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Vol. 22. Issue 6.
(June - July 2026)
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Vol. 22. Issue 6.
(June - July 2026)
Original Article

Antinuclear antibody detection beyond anti-dsDNA and anti-ENA: New insights from intact HEp-2 nucleus ELISA

Detección de anticuerpos antinucleares más allá de anti-dsDNA y anti-ENA: nuevas perspectivas a partir de la ELISA con núcleos intactos de células HEp-2
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Faruk Dişlia,
Corresponding author
faruk.disli@inonu.edu.tr

Corresponding author.
, Sedat Yıldızb
a Bingöl University, Faculty of Physiotherapy and Rehabilitation, Department of Basic Physiotherapy, Bingöl, Turkey
b İnönü University, Faculty of Medicine, Department of Physiology, Malatya, Turkey
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Abstract
Background

Intact HEp-2 nucleus-based ELISA tests are occasionally preferred for antinuclear antibody (ANA) screening, although their correlation with clinically relevant autoantibodies such as anti-dsDNA and anti-ENA remains unclear. This study analyzed the correlation between HEp-2 nucleus-based ELISA and anti-dsDNA and anti-ENA tests in a large sample to provide analytical insight into their relationship.

Material and methods

A total of 900 serum samples were included in the study (mean age: 39.7 years; 481 females and 419 males). Anti-dsDNA, anti-ENA, and intact HEp-2 nucleus-based ELISA tests were performed in all samples using validated ELISA methods. Correlation analyses between test results were performed using Spearman's rank correlation coefficient due to non-normal data distribution.

Results

HEp-2 ELISA showed a moderate correlation with anti-dsDNA (r=0.431, p<0.001) and a stronger correlation with anti-ENA (r=0.625, p<0.001). Among the 431 individuals who tested positive in at least one of the three assays, 96 were positive for all three. Additionally, 41 individuals were positive for both anti-dsDNA and HEp-2, and 44 for both anti-ENA and HEp-2. Isolated positivity was observed in 112 individuals for anti-dsDNA, 48 for anti-ENA, and 54 for HEp-2. This distribution reflects both overlapping and distinct patterns of antibody detection among the tests.

Conclusions

HEp-2 nucleus-based ELISA demonstrated analytical concordance with both anti-dsDNA and anti-ENA assays. Moreover, its ability to detect distinct autoantibody reactivities not identified by conventional methods suggests its value as a complementary tool in comprehensive ANA screening.

Keywords:
Antinuclear antibodies
dsDNA
HEp-2 nucleus
ENA
Resumen
Antecedentes

Las pruebas ELISA basadas en núcleos intactos de células HEp-2 se utilizan ocasionalmente para el cribado de anticuerpos antinucleares (ANA), aunque su correlación con autoanticuerpos clínicamente relevantes, como anti-dsDNA y anti-ENA, no está completamente establecida. Este estudio evaluó la relación entre la ELISA con núcleo intacto de HEp-2 y las pruebas de anti-dsDNA y anti-ENA en una amplia muestra para aportar una visión analítica sobre su concordancia.

Materiales y métodos

Se incluyeron 900 muestras de suero (edad media: 39,7 años; 481 mujeres y 419 hombres). Todas las muestras fueron analizadas mediante métodos ELISA validados para anti-dsDNA, anti-ENA y ELISA basada en núcleo intacto de HEp-2. Debido a la distribución no normal de los datos, las correlaciones entre pruebas se evaluaron mediante el coeficiente de Spearman.

Resultados

La ELISA HEp-2 mostró una correlación moderada con anti-dsDNA (r=0,431; p<0,001) y una correlación más fuerte con anti-ENA (r=0,625; p<0,001). Entre los 431 individuos positivos en al menos una de las pruebas, 96 fueron positivos en las tres. Además, 41 fueron positivos para anti-dsDNA y HEp-2, y 44 para anti-ENA y HEp-2. Se observó positividad aislada en 112 sujetos para anti-dsDNA, 48 para anti-ENA y 54 para HEp-2, lo que muestra patrones superpuestos y diferenciados de detección de anticuerpos.

Conclusiones

La ELISA basada en núcleo intacto de HEp-2 mostró concordancia analítica con los ensayos de anti-dsDNA y anti-ENA. Su capacidad para identificar reactividades antinucleares no detectadas por métodos convencionales sugiere su utilidad como herramienta complementaria en el cribado integral de ANA.

Palabras clave:
Anticuerpos antinucleares
dsDNA
Núcleo HEp-2
ENA

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