Statin-associated autoimmune myopathy: A distinct new IFL pattern can increase the rate of HMGCR antibody detection by clinical laboratories
Por:
Alvarado-Cardenas, M, Marin-Sanchez, A, Martinez, MA, Martinez-Martinez, L, Pinal-Fernandez, I, Labrador-Horrillo, M, Balada, E, Mundet-Tuduri, X, Gonzalez-Mera, L, Casademont, J, Acebes, EM, Moreno, P, Juarez, C, Grau-Junyent, JM, Pujol-Borrell, R, Selva-O'Callaghan, A
Publicada:
1 dic 2016
Resumen:
Background and objective: Statin-associated autoimmune myopathy (SAAM) with anti-HMGCR antibodies has recently been described. Several specific immunoassays are in use to detect HMGCR antibodies. In the course of systematic autoantibody screening we recognized a new distinct IFL staining pattern on rat liver sections that regularly coincided with anti-HMGCR antibodies. In this study we investigated whether this new IFL pattern is specifically associated to statin-associated autoimmune myopathy and corresponds to anti-HMGCR antibodies.
Patients and methods: Twenty-three patients positive for anti-HMGCR antibodies (14 diagnosed with SAAM) were investigated for anti-HMGCR antibodies by two ELISA assays and confirmed by immmunoblot. HMGCR associated liver IFL pattern (HALIP) was detected by indirect IFL and the reactivity against HMGCR was confirmed by immunoabsorption using purified human HMGCR antigen. 90 patients with other autoimmune diseases and 45 non-autoimmune statin treated patients were studied as controls.
Results: 21 out of 23 (91%) anti-HMGCR positive patients were HALIP positive. The staining was completely and specifically removed by immunoabsorption with human purified HMGCR. None of the control sera from autoimmune patients or non-autoimmune statin treated subjects was positive for HALIP. Statistical concordance between HALIP and anti-HMGCR antibody specific tests was 98.7%, kappa 0.95.
Conclusions: A new and distinct IFL staining pattern (HALIP) is associated to HMGCR associated myopathy. Absorption and concordance studies indicate that the antigen recognized in the liver by HALIP is HMGCR or a closely related protein. Awareness of this new pattern can help to detect HMGCR autoantibodies in statin treated patients tested for autoimmune serology. (C) 2016 Elsevier B.V. All rights reserved.
Filiaciones:
Alvarado-Cardenas, M:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Internal Med, Barcelona, Spain
Marin-Sanchez, A:
Hosp Univ Vall dHebron, VHIR, Div Immunol, Barcelona, Spain
Martinez, MA:
Univ Autonoma Barcelona, IIB St Pau, Hosp Santa Creu & St Pau, Dept Immunol, Barcelona, Spain
Martinez-Martinez, L:
Univ Autonoma Barcelona, IIB St Pau, Hosp Santa Creu & St Pau, Dept Immunol, Barcelona, Spain
Pinal-Fernandez, I:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Internal Med, Barcelona, Spain
Labrador-Horrillo, M:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Internal Med, Barcelona, Spain
Balada, E:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Internal Med, Barcelona, Spain
Mundet-Tuduri, X:
Univ Autonoma Barcelona, IDIAP Jordi Gol, Unitat Suport Recerca Barcelona Ciutat, Barcelona, Spain
Gonzalez-Mera, L:
Hosp Viladecans, Neurol, Barcelona, Spain
Casademont, J:
Univ Autonoma Barcelona, St Pau Hosp, Internal Med, Barcelona, Spain
Acebes, EM:
Hosp Infanta Leonor, Neurol, Madrid, Spain
Moreno, P:
Univ Barcelona, Hosp Clin, Internal Med, Muscle Res Grp, Barcelona, Spain
CIBERER, Valencia, Spain
Juarez, C:
Univ Autonoma Barcelona, IIB St Pau, Hosp Santa Creu & St Pau, Dept Immunol, Barcelona, Spain
Grau-Junyent, JM:
Univ Barcelona, Hosp Clin, Internal Med, Muscle Res Grp, Barcelona, Spain
CIBERER, Valencia, Spain
Pujol-Borrell, R:
Hosp Univ Vall dHebron, VHIR, Div Immunol, Barcelona, Spain
Hosp Univ Vall dHebron, Dept Cell Biol Physiol & Immunol, Barcelona, Spain
Selva-O'Callaghan, A:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Internal Med, Barcelona, Spain
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