Article Text

Download PDFPDF
Comments on recent advances and recommendations for the assessment of autoantibodies to cellular antigens referred as antinuclear antibodies
  1. Michael Mahler1,
  2. Thierry Dervieux2
  1. 1INOVA Diagnostics, Inc., San Diego, California, USA
  2. 2Exagen Diagnostics, Inc., Vista, California, USA
  1. Correspondence to Dr Michael Mahler, INOVA Diagnostics, 9900 Old Grove Road, San Diego, CA 32131-1638, USA; mmahler{at} or m.mahler.job{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Despite significant efforts and advances in the field of autoimmune diagnostics, the standardisation and proper use of antinuclear antibody (ANA) testing in clinical practice remains a challenge. Recently, important contributions attempting to clarify and add rigour to this area have been published.1 ,2 In particular, the recommendations published by Agmon-Levin et al1 address very important issues that confront contemporary laboratory medicine. Using a Delphi approach, the authors generated 25 recommendations for the detection of anticellular antibodies, previously referred to ANA, and anti-dsDNA antibodies. In a second important paper, Bossuyt and Fieuws reported added value of solid phase assays (SPA).2 Considering the high impact of published recommendations and associated editorials, careful verification, validation, clarification, education and, if necessary, adjustments are crucial. Some of the recent recommendations requiring further clarification are summarised and discussed in this article.

View this table:
Table 1

Comments about recommendations for the detection of anticelluar antibodies

Terminology of diseases and autoantibodies

Agmon-Levin et al, make an exceedingly important point that the nomenclature of autoantibodies found in systemic autoimmune rheumatic disease (SARD) sera is inconsistent, misleading and/or not in keeping with contemporary cell and molecular biology terminology. The terms ‘antinuclear antibodies’ (ANA) and ‘extractable nuclear antigens’ (ENA) are no longer technically correct and do not cover the entire spectrum of relevant autoantibodies. ‘ANA’ using indirect immunofluorescence (IIF), as well as some other screening assays, detect antibodies directed against nuclear and non-nuclear elements (as in their recommendation 13), while ‘ENA’ may refer to some antigens that are neither extractable nor nuclear. Therefore, it is highly desirable to change these terms to more appropriate and informative ones, such as anticellular antibodies and specific antibodies, respectively. Such a change in nomenclature requires broad agreement and adoption within the broad stakeholder medical …

View Full Text


  • Contributors All authors fulfil the requirements for a coauthorship.

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.