[Review article: Antineutrophil cytoplasmic antibody in small vessel vasculitis]

The vasculitides are defined by the presence of leukocytes in vessel walls with reactive damage to mural structures. Vasculitis may occur as a primary process or may be secondary to another underlying disease. In general, the affected vessels vary in size, type, and location in association with the specific vasculitic disorder. Classically, vasculitic syndromes have been categorized by the predominant sizes of the blood vessels and types of vessel most commonly affected among patients with the disorder. Currently, antineutrophil cytoplasmic antibody (ANCA) testing plays a critical role in the pathogenesis, diagnosis, and classification of vasculitides. Two types of ANCA assay (indirect immunofluorescence assay and enzyme-linked immunosorbent assay (ELISA)) are in wide use. Two major immunofluorescence patterns are observed, the C-ANCA and P-ANCA patterns. In vasculitis, the two relevant target antigens for ANCA are proteinase 3 (PR3) and myeloperoxidase (MPO). Antibodies with target specificities for PR3 and MPO are called PR3-ANCA and MPO-ANCA, respectively. Vasculitides associated with serum positivity for ANCA that affect small to medium-sized vessels are commonly known as ANCA-associated vasculitis and include Wegener's granulomatosis, microscopic polyangiitis, and Churg-Strauss syndrome. In this article, the pathogenesis of ANCA will be reviewed as well as the pitfalls regarding its clinical application.