Evaluation of the association of anti-thyroid peroxidase with antinuclear antibodies and different antinuclear antibodies patterns

Year 2023, Volume: 4 Issue: 4, 311 - 314, 30.08.2023

Alper Togay , Banu Isbilen Basok , Ayfer Çolak , Nisel Yılmaz

https://doi.org/10.47582/jompac.1317134

Abstract

Aims: To investigate the relationship between anti-thyroid peroxidase (TPO), a marker for Hashimoto’s thyroiditis, and antinuclear antibodies (ANA) and ANA patterns, biomarkers for systemic autoimmune diseases.
Methods: In this study, ANA and anti-TPO test results, obtained in our hospital laboratory between 2019 and 2022, were retrospectively evaluated. ANA was detected by the indirect immunofluorescence antibody method using commercial HEp-20-10 cell substrates and anti-TPO was determined by the sandwich immunoassay method using a commercial immunoassay analyzer.
Results: A total of 1750 patients’ results were analyzed. ANA was positive in 28.7% of anti-TPO-positive patients and 19% of anti-TPO-negative patients. While 6.4% (112/1750) of patients were positive for both ANA and anti-TPO, both test results were negative in 62.85% of patients (p<0.001). When the ANA patterns’ distribution in patients with ANA and anti-TPO positivity examined together, the homogeneous pattern was statistically significantly higher than the other patterns (p=0.043).
Conclusion: Individuals with autoimmune thyroid disease had a higher rate of autoantibodies not only to thyroid-specific antigens but also to non-thyroid-specific antigens. Further studies are needed on how epigenetic changes, such as histone modifications might cause other autoimmune diseases and increase their frequency.

Keywords

Autoimmunity, antinuclear antibodies, autoimmune disease, thyroid diseases, Hashimoto disease

Anti-tiroid peroksidazın antinükleer antikorlar ve farklı antinükleer antikor paternleri ile ilişkisinin değerlendirilmesi

Abstract

Arka plan: Otoimmün hastalıkların birlikteliği iyi bilinmektedir, ancak bunlara neden olan mekanizmalar henüz tam olarak anlaşılamamıştır. Histon modifikasyonları gibi çekirdekteki değişikliklerin otoimmün tiroid hastalıklarının nedeni olabileceğine dair artan kanıtlar vardır. Histon ve diğer nükleer antijenlere karşı oluşan antikorların sistemik otoimmün hastalıklara neden olabildiği bilinmektedir.
Amacımız, Hashimoto tiroiditi için bir belirteç olan anti-tiroid peroksidaz (TPO) ile sistemik otoimmün hastalıkların biyobelirteçleri olan antinükleer antikorlar (ANA) ve ANA paternleri arasındaki ilişkiyi araştırmaktır.
Yöntemler: Bu çalışmada 2019-2022 yılları arasında hastanemiz laboratuvarında elde edilen ANA ve anti-TPO test sonuçları retrospektif olarak değerlendirildi. ANA, ticari HEp-20-10 hücre substratları kullanılarak dolaylı immünofloresan antikor yöntemiyle tespit edildi ve anti-TPO, ticari bir immünoassay analiz cihazı kullanılarak sandviç immünoassay yöntemiyle belirlendi.
Bulgular: Toplam 1750 hastanın sonuçları analiz edildi. ANA, anti-TPO pozitif hastaların %28,7'sinde ve anti-TPO negatif hastaların %19'unda pozitifti. Hastaların %6,4'ü (112/1750) hem ANA hem de anti-TPO için pozitif bulunurken, hastaların %62,85'inde her iki test negatifti (p <0,001). ANA ve anti-TPO pozitifliği olan hastalarda ANA paternlerinin dağılımı birlikte incelendiğinde, homojen patern diğer paternlere göre istatistiksel olarak anlamlı derecede yüksekti (p=0,043).
Sonuçlar: Otoimmün tiroid hastalığı olan bireylerde, yalnızca tiroide özgü antijenlere karşı değil, aynı zamanda tiroide özgü olmayan antijenlere karşı da daha yüksek oranda otoantikorlar vardır. Histon modifikasyonları gibi değişikliklerin diğer otoimmün hastalıklara nasıl yol açabileceği ve sıklığını artırabileceği konusunda daha fazla çalışmaya ihtiyaç vardır.

