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Validation of an antiretinal antibody detection strategy for the diagnosis of autoimmune retinopathies
Author(s) -
Draganova D.,
Debaugnies F.,
Postelmans L.,
Caspers L.,
Willermain F.,
Corazza F.
Publication year - 2016
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2016.0612
Subject(s) - medicine , retinal , anti nuclear antibody , outer nuclear layer , autoantibody , context (archaeology) , electroretinography , pathology , antibody , ophthalmology , immunology , biology , paleontology
Purpose Antiretinal antibody (ARA) detection is a key element in the diagnosis of autoimmune retinopathies (AIR). We present the indirect immunofluorescence data from a series of suspected AIR patients and controls. Methods Primate retinal sections were incubated with 1:100 diluted sera. Patients with suspected paraneoplasic AIR (pAIR) ( n = 13) or non paraneoplasic AIR (npAIR) ( n = 15) were included. Diagnosis of AIR was based on a combination of symptoms (visual loss, photopsia, nyctalopia) and signs (decreased visual acuity, reduced visual field, abnormal electroretinography and retinal imaging) in a context of history of cancer or autoimmune disease. 3 control groups were used to define the threshold of positivity: negative: sera from healthy individuals without ophthalmological history ( n = 15), pathological: patients with outer retinal inflammation (ORI) ( n = 12) and positive: commercial antibodies against recoverin, α ‐enolase, IRBP and TRPM‐1. Antinuclear antibodies (ANA) were screened when a nuclear pattern was observed. Results As expected, in sera positive for ANA there was a signal in all nuclear layers, complicating ARA interpretation. ANA positivity was found in 4/15 negative controls, 2/12 ORI, 2/13 pAIR, 7/15 npAIR. In ORI, 1/12 patient had positive ARA. We found ARA respectively in 6/13 pAIR and 4/15 npAIR patients. ARA were localized at the following retinal layers: photoreceptors (PR), external limiting membrane, outer plexiform layer, outer nuclear layer. In pAIR, PR staining was most frequently observed. In contrast, no predominant location was found in npAIR. Conclusions We show that ARA detection can help the management of suspected AIR patients but should be integrated in the overall clinical context. Furthermore, we underline the importance of using negative controls and being aware that positive ANA complicate interpretation of results.