Clinical Immunological Laboratory Am Sonnenberg 9 Prof. Dr. Winfried Stöcker D-23627 Groß Grönau (Germany) Clinical Pathologist Telephone +49 451 58 55 100 Fax 5855 101 Order Form for Autoimmune Diagnostics This form can be downloaded at www.labor-stoecker.de Surname: First name: Date of birth: Sex: Female Male ....................................................................................................................................................................................................... ....................................................... Address: Patient ....................................................................................................................................................................................................... ............................................................................................................ Medical insurance Doctor’s stamp and signature Doctor/hospital Patient Name and address: ....................................................................................................................................................................................................... Billing details ....................................................................................................................................................................................................... Type of sample: Date of collection: Sample ID of sender/report recipient: Serum .................................................................... Comments (diagnosis, presumptive diagnosis, medication, major results, etc.): E-mail of sender/report recipient: Fax no. of sender/report recipient: Systemic Autoantibodies against P A G M BASIC SPECTRUM P A G M SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) P A G M SHARP SYNDROME MCTD ANA (cell nuclei) IF global testing ANA (cell nuclei) IF global testing U1-nRNP (70K, A, C) ANA profile for differentiation Nucleosomes ANA (cell nuclei) IF global testing dsDNA NcX ELISA dsDNA NcX ELISA ssDNA dsDNA IFT SLE-specific dsDNA IFT (C. luciliae) ENA-ProfilePlus 1 ELISA dsDNA RIA P A G M POLYMYOSITIS, nRNP/Sm, Sm, SS-A, SS-B, Scl-70, Jo-1 ENA PoolPlus ELISA DERMATOMYOSITIS SLE Profile ELISA (dsDNA, histones, U1-nRNP (70K, A, C) ANA (cell nuclei) IF global testing nucleosomes, nRNP/Sm, Sm, SS-A, SS-B, Sm Myopathy Profile EUROLINE Scl-70) SS-A (Ro) 60 kDa: native (Mi-2 alpha, Mi-2 beta, TIF1 gamma, AMA (mitochondria) Ro-52: recombinant MDA5, NXP2, SAE1, Ku, PM100, PM75, ASMA (smooth muscle) SS-B (La) Jo-1, SRP, PL-7, PL-12, EJ, OJ, Ro-52, cN-1A) cANCA 1 (granulocytes) Ribosomal P-protein Jo-1 pANCA 1 (granulocytes) Ku PL-7 Autoantibody profile 30 IF substrates Cyclin I (PCNA) PL-12 Histones (global) OJ P A G M ANA DIAGNOSTICS ssDNA (single-stranded DNA) EJ EUROLINE (nucleosomes, dsDNA, histones, pANCA 1 (granulocytes) PM-Scl75, PM-Scl100 SS-A, Ro-52, SS-B, nRNP/Sm, Sm, Mi-2 SRP (signal recognition particle) alpha, Mi-2 beta, Ku, CENP A, CENP B, P A G M SJÖGREN’S SYNDROME Ro-52: recombinant Sp100, PML, Scl-70, PM-Scl100, PM-Scl75, ANA (cell nuclei) IF global testing Ku RP11, RP155, gp210, PCNA, DFS70) SS-A (Ro) 60 kDa: native Mi-2 