Autoimmune rheumatologic diseases

Oral

The Distinct New Ifl Liver Staining Halip (hmgcr-associated Liver Ifl Pattern) May Help Detection of Hmgcr Autoantibodies in Clinical Laboratories and Lead to a Higher Rate of Statin Associated Autoimmune Myopathy Diagnosis

Thursday, June 15
5:45 PM - 7:00 PM

Statin-Associated Autoimmune Myopathy (SAAM) with Hydroxyl-Methyl-Glut aryl-CoA Reductase Antibodies (HMGCRAb) has recently been described. Several specific immunoassays are in use to detect HMGCRAbs but require a high degree of clinical suspicion. In the course of systematic autoantibody screening a new and distinct IFL staining that regularly coincided with HMGCRAbs was detected. Here we investigated whether this new IFL pattern is specifically linked to SAAM and correlated with HMGCAb tests currently used. Twenty-three patients (14 SAAM) positive for HMGCRAb by two ELISAs from different sources and confirmed by immmunoblot, were tested by IFL on rat liver cryostat sections from four providers. Sera from autoimmune diseases (n=90) and non-autoimmune statin treated patients (n=45) were the controls. A characteristic IFL staining of sparse distinct hepatocytes was seen in 21/23 (91%) HMGCRAb+ sera on all the liver substrates thus generating a pattern designated as HALIP (HMGCR-Associated Liver IFL Pattern). Statistical concordance between HALIP and HMGCRAb ELISAs was 98.7%, kappa 0.95. Control sera from autoimmune or non-autoimmune statin treated patients did not produce the HALIP staining which was completely and specifically removed by absorption with human purified HMGCR. HALIP therefore is a new and distinct IFL staining pattern associated to HMGCR myopathy detectable in the routine screening for autoantibodies by IFL. Since the initial communication of HALIP in SAAM, it has already been confirmed by at least another group. Awareness of this new pattern can help to detect HMGCR autoantibodies in statin-treated-patients in which the associated mypathy is not suspected.

Ana Marin-Sánchez

Immunology Division, Hospital Universitari Vall d'Hebron / Vall d'Hebron Research Institute (VHIR),

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    Marcelo Alvarado-Cardenas

    Immunology Department Hospital Universitari Vall d'Hebron

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      Maria Angeles Martinez

      Immunology Specialist
      Immunology Department, Hospital de la Santa Creu i San tPau,

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        Laura Martínez-Martinez

        Immunology Specialist
        Immunology Department, Hospital de la Santa Creu i Sant Pau

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          Iago Pinal-Fernández

          Internal Medicine Department, Hospital Universitari Vall d'Hebron

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            Moises Labrador

            Allergy Consultant
            Allergy Division, Hospital Universitari Vall d'Hebron

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              Eva Balada

              Research Associate
              Vall d'Hebron Institut de Recerca, VHIR

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                Xavier Mundet-Tuduri

                rdi Gol Primary Care Research Institute (IDIAP)

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                  Laura Gonzalez-Mera

                  Neurology Specialist
                  Neurology, Hospital de Viladecans,

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                    Jordi Casademont

                    Consultant Interna Medicine
                    Internal Medicine, Sant Pau Hospital, Universitat Autonoma de Barcelona

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                      Eva Maria Martínez-Acebes

                      Neurology Specialist
                      Neurology, Hospital Universitario Infanta Leonor

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                        Pedro Juan Moreno

                        Neurology Specialist
                        Hospital Universitario Infanta Leonor

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                          Candido Juarez Rubio

                          Consultant Immunologist
                          Immunology Department, Hospital de la Santa Creu i Sant Pau / Department of Cell Biology, Physiology and Immunology, Universitat Autonoma de Barcelona

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                            Josep Grau-Junyent

                            Consultant
                            Muscle Research Group, Internal Medicine, Hospital Clinic, University of Barcelona

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                              Ricardo Pujol Borrell

                              Professor
                              Immunology Division, Hospital Universitari Vall d'Hebron / Department of Cell Biology, Physiology and Immunology, Universitat Autonoma de Barcelona

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                                Albert Selva O'Callaghan

                                Internal Medicine Department
                                Internal Medicine Department, Hospital Universitari Vall d'Hebron / Department of Medicine, Universitat Autonoma de Barcelona

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                                  The Distinct New Ifl Liver Staining Halip (hmgcr-associated Liver Ifl Pattern) May Help Detection of Hmgcr Autoantibodies in Clinical Laboratories and Lead to a Higher Rate of Statin Associated Autoimmune Myopathy Diagnosis



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