ORGENTEC Autoimmunity Blog

Covering Autoimmune Diseases

2020 Update of the Guidelines for diagnosing Coeliac disease published by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition

In 2012 the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) has issued diagnostic guidelines for coeliac disease (CD) that should support physicians in accurately diagnosing CD without performing duodenal biopsies in selected patients. These guidelines have now been updated, new clinical evidence for this approach has been implemented and the non-biopsy approach has been evaluated also in asymptomatic children.

Cutting-edge research for biomarker discovery in rheumatoid arthritis

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Towards Early diagnosis and biomarker validation in Arthritis Management

EuroTEAM Arthritis (Towards Early diagnosis and biomarker validation in Arthritis Management) is a challenging research project, funded by the European Union with 5.77 Million Euro for four years. Clinicians and lab scientists with world class expertise in rheumatoid arthritis research from 13 renowned European research institutions and three industrial partners with competence in design and development of diagnostic test kits for autoimmune diseases, local gene therapy for rheumatic diseases, and human genome analysis join their efforts in the discovery of novel biomarkers for early detection of rheumatoid arthritis. The EuroTEAM members intend to develop approaches to predict the onset of rheumatoid arthritis in people who do not yet have the disease. Ultimately, this will help in the development of treatments to prevent people from getting rheumatoid arthritis.

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Biomarkers for disease activity in Crohn’s disease

May measuring of fecal calprotectin replace colonoscopy for follow up of patients with Crohn’s disease after surgery?

After intestinal resection patients with Crohn’s disease need close monitoring and tailored therapy adjustment to reduce the risk of relapses. Today, colonoscopy is still the gold standard for the detection of disease reactivation, an invasive procedure which is unpleasant for the patient and expensive for the health care systems.

Crohn's Disease

©tashatuvango/fotolia.com

Biomarkers in blood or stool samples that correlate with endoscopic findings could therefor improve the surveillance of patients with inflammatory bowel diseases.

A candidate marker for this purpose is measurement of calprotectin concentrations in stool samples from affected patients.

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Rheumatoid Factor revisited: An “old” test but still up to date

Rheumatoid factor (RF) is one of the best known serological markers in rheumatology – development of the test dates back into the 1940ies. Since this time the toolkit of serological diagnostic tests for rheumatoid arthritis (RA) has been complemented by the more specific anti-citrullinated protein antibody (ACPA) tests. However, none of the various ACPA tests has completly replaced RF until now.

The jigsaw puzzle of rheumatoid arthritis classification

The jigsaw puzzle of rheumatoid arthritis classification

 

In contrast, the significance of RF has been further substantiated with the definition of the 2010 ACR criteria for classification of RA. Moreover, recent studies have shown the potential of RF as a contributor to disease pathogenesis.

 

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The 2012 revised SLICC criteria for classification of systemic lupus erythematosus

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The famous musician Seal is known for his numerous international hits, and for living with an autoimmune disease: the scars on his face are the result of discoid lupus erythematosus. Picture: C. Grube for Access2music.de, wikimedia

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease with manifold manifestations. SLE belongs to the family of autoimmune disorders, diseases that occur, when a mislead immune system attacks the body’s own structures. SLE can affect almost any organ system, thus its presentation and course are highly variable, and diagnosis and therapy may be challenging.

With the intention to classify SLE patients for research and surveillance studies and to support clinicians in confirming a diagnosis, a set of clinical and laboratory classification criteria has been developed and released by the American College of Rheumatology (ACR). The first classification criteria for SLE were originally published in 1971 [1,2]. They have been updated 1982 [3] and 1997 [4] to incorporate new immunologic knowledge and improve patient classification. In contrast to the 1987 criteria, the 1997 criteria have not been validated.

The most recent addendum to the classification criteria for SLE dates from 2012, when the Systemic Lupus International Collaborating Clinics (SLICC) group published a revision and validation of the ACR criteria [5].

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Research Update: Rheumatic Disease and Pregnancy

mother and childInflammatory rheumatic diseases predominantly affect women. This also includes many young women who would like to have children or who have not yet completed their family planning when they are first diagnosed. These women do not need to give up on their desire to have children forever. Women with rheumatic disease tend to have fewer children than other women, and it often takes them longer to achieve a desired pregnancy. Today, carefully monitored medical treatment and close collaboration between the rheumatologist and the gynaecologist give these women the opportunity to bring a healthy child into the world.

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Calprotectin for discriminiation of functional and organic bowel disease

Silhouette junges Mannes mit Magen-Darm-TraktDifferential diagnosis of bowel diseases can be challenging, because most of them present with similar common symptoms: abdominal pain and discomfort, diarrhea, weight loss. Infections by common gastrointestinal pathogens may soon be identified, but discrimination of inflammatory bowel disease, of which ulcerative colitis and Crohn’s disease are the most common, and irritable bowel syndrome, remains difficult.

Inflammatory bowel disease (IBD) is characterised by inflammation of the bowel, which is not seen in most patients with irritable bowel syndrome (IBS), and both conditions request different diagnostic and therapeutic approaches. IBD are serious diseases with severe comorbidities, and affected patients need further investigation with extensive diagnostic measures and intensive medical treatment. In contrast to that, IBS may be painful and impairs quality of life, but it does not usually cause serious morbidity. However, patients with IBS can have symptoms for many years and they often experience unnecessary and stressing diagnostic procedures.

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Portrait of the HEp2 cell, the pet of immunofluorescence professionals

HEp2 cells -- centromere B

Anti-Centromere B on HEp2 cells

HEp2 cells are held dear in autoimmune diagnostics. They are invaluable for people engaged in analysing autoantibodies, as E. coli is for molecular biologists or mice for toxicologists.

In spite of a wide range of other suitable methods and technologies, determination of autoantibodies with indirect immuno-fluorescence assays (IFA) on human epithelioma (HEp2) cells still contributes significantly to the diagnosis of autoimmune diseases. The widely recognised advantages of this method are high sensitivity and a broad spectrum of antibodies that can be analysed simultaneously. In addition to mere detection of antibodies a characteristic fluorescence pattern and staining of metaphase and cytoplasmic cells offer supplementary information.

When an autoimmune disease is suspected, the HEp-2 test usually is the first line test. Any positive result is then followed up by a step-wise diagnostic approach, including other immunological tests like ELISA (enzyme-linked immunosorbent assay) for single antibody specificities or immunoblot tests.
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