EUROLINE Cytoplasm Profile (AMA M2, Ro-52: recombinant cN-1A (Mup44, NT5C1A) M2-3E, rib. P-prot., Jo-1, SRP, PL-7, PL-12, EJ, SS-B (La) OJ, Ro-52) ssDNA P A G M (RHEUMATOID) ARTHRITIS CCP (cyclic citrullinated peptide) P A G M VARIOUS AUTOANTIBODIES P A G M ANTI-PHOSPHOLIPID Sa DFS70 SYNDROME (APS) CEP-1 Centrioles Cardiolipin RF (classic rheumatoid factor) MSA-1 (NuMa, spindle fibres) ß-2-glycoprotein 1 Filaggrin (RA keratin) MSA-2 (HsEg5, spindle fibres) Phosphatidylserine GS-ANA (granulocyte-specific ANA) MSA-3 (chromosome-associated antigen) ANA (cell nuclei) IF global testing Centromere F protein (CENP-F, mitosin) P A G M SYSTEMIC SCLEROSIS Histones Midbody (DIFFUSE + LIMITED FORM) RANA (rheumatoid arthritis nuclear antigen) Ribosomes ANA (cell nuclei) IF global testing pANCA 1 (granulocytes) Golgi apparatus Systemic Sclerosis Profile EUROLINE Cartilage Lysosomes (Scl-70, CENP A, CENP B, RP11, RP155, Cytoskeleton fibrillarin, NOR90, Th/To, PM-Scl100, Therapy monitoring Actin PM-Scl75, Ku, PDGFR, Ro-52) MabTrack Level Adalimumab Vimentin Scl-70 (DNA topoisomerase I) MabTrack Anti-Drug Antibody Adalimumab Cytokeratin PM-Scl75 (75 kDa) MabTrack Level Infliximab Tropomyosin PM-Scl100 (100 kDa) MabTrack Anti-Drug Antibody Infliximab Vinculin Centromeres Desmin Centromere A protein (recombinant) Laminin (basement membrane) Centromere B protein (recombinant) P A G M IMMUNE HAEMATOLOGY Elastin U3-nRNP (fibrillarin) Lymphocytes Vessel endothelium RNA polymerase III Thrombocytes, indirect (free antibodies) 7-2-RNP (Th/To) Thrombocytes, direct (bound antibodies) 3 CIRCULATING IMMUNE COMPLEXES NOR (nucleolus organisator region) PCA (parietal cells) CIC-C1q ELISA (antigen detection) Ku H+/K+-ATPase ELISA (PCA) C1q ELISA Grey boxes: standard analysis. Immunoglobulin classes: P = IgAGM, A = IgA, G = IgG, M = IgM 1) ANCA diagnostics in acute cases within one hour 2) Send frozen sample(s) 3) Use special sampling procedure SA_0000_I_UK_A14, 03/2020 Page 1/2 PLEASE ENTER AGAIN! Clinical Immunological Laboratory Sample ID of sender/report recipient: Am Sonnenberg 9 Prof. Dr. Winfried Stöcker D-23627 Groß Grönau (Germany) Clinical Pathologist Telephone +49 451 58 55 100 Fax 5855 101 Organ /Tissue-Specific Autoimmunity: Autoantibodies against P A G M THYROID GLAND P A G M KIDNEY, LUNG P A G M ANCA-ASSOCIATED VASCULITIDES 1 TRAb (TSH receptors) cANCA IFT granulocytes (WEGENER’S DIS., MICROSC. ARTERIITIS, 1 TPO (thyroidea peroxidase) pANCA IFT granulocytes CHURG-STRAUSS SYNDROME) 1 TAb (thyroglobulin) Kidney IF global testing cANCA IFT granulocytes MAb (microsomes) GBM ELISA glomerular basement membrane PR3 (proteinase 3) PLA2R BPI (CAP 57) 1 P A G M DIABETES MELLITUS THSD7A pANCA IFT granulocytes ICA (islet cells) ANA (cell nuclei) IF global testing MPO (myeloperoxidase) GAD (glutamic acid decarboxylase) dsDNA IFT Elastase IA2 (tyrosin phosphatase) TBM (tubular basement membrane) Cathepsin G Insulin, human Lung alveolar basement membrane Lactoferrin Glucagon-producing cells ANCA Profile ELISA Zinc transporter 8 PR3, MPO, elastase, cathepsin G, BPI, lactoferrin Lipocytes P A G M NERVOUS SYSTEM ANA (cell nuclei) IF global testing Neural Antigens IFT Elastin P A G M (POLY-)ENDOCRINOPATHY Hu, Ri, ANNA-3, Yo, Tr/DNER, myelin, Vessel endothelium Adrenal cortex Ma/Ta, GAD65, amphiphysin, aquaporin-4, 21-Hydroxylase glutamate receptors (type NMDA, AMPA), Ovary: theka cells GABAA/B receptors, LGI1, CASPR2, ZIC4, P A G M LIVER, BILE DUCTS Ovary: corpus luteum DPPX, glycin receptors, mGluR1, mGluR5, Liver IFT global testing Testis: Leydig cells Rho-GTPase activating protein 26, ITPR1, Autoimmune Liver Diseases Profile Steroid hormone-producing cells Homer 3, MOG, recoverin, neurochondrin, EUROLINE AMA M2, M2-3E, Sp100, Paratyhroid gland GluRD2, flotillin 1/2, IgLON5 PML, gp210, LKM-1, LC-1, SLA/LP, SS-A, ICA (islet cells) Ro-52, Scl-70, CENP A, CENP B, PGDH TPO (thyroidea peroxidase) Paraneoplastic neurological syndromes PCA (parietal cells) Neuronal Antigens Profile Autoimmune hepatitis (AIH) H+/K+-ATPase ELISA (PCA) EUROLINE amphiphysin, CV2, PNMA2 SLA/LP (soluble liver antigen) Pituitary gland: anterior lobe (Ma-2), Ri, Yo, Hu, recoverin, SOX1, F-actin Pituitary gland: posterior lobe titin, Zic4, GAD65, Tr (DNER) ANA (cell nuclei) IF global testing MAb (thyroid microsomes) LGI1 LC-1 (liver cytosol) Adrenal medulla CASPR2 LKM (liver kidney microsomes) Placenta Potassium channel (VGKC) RIA LKM-1 ELISA Vasopressin-producing cells NMDA receptors ASGPR (asialoglycoprotein receptors) AMPA receptors (GluR1, GluR2) ASMA (smooth muscle) P A G M INFERTILITY GABAB receptors LSP (liver-specific protein) Cardiolipin GAD65 LMA (liver cell membrane) Ovary: theka cells, c. luteum, zona pellucida Hu (neurone nuclei; ANNA-1) PGDH Testis: Leydig cells Ri (neurone nuclei; ANNA-2) Spermatozoa Yo (Purkinje cell cytoplasm; PCA-1) Primary biliary cholangitis (PBC) Pituitary gland: anterior lobe Amphiphysin AMA (mitochondria) Placenta CV2 (CRMP-5) AMA M2-3E (PDH + BPO) Prostate Ma1/Ma2 (neurone nucleoli; Ta) AMA M4 (sulfitoxidase) ANNA-3 AMA M9 (glycogen phosphorylase) P A G M EPIDERMIS PCA-2 (Purkinje cell cytoplasm) Sp100, PML (nuclear dots) Desmosomes Tr (DNER) gp210 (nuclear membrane, lamin) Desmoglein 1 ZIC4 SS-A / SS-B Desmoglein 3 IgLON5 Centromeres Envoplakin AGNA (anti-glia nuclear antigen) Epidermal basement membrane SOX-1 Primary sclerosing cholangitis (PSC) BP180 (NC16A-4X) Recoverin pANCA (granulocytes) BP230 Oral mucosa Further parameters Further antibodies Transitional epithelium (urinary bladder) Aquaporin-4 Bile ducts Epidermal keratin MOG (myelin-oligodendrocyte glycoprotein) Bile canaliculi Endomysium Glycin receptors Coilin; P80 (few nuclear dots) Deamidated gliadin (CD-AGFA, GAF-3X) DPPX Melanocytes ITPR1 Hair follicle CARPVIII P A G M STOMACH, INTESTINE Collagen type VII NC1 Flotillin 1/2 PCA (parietal cells) + + p200 mGluR1 H /K -ATPase (PCA) ELISA mGluR5 Intrinsic Factor ELISA Myelin Gastrin (G) cells P A G M EYE MBP (myelin-basic protein) Pancreas acini Recoverin MAG (myelin-associated glycoprotein) CUZD1 Tunica choroidea GFAP (glial fibrillary acidic protein) GP2 Cornea Astrocytes Pankreas secretion Retina Basal ganglia Saccharomyces cerevisiae Lens oculi Plexus myentericus (non-medullated nerves) Oral mucosa Corpus ciliare Gangliosides Profile Goblet cells, intestinal Eye muscle GM1, GM2, GM3, GD1a, GD1b, GT1b, GQ1b pANCA