Akihiro Murakami

High diagnostic performance of ELISA detection of antibodies to citrullinated antigens in rheumatoid arthritis.

Objective: We investigated the rheumatoid arthritis (RA) diagnostic performances of anti‐cyclic citrullinated peptide antibody (anti‐CCP) and antifilaggrin antibody (AFA) in comparison with RF and matrix metalloproteinase‐3 (MMP‐3). Methods: We used a second generation enzyme‐linked immunosorbent assay (ELISA) kit for the detection of anti‐CCP. We constructed recombinant human filaggrin, which was citrullinated in vitro by human peptidylarginine deiminase, and subsequently used it as the coating antigen for AFA‐ELISA. A total of 549 RA patients and 208 other rheumatic disease patients were included in the study. Results: The specificities of anti‐CCP (88.9%) and AFA (94.7%) were superior to those of RF (81.7%) and MMP‐3 (49.5%). The sensitivity of anti‐CCP (87.6%) was superior to all others. However, the sensitivity of AFA (68.7%) was inferior to those of RF (69.8%) and MMP‐3 (75.7%). Furthermore, receiver operating characteristic curves of anti‐CCP and AFA passed closer to the upper left corner than those of RF and MMP‐3, and the areas under the curves (AUC) of AFA and anti‐CCP were significantly larger. In addition, the AUC of anti‐CCP was significantly larger than that of AFA. Conclusion: ELISA detection of antibodies to citrullinated antigens, especially a second generation anti‐CCP, showed higher discriminative ability than other assays, including RF, and would be useful to aid the diagnosis of RA in clinical practice.

The Multicenter Study of a New Assay for Simultaneous Detection of Multiple Anti-Aminoacyl-tRNA Synthetases in Myositis and Interstitial Pneumonia

Objective Autoantibodies to aminoacyl-tRNA synthetases (ARSs) are useful in the diagnosis of idiopathic inflammatory myopathy (IIM) with interstitial pneumonia (IP). We developed an enzyme-linked immunosorbent assay (ELISA) system using a mixture of recombinant ARS antigens and tested its utility in a multicenter study. Methods: We prepared six recombinant ARSs: GST-Jo-1, His-PL-12, His-EJ and GST-KS expressed in Escherichia coli, and His-PL-7 and His-OJ expressed in Hi-5 cells. After confirming their antigenic activity, with the exception of His-OJ, we developed our ELISA system in which the five recombinant ARSs (without His-OJ) were mixed. Efficiency was confirmed using the sera from 526 Japanese patients with connective tissue disease (CTD) (IIM n = 250, systemic lupus erythematosus n = 91, systemic sclerosis n = 70, rheumatoid arthritis n = 75, Sjögren’s syndrome n = 27 and other diseases n = 13), 168 with idiopathic interstitial pneumonia (IIP) and 30 healthy controls collected from eight institutes. IIPs were classified into two groups; idiopathic pulmonary fibrosis (IPF) (n = 38) and non-IPF (n = 130). Results were compared with those of RNA immunoprecipitation. Results: Sensitivity and specificity of the ELISA were 97.1% and 99.8%, respectively when compared with the RNA immunoprecipitation assay. Anti-ARS antibodies were detected in 30.8% of IIM, 2.5% of non-myositis CTD, and 10.7% of IIP (5.3% of IPF and 12.3% of non-IPF). Anti-ARS-positive non-IPF patients were younger and more frequently treated with glucocorticoids and/or immunosuppressants than anti-ARS-negative patients. Conclusion: A newly established ELISA detected anti-ARS antibodies as efficiently as RNA immunoprecipitation. This system will enable easier and wider use in the detection of anti-ARS antibodies in patients with IIM and IIP.

Clinical Utility of an Enzyme-Linked Immunosorbent Assay for Detecting Anti-Melanoma Differentiation-Associated Gene 5 Autoantibodies.

Objective Autoantibodies to melanoma differentiation-associated gene 5 (MDA5) are specifically expressed in patients with dermatomyositis (DM) and are associated with a subset of DM patients with rapidly progressive interstitial lung disease (RP-ILD). Here, we examined the clinical utility of a newly developed enzyme-linked immunosorbent assay (ELISA) system for detecting these antibodies. Methods Here we developed an improved ELISA for detecting anti-MDA5 antibodies. We then performed a multicenter clinical study involving 8 medical centers and enrolled 242 adult patients with polymyositis (PM)/DM, 190 with non-PM/DM connective tissue disease (CTD), 154 with idiopathic interstitial pneumonia (IIP), and 123 healthy controls. Anti-MDA5 antibodies in the patients’ serum samples were quantified using our newly developed ELISA, and the results were compared to those obtained using the gold-standard immunoprecipitation (IP) assay. In addition, correlations between the ELISA-quantified anti-MDA5 antibodies and clinical characteristics were evaluated. Results In patients with PM/DM, the anti-MDA5 antibody measurements obtained from the ELISA and IP assay were highly concordant; the ELISA exhibited an analytical sensitivity of 98.2%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 99.5% (compared to the IP assay). Anti-MDA5 antibodies were detected in 22.7% of the DM patients, but not in any of the patients with PM, non-PM/DM CTD, or IIP. Clinically amyopathic DM, RP-ILD, arthritis, and fever were more prevalent in DM patients who were anti-MDA5 antibody-positive than in those who were antibody-negative (P ≤ 0.0002 for all comparisons). In addition, anti-MDA5 antibody-positive patients with RP-ILD exhibited higher antibody levels than those without RP-ILD (P = 0.006). Conclusion Our newly developed ELISA can detect anti-MDA5 antibodies as efficiently as the gold standard IP assay and has the potential to facilitate the routine clinical measurement of anti-MDA5 antibodies in patients who suspected to have DM.

