Prevalence and clinical implications of major and minor ANCAs in Tunisian (North African) patients with systemic lupus erythematosus
IntroductionAnti-neutrophil cytoplasmic antibodies (ANCAs) have been reported in systemic lupus erythematosus (SLE). Their clinical significance remains unclear especially in the African populations. This study aimed to assess the prevalence, antigenic targets, and clinical correlations of ANCAs in...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-08-01
|
| Series: | Frontiers in Immunology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2025.1657670/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849229185337262080 |
|---|---|
| author | Zeineb Meddeb Zeineb Meddeb Zeineb Meddeb Houssem Abida Houssem Abida Dhouha Krir Dhouha Krir Ahlem Ben Hmid Ahlem Ben Hmid Ahlem Ben Hmid Raja Aouaidia Raja Aouaidia Cherifa Abdelkéfi Cherifa Abdelkéfi Yosra Nasri Ines Ben Sghaier Hayet Kebaier Samar Samoud Samar Samoud Rim Goucha Rim Goucha Saloua B’Chir Hamzaoui Saloua B’Chir Hamzaoui Mélika Ben Ahmed Mélika Ben Ahmed Mélika Ben Ahmed Thara Larbi Thara Larbi Imen Zamali Imen Zamali Imen Zamali Yousr Galai Yousr Galai |
| author_facet | Zeineb Meddeb Zeineb Meddeb Zeineb Meddeb Houssem Abida Houssem Abida Dhouha Krir Dhouha Krir Ahlem Ben Hmid Ahlem Ben Hmid Ahlem Ben Hmid Raja Aouaidia Raja Aouaidia Cherifa Abdelkéfi Cherifa Abdelkéfi Yosra Nasri Ines Ben Sghaier Hayet Kebaier Samar Samoud Samar Samoud Rim Goucha Rim Goucha Saloua B’Chir Hamzaoui Saloua B’Chir Hamzaoui Mélika Ben Ahmed Mélika Ben Ahmed Mélika Ben Ahmed Thara Larbi Thara Larbi Imen Zamali Imen Zamali Imen Zamali Yousr Galai Yousr Galai |
| author_sort | Zeineb Meddeb |
| collection | DOAJ |
| description | IntroductionAnti-neutrophil cytoplasmic antibodies (ANCAs) have been reported in systemic lupus erythematosus (SLE). Their clinical significance remains unclear especially in the African populations. This study aimed to assess the prevalence, antigenic targets, and clinical correlations of ANCAs in SLE patients in a Tunisian (North African) cohort. MethodsWe conducted a cross-sectional case-control study involving 30 patients with systemic lupus erythematosus (SLE) and 30 healthy controls. Blood samples were screened for antineutrophil cytoplasmic antibodies (ANCAs) using indirect immunofluorescence (IIF) (FA 1201-1005-13, Euroimmun®). Enzyme-linked immunosorbent assay (ELISA) (Euroimmun®) was performed on IIF-positive samples to assess six ANCA antigenic targets: proteinase 3, lactoferrin, myeloperoxidase, elastase, cathepsin G, and bactericidal/permeability-increasing protein (BPI). Clinical and immunological evaluations were conducted for all SLE patients at the time of the study. No ANCA- associated vasculitis-SLE overlap cases were identified.Results and discussionANCAs were detected in 16 of 30 SLE patients (53%) and in 1 of 30 healthy controls (3%). Among the ANCA-positive patients, nine showed reactivity to lactoferrin, while the antigenic target remained undetermined in 7 cases. The median SLEDAI-2K score at inclusion was 8 [1.75–12]. In univariate study, ANCA positivity was significantly associated with acute cutaneous manifestations (p=0.021), lupus nephritis (p=0.001), as well as use of glucocorticoids (p=0.014) and mycophenolate mofetil (p=0.009). Besides, it was associated with lower C3 (p=0.0036) and C4 (p=0.0032) titers and higher anti-dsDNA titers (p<0.0001). In multivariate analysis, ANCA positivity was correlated to anti-ds DNA (p=0.008). When comparing anti-LF positive and anti-LF negative patients, univariate analysis found an association with articular involvement (p=0.011), renal activity index (p=0.036) and ELISA titers (p=0.0004). ANCAs were frequent in our SLE cohort, with lactoferrin as the only identifiable antigenic target, unlike previous reports, which suggests a role to ethnicity and environment components. Their presence was associated with higher disease activity and more severe renal involvement. |
| format | Article |
| id | doaj-art-a90fd8a993bb412ea050380cd8916a7f |
| institution | Kabale University |
