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Reliable autoantibody detection is important for early diagnosis and appropriate treatment of autoimmune disorders. However, in contrast to testing for classical clinical chemistry analytes, autoantibody testing is complex and evolving. Moreover, there is a lack of standardization. Nevertheless, it is important that laboratories that provide autoimmune tests comply with the requirements set forward by general international accreditation bodies. In the present manuscript, an ad hoc committee of the European Autoimmunity Standardisation Initiative (EASI) group provides background information on accreditation and identifies the minimum requirements needed to set up an accredited autoimmunity lab and to ensure that high-quality results are provided (in terms of personnel, procedures, validation, quality control, and reporting). Areas in which additional work needs to be done are identified.

Disease associated autoantibodies (AAB) are important biomarkers not only to confirm the diagnosis of the respective systemic autoimmune disease but also to diagnose the disease at very early stages (mono- or oligosymptomatic manifestations) or to diagnose the respective disease without the typical clinical manifestations (atypical forms). A confirmation of the diagnosis in early stages is required, if patients should benefit from early therapeutic intervention. Furthermore, AAB determinations are used for prognostic purposes and for monitoring of disease activity or response to therapy. For the advancement of autoantibody diagnostics in clinical practice the following aspects have to be considered: (i) The search for novel clinically relevant AAB and the identification of autoantigenic targets of AAB broadened the spectrum of autoimmune diagnostics and permit the diagnosis of former idiopathic diseases. (ii) To obtain steady diagnostic variables of clinically relevant AAB, the evaluation studies have to be standardized. (iii) Several special features and novel developments of autoantibody diagnostics make correct interpretation of antibody test results increasingly difficult. (iv) Beside standardization of AAB detection methods and quality management efforts the improvement of autoantibody diagnostics depends on further development of diagnostic algorithms including cost-effective multiparametric analyses.

With all the incredible progress in scientific research over the past two decades, the trigger of the majority of autoimmune disorders remains largely elusive. Research on the biology of T helper type 17 (T H 17) cells over the last decade not only clarified previous observations of immune regulations and disease manifestations, but also provided considerable information on the signaling pathways mediating the effects of this lineage and its seemingly dual role in fighting the invading pathogens on one hand, and in frightening the host by inducing chronic inflammation and autoimmunity on the other hand. In this context, recent reports have implicated T H 17 cells in mediating host defense as well as a growing list of autoimmune diseases in genetically-susceptible individuals. Herein, we summarize the current knowledge on T H 17 in autoimmunity with emphasis on its differentiation factors and some mechanisms involved in initiating pathological events of autoimmunity.

Analysis of autoantibodies (AAB) by indirect immunofluorescence (IIF) remains the hallmark of diagnosing autoimmune diseases despite the introduction of multiplex techniques. Non-organ specific AAB are screened in routine diagnostics by IIF on HEp-2 cells. However, IIF results vary due to objective (e.g., cell fixation) and subjective factors (e.g., expert knowledge). Therefore, inter- and intralaboratory variance is relatively high. Standardisation of AAB testing by IIF remains a critical issue in and between routine laboratories and may be improved by automated interpretation systems. An overview of existing interpretation techniques will be given taking into account own data of the first fully automated reading system AKLIDES. The novel system provides fully automated reading of IIF images and software algorithms for the mathematical description of IIF AAB patterns. It can be used for screening and preclassification of non-organ specific AAB in routine diagnostics regarding systemic autoimmune and autoimmune liver diseases. Furthermore, this system paves the way for economic data processing of cell-based IIF assays and can contribute to the reduction of interlaboratory variance of AAB testing. More sophisticated pattern recognition algorithms and novel calibration systems will improve standardised quantifications of IIF image interpretation.

Indirect immunofluorescence with HEp-2 cells presents the major screening method for detection of autoantibodies in systemic autoimmune diseases. Hereby, a large variety of autoantibody entities can be detected and recognized by at least partially typic fluorescence patterns. Currently, this method requires highly specialized technicians and resists automatization. Nevertheless, requirements of good laboratory practice, especially standardization and documentation are hampered by the common microscopic technique. Here, we present a computer-assisted system for classification of interphase HEp-2 immunofluorescence patterns in autoimmune diagnostics. Designed as an assisting system, representative patterns are acquired by an operator with a digital microscope camera and transferred to a personal computer. By use of a novel software package based on image analysis, feature extraction and machine learning algorithms, relevant characteristics describing patterns could be found out. Our results show that identification of positive fluorescence and pre-differentiation between most important HEp-2 staining patterns can be performed by this system. Results and documentation of fluorescence patterns can be integrated into the laboratory system. To enable the usage of such a system in routine diagnostics, accuracy of this system and correct recognition of interferring patterns must be further improved.