Enzyme-linked immunosorbent assays for detection of anti-transcriptional intermediary factor-1 gamma and anti-Mi-2 autoantibodies in dermatomyositis

BACKGROUND Autoantibodies against transcriptional intermediary factor 1 (TIF1) and Mi-2 are selectively detected in patients with dermatomyositis (DM). To measure these antibodies readily, the development of reliable ELISA systems has been needed. OBJECTIVE This study aimed to establish enzyme-linked immunosorbent assays (ELISAs) for anti-TIF1γ and anti-Mi-2β antibodies (Abs) and to assess their utility. METHODS Serum samples were obtained from 104 patients with classic DM, 68 with clinically amyopathic DM (CADM) and 70 with polymyositis, who were followed up at 8 medical centers across Japan. Serum samples from 190 patients with other connective tissue diseases (CTDs) and 123 healthy individuals were also assessed. Serum antibody levels were examined by ELISAs coated with full-length TIF1γ or Mi-2β proteins produced by a baculovirus expression system. To assess the cross-reactivity, partial-length Mi-2β proteins with or without mutations were produced and examined for reactivity. RESULTS When compared with immunoprecipitation assay, anti-TIF1γ Ab ELISA showed 100% sensitivity and 100% specificity, while anti-Mi-2β Ab ELISA showed 100% sensitivity and 99.6% specificity. Anti-TIF1γ Ab was positive in 30 (28.8%) with classic DM and 4 (5.9%) with CADM, whereas 14 (13.5%) with classic DM, but none with CADM, were positive for anti-Mi-2β Ab. Of 30 anti-TIF1γ Ab-positive DM patients, 23 (67.6%) had malignancy. Anti-Mi-2β Ab-positive serum samples exhibited modest cross-reactivity with the TIF1γ protein due to the homologous amino acid sequence containing cysteines in their plant homeodomains. CONCLUSION The current study demonstrates the utility of newly established ELISAs for anti-TIF1γ and anti-Mi-2β Abs, which can serve as easier detection systems for routine testing.

Identification of a novel SEREX antigen family, ECSA, in esophageal squamous cell carcinoma

BackgroundDiagnosis of esophageal squamous cell carcinoma (SCC) may improve with early diagnosis. Currently it is difficult to diagnose SCC in the early stage because there is a limited number of tumor markers available.ResultsFifty-two esophageal SCC SEREX antigens were identified by SEREX (serological identification of antigens by recombinant cDNA expression cloning) using a cDNA phage library and sera of patients with esophageal SCC. Sequence analysis revealed that three of these antigens were similar in amino acid sequences, and they were designated as ECSA (e sophageal c arcinoma S EREX a ntigen)-1, -2 and -3. The ECSA family was also similar to an EST clone, hepatocellular carcinoma-associated antigen 25a (HCA25a). Serum antibody levels to ECSA-1, -2 and -3 were significantly higher in patients with esophageal SCC than in healthy donors. Based on the conserved amino acid sequences, three peptides were synthesized and used for enzyme-linked immunosorbent assays (ELISA). The serum antibody levels against one of these peptides were significantly higher in patients with esophageal SCC. This peptide sequence was also conserved in FAM119A, GOSR1 and BBS5, suggesting that these are also ECSA family members. Reverse transcription followed by quantitative PCR analysis showed that the mRNA expression levels of ECSA-1, -2 and -3 and FAM119A but not of HCA25a, GOSR1 and BBS5 were frequently elevated in esophageal SCC tissues.ConclusionsWe have identified a new gene family designated ECSA. Serum antibodies against the conserved domain of the ECSA family may be a promising tumor marker for esophageal SCC.

NY-ESO-1 autoantibody as a tumor-specific biomarker for esophageal cancer: screening in 1969 patients with various cancers

Background Although serum NY-ESO-1 antibodies (s-NY-ESO-1-Abs) have been reported in patients with esophageal carcinoma, this assay system has not been used to study a large series of patients with various other cancers.

