Anti-Histone

Anti-Scl-70 Anti Ribosomal P protein

Anti-PM-Scl Anti AMA-M2

Anti-Jo-1

Objective

Our purpose is to study the clinical significance and immunological association in patients displaying aSSA52 in various autoimmune diseases(AD).

Material and Method

• single center• Mureș County Emergency Clinical

Hospital,Rheumatology Division• retrospective and prospective(2013-2015)• 41 patients• ENA immunoblotting panels analysis

Material and method

Autoimmune Disease (AD) was defined when a patient displayed one of these:

1.Systemic Lupus Erythematosus(SLE)2.Polymyositis/Dermatomyositis(PM/DM)3.Sjogren Syndrome(SjS)4.Rheumatoid Arthritis(RA)5.Systemic Sclerosis(SSc)6.Unedifferentiated Connective tissue disease(UCTD)

Material and method

Inclusion criteria Exclusion criteria

Results

Gender distribution through connective tissue diseases(CTD)

Gender distribution

Mean age of onset of CTDs between aSSA52- and aSSA52+ groups

Distribution of aSSA52 through CTDs

P value=0.058

Extractable nuclear antigen (ENA) antibodies distribution

25

2912

22

710

77

22

0 10 20 30 40

Rnp/SmSm

SSARoSSBLaScl 70

PM-SclJo-1

dsDNANucleosom

HistoneRib P prot

AMA-2

ENA

Pan

el a

nti

bo

die

s

Percentage %

aSSA52 associated auto-antibodies

(p-0.01)

(p-0.03)

Interstitial pulmonary fibrosis (IFP) prevalence in positive and negative aSSA52 groups

12.2%7.3%

58.5%

22%

P-0.059 (ns)

Distribution of IPF through Connective tissue diseases (CTDs) in aSSA52+ group

Clinical manifestations in CTDs and aSSA52

Study limitations

In our study, only a few patients had inclusion criteria (n=41) and the small sample size limits the power of the study.

Differences between aSSA52+ and aSSA52- groups regarding CTDs features were not significant perhaps due to low absolute numbers which limit the statistical analysis.

Conclusions

• It seems that the presence of aSSA52 are associated with IPF in CTDs.

• The most prevalent autoimmune diseases associating aSSA52 are PM and SLE.

• It is recommended to monitor aSSA52 in patiens diagnosed with CTDs in order to predict the outcome.