| issn | 1664-3224 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj-art-a90fd8a993bb412ea050380cd8916a7f2025-08-22T05:26:55ZengFrontiers Media S.A.Frontiers in Immunology1664-32242025-08-011610.3389/fimmu.2025.16576701657670Prevalence and clinical implications of major and minor ANCAs in Tunisian (North African) patients with systemic lupus erythematosusZeineb Meddeb0Zeineb Meddeb1Zeineb Meddeb2Houssem Abida3Houssem Abida4Dhouha Krir5Dhouha Krir6Ahlem Ben Hmid7Ahlem Ben Hmid8Ahlem Ben Hmid9Raja Aouaidia10Raja Aouaidia11Cherifa Abdelkéfi12Cherifa Abdelkéfi13Yosra Nasri14Ines Ben Sghaier15Hayet Kebaier16Samar Samoud17Samar Samoud18Rim Goucha19Rim Goucha20Saloua B’Chir Hamzaoui21Saloua B’Chir Hamzaoui22Mélika Ben Ahmed23Mélika Ben Ahmed24Mélika Ben Ahmed25Thara Larbi26Thara Larbi27Imen Zamali28Imen Zamali29Imen Zamali30Yousr Galai31Yousr Galai32Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, TunisiaInternal Medicine Department, Mongi Slim University Hospital, La Marsa, TunisiaLaboratory of Genetics, Immunology, and Human Pathology, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, TunisiaFaculty of Medicine of Tunis, University of Tunis El Manar, Tunis, TunisiaInternal Medicine Department, Mongi Slim University Hospital, La Marsa, TunisiaFaculty of Medicine of Tunis, University of Tunis El Manar, Tunis, TunisiaClinical Immunology Department, Pasteur Institute of Tunis, Tunis, TunisiaFaculty of Medicine of Tunis, University of Tunis El Manar, Tunis, TunisiaClinical Immunology Department, Pasteur Institute of Tunis, Tunis, TunisiaLaboratory of Transmission, Control and Immunobiology of Infection, Pasteur Institute of Tunis, Tunis, TunisiaFaculty of Medicine of Tunis, University of Tunis El Manar, Tunis, TunisiaNephrology Department, Mongi Slim University Hospital, La Marsa, TunisiaFaculty of Medicine of Tunis, University of Tunis El Manar, Tunis, TunisiaInternal Medicine Department, Mongi Slim University Hospital, La Marsa, TunisiaClinical Immunology Department, Pasteur Institute of Tunis, Tunis, TunisiaClinical Immunology Department, Pasteur Institute of Tunis, Tunis, TunisiaClinical Immunology Department, Pasteur Institute of Tunis, Tunis, TunisiaClinical Immunology Department, Pasteur Institute of Tunis, Tunis, TunisiaLaboratory of Transmission, Control and Immunobiology of Infection, Pasteur Institute of Tunis, Tunis, TunisiaFaculty of Medicine of Tunis, University of Tunis El Manar, Tunis, TunisiaNephrology Department, Mongi Slim University Hospital, La Marsa, TunisiaFaculty of Medicine of Tunis, University of Tunis El Manar, Tunis, TunisiaInternal Medicine Department, Mongi Slim University Hospital, La Marsa, TunisiaFaculty of Medicine of Tunis, University of Tunis El Manar, Tunis, TunisiaClinical Immunology Department, Pasteur Institute of Tunis, Tunis, TunisiaLaboratory of Transmission, Control and Immunobiology of Infection, Pasteur Institute of Tunis, Tunis, TunisiaFaculty of Medicine of Tunis, University of Tunis El Manar, Tunis, TunisiaInternal Medicine Department, Mongi Slim University Hospital, La Marsa, TunisiaFaculty of Medicine of Tunis, University of Tunis El Manar, Tunis, TunisiaClinical Immunology Department, Pasteur Institute of Tunis, Tunis, TunisiaLaboratory of Transmission, Control and Immunobiology of Infection, Pasteur Institute of Tunis, Tunis, TunisiaClinical Immunology Department, Pasteur Institute of Tunis, Tunis, TunisiaFaculty of Pharmacy of Monastir, University of Monastir, Monastir, TunisiaIntroductionAnti-neutrophil cytoplasmic antibodies (ANCAs) have been reported in systemic lupus erythematosus (SLE). Their clinical significance remains unclear especially in the African populations. This study aimed to assess the prevalence, antigenic targets, and clinical correlations of ANCAs in SLE patients in a Tunisian (North African) cohort. MethodsWe conducted a cross-sectional case-control study involving 30 patients with systemic lupus erythematosus (SLE) and 30 healthy controls. Blood samples were screened for antineutrophil cytoplasmic antibodies (ANCAs) using indirect immunofluorescence (IIF) (FA 1201-1005-13, Euroimmun®). Enzyme-linked immunosorbent assay (ELISA) (Euroimmun®) was performed on IIF-positive samples to assess six ANCA antigenic targets: proteinase 3, lactoferrin, myeloperoxidase, elastase, cathepsin G, and bactericidal/permeability-increasing protein (BPI). Clinical and immunological evaluations were conducted for all SLE patients at the time of the study. No ANCA- associated vasculitis-SLE overlap cases were identified.Results and discussionANCAs were detected in 16 of 30 SLE patients (53%) and in 1 of 30 healthy controls (3%). Among the ANCA-positive patients, nine showed reactivity to lactoferrin, while the antigenic target remained undetermined in 7 cases. The median SLEDAI-2K score at inclusion was 8 [1.75–12]. In univariate study, ANCA positivity was significantly associated with acute cutaneous manifestations (p=0.021), lupus nephritis (p=0.001), as well as use of glucocorticoids (p=0.014) and mycophenolate mofetil (p=0.009). Besides, it was associated with lower C3 (p=0.0036) and C4 (p=0.0032) titers and higher anti-dsDNA titers (p<0.0001). In multivariate analysis, ANCA positivity was correlated to anti-ds DNA (p=0.008). When comparing anti-LF positive and anti-LF negative patients, univariate analysis found an association with articular involvement (p=0.011), renal activity index (p=0.036) and ELISA titers (p=0.0004). ANCAs were frequent in our SLE cohort, with lactoferrin as the only identifiable antigenic target, unlike previous reports, which suggests a role to ethnicity and environment components. Their presence was associated with higher disease activity and more severe renal involvement.https://www.frontiersin.org/articles/10.3389/fimmu.2025.1657670/fullsystemic lupus erythematosusANCAlactoferrin antibodiesdisease activityorgan involvementlupus nephritis |