Clinical Utility of YKL-40 in Polymyositis/dermatomyositis-associated Interstitial Lung Disease

Objective. Interstitial lung disease (ILD) is involved in polymyositis/dermatomyositis (PM/DM), a disease associated with poor prognoses. Chitinase-3-like-1 protein (YKL-40) has pleiotropic biological activities involved in inflammation, cell proliferation, and tissue remodeling; however, the clinical application of YKL-40 remains limited. We investigated the clinical significance of YKL-40 in PM/DM–ILD. Methods. Sixty-nine consecutive patients with PM/DM–ILD and 34 healthy controls were analyzed. We measured baseline and followup serum YKL-40 using an ELISA, evaluated the association of YKL-40 with clinical variables and survival, and examined YKL-40 expression in lung specimens from patients with PM/DM–ILD using immunohistochemistry. Results. Serum YKL-40 levels were significantly greater in patients with PM/DM–ILD compared with healthy controls (p < 0.0001). Serum YKL-40 was correlated with arterial oxygen pressure (r = –0.40, p < 0.001) and percent-predicted DLCO (r = –0.41, p = 0.01) in patients with PM/DM–ILD. Multivariate Cox hazard analysis demonstrated that higher serum YKL-40 and lower percent-predicted forced vital capacity were independently associated with a poor prognosis. Immunohistochemistry analysis demonstrated that YKL-40 expression was enhanced in aggregated intraalveolar macrophages and hyperproliferative alveolar epithelial cells in patients with PM/DM–ILD. Conclusion. YKL-40 is a promising biomarker for evaluating PM/DM–ILD activity/severity and predicting disease prognosis. Insights into YKL-40 might help elucidate the pathogenesis of PM/DM–ILD.

Potential inhibition of development of rapidly progressive interstitial lung disease by prompt and sufficient immunosuppressive treatment in patients with anti‐melanoma differentiation‐associated gene 5 antibody‐positive dermatomyositis

Dear Editor, Anti-melanoma differentiation-associated gene (MDA)5 antibodies are considered to be related to amyopathic dermatomyositis (DM) and are associated with a high rate of rapidly progressive interstitial lung disease (RP-ILD), which usually requires intensive treatment and yet yields a poor prognosis. However, we found that not all patients with this antibody develop lethal ILD. We herein evaluated the clinical manifestations, laboratory findings, treatments and prognosis of six DM patients who tested positive for anti-MDA5 antibody by enzyme-linked immunoassay (Table 1). These patients were diagnosed and treated in the Department of Dermatology, Gifu University Hospital. This study was approved by the ethical review board of Gifu University School of Medicine (approval No. 25-382). Gottron’s sign and arthralgia were observed in all patients, whereas heliotrope rash was found in four patients. Patients who did not have heliotrope rash exhibited a seborrheic dermatitis-like rash or erythema adjacent to medial canthus. In most patients, skin rash was the first symptom and the interval between the onset of symptoms and the first hospital visit ranged from 2 weeks to 9 months, with most patients consulting a physician within 1–3 months after the onset of rash. Despite the lack of respiratory symptoms, interstitial lung disease (ILD) was observed in all of the patients. Four of the six patients showed lower reticular opacities with subpleural sparing and were therefore diagnosed with non-specific interstitial pneumonia (NSIP). The other two had organizing pneumonia (OP) with lower consolidation of the lungs. All of the patients were treated with a combination of corticosteroids (0.6–1 mg/kg per day) and immunosuppressive agents. Five patients also received i.v. steroid pulse therapy (1 g/day for 3 days consecutively) at the beginning of the treatment. Two patients experienced relapses of ILD; however, they improved after the dose of corticosteroids was increased. None of the patients developed RP-ILD or died of other complications during a follow-up period of 18– 112 months. In the present study, although ILD was not obvious at the onset of symptoms, it gradually became evident in most patients. Moreover, the serum levels of ferritin kept increasing even after the initiation of treatment, suggesting a strong potential for disease progression. However, no patients developed RP-ILD and all of them showed a good response to treatments. In comparison with previous reports, our patients seemed to have a milder course. Although the reason for this phenomenon is unknown, there

Improved quantification of a commercial enzyme-linked immunosorbent assay kit for measuring anti-MDA5 antibody

Abstract Objectives: To compare the quantitative performance for measuring anti-MDA5 antibody titer of two enzyme-linked immunosorbent assay (ELISA) systems: an in-house ELISA and the commercial MESACUPTM anti-MDA5 test. Methods: Anti-MDA5 antibody titer was measured in sera from 70 patients with dermatomyositis using an in-house ELISA and the MESACUPTM anti-MDA5 test side-by-side. For the commercial ELISA kit, serum samples diluted 1:101 were used according to the manufacturer’s protocol, but serial dilutions of sera were also examined to identify the optimal serum dilution for quantification. Results: The anti-MDA5 antibody titers measured by the in-house and commercial ELISAs were positively correlated with each other (r = 0.53, p = .0001), but the antibody titer measured by the commercial ELISA was less sensitive to change after medical treatment, and 37 (80%) of 46 anti-MDA5-positive sera had antibody titer exceeding the quantification range specified by the manufacturer (≥150 index). Experiments using diluted serum samples revealed that diluting the sera 1:5050 improved the quantitative performance of the MESACUPTM anti-MDA5 test, including a better correlation with the in-house ELISA results and an increased sensitivity to change. Conclusion: We improved the ability of the commercial ELISA kit to quantify anti-MDA5 antibody titer by altering its protocol.