Miscellaneous reactivities

M.M, Portsmouth ".....cardiac autoantibodies... Your website is one of the few which actually has an image, ............"

Endomysial (A & G) antibodies - Coeliac disease

Antigen: IgA to tissue transglutaminase located in the muscularis mucosa. Note the staining of network of fibrous network around smooth muscle cells in the muscularis mucosa.

Clinical: Coeliac disease (gluten sensitivity)

Majority of the patients with coeliac disease are positive for endomysial antibodies.

Endomysial antibodies in IgA deficient patients

Antigen: IgG to tissue transglutaminase. In patients with IgA deficiency, assessment of IgG transglutaminase and endomysial antibodies is recommended.

Clinical: Coeliac disease

Skin antibodies - Pemphigus / Pemphigoid

Intercellular cement (pemphigus)

Antigen: This antigen (130 kDa desmoglein 3) can be visualised on primate oesophagus.

Disease: Active form of Pemphigus vulgaris (90%).


Basement membrane (pemphigoid)

Antigen: This antigen (180 kDa transmembrane protein (BP180)) can also be detected on primate oesophagus.

Disease: Associated with blistering or bullous pemphigoid (70%).


Both IgG antibodies

Mixture of intercellular cement and basement layer antibody.

Myocardial/Intercalated disc antibodies - Dressler's syndrome

Antigen: Range of targets (e.g. myosin, actin): Antifibrillary antibody binding to the striations of primate cardiac muscle.

Disease: Antibody found in autoimmune myocarditis, cardiomyopathy and Dressler's syndrome

Clinical case

2004: A 37 year old male with previous history of chest pains. He was then treated for pericarditis.

2012: Admission reason for severe chest pain

Examination and work-up

• CT coronary angiography showed no evidence of coronary disease
• Echocardiography unremarkable
• Cardiovascular examination was normal
• ECG was within normal
• Trans-thoracic echocardiogram was normal
• Blood tests showed no increase in his inflammatory markers

• The initial assessment - recurrent pericarditis
• Pain was not typical of pericarditis

• Also complained of recurrent migraine
• Neurological review normal
• Head MRI - a few tiny high bi-frontal sub-cortical bright areas and scarring (not new)

Immunology:

• ANA, ANCA and double stranded DNA titres were all negative
• Cardiac striations were negative. No reaction with skeletal muscle 
• Intercalated disc antibody present (see arrow heads)

 

Clinical indication: Intercalated disc antibody has been reported in association with autoimmunity idiopathic recurrent acute pericarditis.

Salivary duct antibodies

Antigen: Primate parotid gland showing location of antigen; intra-cytoplasmic granules in the primary ductules and collecting ducts

Disease: Commonly found in 50% of patients with Sjögren's syndrome.

SG, Argentina "... congratulate you on images of antibodies in autoimmunity"