Determination of pediatric reference limits for 10 commonly measured autoantibodies

Lusia Sepiashvili; Mary Kathryn Bohn; Alexandra Hall; Tina Henderson; Jack Chen; Roseline Dunst; Khosrow Adeli

doi:10.1515/cclm-2022-0675

Article

Determination of pediatric reference limits for 10 commonly measured autoantibodies

Lusia Sepiashvili , Mary Kathryn Bohn , Alexandra Hall , Tina Henderson , Jack Chen , Roseline Dunst and Khosrow Adeli

Published/Copyright: September 19, 2022

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From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 60 Issue 11

Abstract

Objectives

The objective of this study was to establish pediatric reference limits for autoimmune disease markers in the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) cohort of healthy children and adolescents to support their interpretation and clinical decision making. The CALIPER is a national study of healthy children aiming to close gaps in pediatric laboratory medicine by establishing a robust database of pediatric reference intervals for pediatric disease biomarkers (caliperdatabase.org).

Methods

Healthy children and adolescents (n=123, aged 1–19) were recruited to CALIPER with informed consent. Serum autoantibody testing conducted on the BIO-FLASH analyzer (Werfen, Barcelona, Spain) included anti-dsDNA IgG, anti-Sm IgG, anti-RNP IgG, anti-SSB/La IgG, anti-Ro60 IgG, anti-Ro52 IgG, anti-cardiolipin IgG, anti-MPO IgG, anti-PR3 IgG, and anti-tTG IgA. Pediatric reference limits representing 95th, 97.5th, and 99th percentiles were calculated using the non-parametric rank method according to Clinical Laboratory Standards Institute C28-A3 guidelines.

Results

The proportion of samples with results above the lower limit of the analytical measuring range were: anti-cardiolipin IgG 90%, anti-dsDNA 22%, anti-Sm 13%, anti-RNP 0.8%, anti-SSB/La 0%, anti-Ro60 0%, anti-Ro52 0%, anti-MPO 25%, anti-PR3 9%, and anti-tTG IgA 28%. Pediatric reference limits and associated 90% confidence intervals were established for all 10 markers. All autoantibodies could be described by one age range except for anti-cardiolipin IgG and anti-MPO. A sex-specific difference was identified for anti-tTG IgA.

Conclusions

Robust pediatric reference limits for 10 commonly clinically utilized autoimmune markers established herein will allow for improved laboratory assessment and clinical decision making in pediatric patients using the BIO-FLASH assay platform worldwide.

Keywords: anti-dsDNA; anti-myeloperoxidase IgG (anti-MPO); anti-proteinase 3 IgG (anti-PR3); antibodies against extractable nuclear antigens (anti-ENA); autoantibodies; pediatric reference intervals

Corresponding author: Dr. Lusia Sepiashvili, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, 555 University Ave, rm 3652, Toronto, ON, Canada M5G 1X8; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; and Molecular Medicine, SickKids Research Institute, Toronto, ON, Canada, Phone: 416-813-6817, Fax: 416-813-6257, E-mail: lusia.sepiahvili@sickkids.ca

Funding source: Canadian Institutes for Health Research Foundation Grant

Award Identifier / Grant number: 353989

Acknowledgments

We sincerely thank all the participants, and their families as well as the CALIPER volunteers whose dedication and work made this study possible. We wish to thank Werfen Autoimmunity for supporting this work by providing assay reagents.

Research funding: This work was supported by the Canadian Institutes for Health Research Foundation Grant #353989. Werfen Autoimmunity (Barcelona, Spain) provided all study reagents.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: This study was approved by the Research Ethics Board at the Hospital for Sick Children, Toronto, Canada.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2022-0675).

Received: 2022-07-12

Accepted: 2022-08-30

Published Online: 2022-09-19

Published in Print: 2022-10-26

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Keywords for this article

anti-dsDNA; anti-myeloperoxidase IgG (anti-MPO); anti-proteinase 3 IgG (anti-PR3); antibodies against extractable nuclear antigens (anti-ENA); autoantibodies; pediatric reference intervals