Is a homogeneous antinuclear antibody (ANA) pattern seen in extractable nuclear antigen (ENA) negative patients?

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Last updated: February 10, 2025View editorial policy

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From the Research

Homogeneous ANA Pattern in ENA Negative Patients

  • The study 1 found that nuclear homogeneous patterns on ANA-HEp-2 cells can result from anti-double-stranded DNA (dsDNA), anti-nucleosome, anti-histone, anti-Scl-70, or anti-dense fine speckles 70 (DFS70) antibodies.
  • Another study 2 observed that histones were found at a higher frequency in different ANA patterns, including homogenous and speckled nuclear patterns.
  • The study 3 revealed that speckled and homogenous were predominant ANA patterns in ANA-specific antibody-positives, with 56% and 42% respectively.
  • A study 4 detected anti-SS-A/Ro antibodies in 16 (4%) of the "ANA negative" samples, and also identified antibodies to histone in 17 samples with homogeneous staining patterns.
  • The study 5 found that patients with antibodies to extractable nuclear antigens (ENA) despite negative antinuclear antibodies (ANA) had clinical features suggestive of connective tissue disease (CTD), including neurologic disorders.

ENA Negative Patients with Homogeneous ANA Pattern

  • The study 4 found that 23 positive samples with homogeneous staining patterns did not have antibodies to dsDNA, but 17 of these samples tested positive for antibodies to histone.
  • The study 5 suggested that the finding of anti-ENA despite negative ANA may be associated with neurologic disorders and CTD, or may imply immune-related mechanisms not previously described.
  • The study 1 found that the assessment of nuclear staining on ANCA-neutrophils can help to stratify nuclear homogeneous patterns on ANA-HEp-2 cells and thus to determine whether the ANA pattern is attributed to DFS70 Abs, which can be found in healthy individuals, especially in young individuals 1.
  • The presence of a homogeneous ANA pattern in ENA negative patients may be due to various factors, including the presence of anti-histone antibodies 4 or other autoantibodies 3.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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