Fabrizio Conti

TLC immunostaining for detection of "antiphospholipid" antibodies.

Thin-layer chromatography (TLC) is a nonquantitative technique, which has been employed in the detection of antiphospholipid (aPL) antibodies. Antiphospholipid syndrome (APS) is the most frequently acquired thrombophilia, characterized by thrombosis and obstetric manifestations associated to an autoimmune trait, represented by the positivity of antiphospholipid (aPL) antibodies. Immunoassays for anticardiolipin (aCL) and anti-β2 glycoprotein I (aβ2GPI) antibodies and clotting tests for lupus anticoagulant (LA) represent the standard tests for the routine detection of aPL. The term seronegative APS has been used to describe patients with clinical manifestation of APS and persistently negative aPL assessed with routine assays. TLC immunostaining is a useful method for the detection of different antigenic targets of antiphospholipid antibodies; it is able to identify the reactivity of serum aPL experimented with purified phospholipid molecules with a different exposure compared to ELISA methods. This method seems to be applicable in patients who repeatedly tested negative for the standard aPL, i.e., aCL, aβ2GPI, and LA. Therefore, this technique may be proposed as a second step test for the diagnosis of APS.

Use of 99mTc-labelled Anti-TNF Monoclonal Antibodies to Assess Patients Affected by Inflammatory Arthropathies

Nuclear medicine techniques have been applied for many years to assess the activity in patients with different inflammatory arthropathies. The recent development of specific radiopharmaceuticals suggested the possibility to use nuclear medicine in order to clarify the disease mechanisms and predict response to treatment. In this review, we aimed at presenting data concerning the use of 99mTc-labelled anti-TNF monoclonal antibodies. Few studies have been conducted in patients affected by Rheumatoid Arthritis and Spondyloarthropathies, treated for systemic or mono-articular involvement, showing the possible use of this specific scintigraphy.

Chapter 13 – Vaccination and Autoimmunity

Chronic infection with the hepatitis C virus (HCV) is among the most common aetiologic factors influencing vasculitis in humans. Long-term infection is associated with small-vessel vasculitis (HCV-associated cryoglobulinemic vasculitis [CV]) in less than 5% of cases, and it is associated more rarely with medium-size vasculitis (polyarteritis nodosa-like). In recent years, significant advances have been made in our understanding of the pathogenesis of HCV-associated CV and its long-term prognosis. Furthermore, new immunosuppressive agents such as rituximab (a B cell–depleting agent) have been shown to be efficacious with limited toxicity, providing a promising alternative to current immunosuppressives for the treatment of HCV-associated CV. This chapter presents the pathogenesis, clinical features and recent therapeutic options for HCV-associated CV and medium-size vasculitis.