| spellingShingle | Zeineb Meddeb Zeineb Meddeb Zeineb Meddeb Houssem Abida Houssem Abida Dhouha Krir Dhouha Krir Ahlem Ben Hmid Ahlem Ben Hmid Ahlem Ben Hmid Raja Aouaidia Raja Aouaidia Cherifa Abdelkéfi Cherifa Abdelkéfi Yosra Nasri Ines Ben Sghaier Hayet Kebaier Samar Samoud Samar Samoud Rim Goucha Rim Goucha Saloua B’Chir Hamzaoui Saloua B’Chir Hamzaoui Mélika Ben Ahmed Mélika Ben Ahmed Mélika Ben Ahmed Thara Larbi Thara Larbi Imen Zamali Imen Zamali Imen Zamali Yousr Galai Yousr Galai Prevalence and clinical implications of major and minor ANCAs in Tunisian (North African) patients with systemic lupus erythematosus Frontiers in Immunology systemic lupus erythematosus ANCA lactoferrin antibodies disease activity organ involvement lupus nephritis |
| title | Prevalence and clinical implications of major and minor ANCAs in Tunisian (North African) patients with systemic lupus erythematosus |
| title_full | Prevalence and clinical implications of major and minor ANCAs in Tunisian (North African) patients with systemic lupus erythematosus |
| title_fullStr | Prevalence and clinical implications of major and minor ANCAs in Tunisian (North African) patients with systemic lupus erythematosus |
| title_full_unstemmed | Prevalence and clinical implications of major and minor ANCAs in Tunisian (North African) patients with systemic lupus erythematosus |
| title_short | Prevalence and clinical implications of major and minor ANCAs in Tunisian (North African) patients with systemic lupus erythematosus |
| title_sort | prevalence and clinical implications of major and minor ancas in tunisian north african patients with systemic lupus erythematosus |
| topic | systemic lupus erythematosus ANCA lactoferrin antibodies disease activity organ involvement lupus nephritis |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2025.1657670/full |
| work_keys_str_mv | AT zeinebmeddeb prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT zeinebmeddeb prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT zeinebmeddeb prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT houssemabida prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT houssemabida prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT dhouhakrir prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT dhouhakrir prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT ahlembenhmid prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT ahlembenhmid prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT ahlembenhmid prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT rajaaouaidia prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT rajaaouaidia prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT cherifaabdelkefi prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT cherifaabdelkefi prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT yosranasri prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT inesbensghaier prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT hayetkebaier prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT samarsamoud prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT samarsamoud prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT rimgoucha prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT rimgoucha prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT salouabchirhamzaoui prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT salouabchirhamzaoui prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT melikabenahmed prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT melikabenahmed prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT melikabenahmed prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT tharalarbi prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT tharalarbi prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT imenzamali prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT imenzamali prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT imenzamali prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT yousrgalai prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus AT yousrgalai prevalenceandclinicalimplicationsofmajorandminorancasintunisiannorthafricanpatientswithsystemiclupuserythematosus |