Keywords

ANA, Anti-TPO, otoimmün hastalık, otoimmün tiroid hastalığı

References

• Hernández-Negrín H, Roque-Dapresa Y, Martínez-Morales O, Mederos-Portal A. Using multiple cause-of-death analysis to estimate systemic autoimmune disease mortality burden in low- and middle-income countries. MEDICC Review. 2021;23(2):69–74.
• Frederick WM, Lars A, Karen HC, et al. Epidemiology of environmental exposures and human autoimmune diseases: Findings from a National Institute of Environmental Health Sciences Expert Panel Workshop. J Autoimmun. 2012;39(4):259-271
• Tsokos GC. Mechanisms of disease systemic lupus erythematosus. N Engl J Med. 2011;365:2110-2121.
• Andrade LEC, Damoiseaux J, Vergani D, Fritzler MJ. Antinuclear antibodies (ANA) as a criterion for classification and diagnosis of systemic autoimmune diseases. J Transl Autoimmun 2022;5:100145.
• Bilgin M, Keskin A, Aci R, Baklacioglu HS, Arslanbek Erdem M. Darkness hormone or daylight hormone in women with systemic lupus erythematosus? Clin Rheumatol. 2023;42(1):93-99.
• Conrad K, Bachmann M. Autoantibodies and systemic autoimmune diseases. Autoantibodies and Autoimmunity, 2006;225-245.
• Weetman A, DeGroot LJ. Autoimmunity to the Thyroid Gland. In: Feingold KR, Anawalt B, Blackman MR, et al (ed). Endotext (Internet). Jan 14. South Dartmouth (MA): MDText.com, Inc.; 2000–. PMID: 25905407.
• Siriwardhane T, Krishna K, Ranganathan V, et al. Exploring Systemic Autoimmunity in Thyroid Disease Subjects. J Immunol Res. 2018;6895146.
• Matusiewicz A, Stróżyńska-Byrska J, Olesińska M. Polyautoimmunity in rheumatological conditions. Int J Rheum Dis. 2019;22(3):386–391.
• Giuffrida G, Bagnato G, Campennì A, et al. Non-specific rheumatic manifestations in patients with Hashimoto’s thyroiditis: a pilot cross-sectional study. J Endocrinolo Investigation. 2020;43(1):87–94.
• Damoiseaux J, Andrade LEC, Carballo OG, et al. Clinical relevance of HEp-2 indirect immunofluorescent patterns: the international consensus on ANA patterns (ICAP) perspective. Ann Rheum Dis. 2019;78(7):879–889.
• Moroni L, Bianchi I, Lleo A. Geoepidemiology, gender and autoimmune disease. Autoimmun Rev. 2012;11(6-7):A386-A392.
• Agmon-Levin N, Damoiseaux J, Kallenberg C, et al. International recommendations for the assessment of autoantibodies to cellular antigens referred to as anti-nuclear antibodies. Ann Rheum Dis 2014;73:17–23.
• Tektonidou MG, Anapliotou M, Vlachoyiannopoulos P, Moutsopoulos HM. Presence of systemic autoimmune disorders in patients with autoimmune thyroid diseases. Ann Rheum Dis. 2004;63(9):1159–1161.
• Lazúrová I, Benhatchi K, Rovenský J, et al. Autoimmune thyroid disease and autoimmune rheumatic disorders: A two-sided analysis. Ann New York Acad Sci. 2009;1173:211–216.
• Morita S, Arima T, Matsuda M. Prevalence of nonthyroid specific autoantibodies in autoimmune thyroid diseases. J Clin Endocrinol Metab. 1995;80(4):1203-1206.
• Solomon DH, Kavanaugh AJ, Schur PH. American College of Rheumatology Ad Hoc Committee on Immunologic Testing Guidelines. Evidence-based guidelines for the use of immunologic tests: antinuclear antibody testing. Arthritis Rheum. 2002;47(4):434-444.
• Carbone T, Pafundi V, Tramontano G, et al. Prevalence and serological profile of anti-DFS70 positive subjects from a routine ANA cohort. Sci Rep. 2019;18;9(1):2177.
• Wang B, Shao X, Song R, Xu D, Zhang JA. The emerging role of epigenetics in autoimmune thyroid diseases. Front Immunol. 2017;7;8:396.
• Yan N, Zhou JZ, Zhang JA, et al. Histone hypoacetylation and increased histone deacetylases in peripheral blood mononuclear cells from patients with Graves’ disease. Mol Cell Endocrinol. 2015;15;414:143-147.
• Angiolilli C, Kabala PA, Grabiec AM, et al. Histone deacetylase 3 regulates the inflammatory gene expression programme of rheumatoid arthritis fibroblast-like synoviocytes. Ann Rheum Dis. 2017;76(1):277-285.
• Cheng F, Lienlaf M, Wang HW, et al. A Novel role for histone deacetylase 6 in the regulation of the tolerogenic STAT3/IL-10 pathway in APCs. J Immunol. 2014;15;193(6):2850-2862.