Ateneo - UPO

The course aims to provide: the essential elements to guide the student in the field of autoimmune diseases; the tools to optimize the laboratory's response to the question posed by the clinician and illustrate the main critical issues related to the diagnosis of autoimmune diseases in order to identify possible solutions based on the evidence emerging from the literature. The training, also expected “on site”, is the diagnosis process as a whole known by integrating organizational, technical and methodological knowledge, with diagnostic algorithms and interpretation of results in order to provide essential knowledge for orientation in the world of autoimmune diseases.

The texts are complete for understanding and guidance within the training path and are represented by the “Guidelines” proposed by national and international accredited scientific societes and scientific articles.
• “The laboratory in organ autoimmune disease”. Renato Tozzoli, Nicola Bizzaro, Danilo Villalta, Elio Tonutti. Aldo Pinchera, Società Editrice ESCULAPIO.
• “ The laboratory in autoimmune rheumatic diseases” Renato Tozzoli, Nicola Bizzaro, Danilo Villalta, Elio Tonutti. Società Editrice ESCULAPIO.
• “Autoimmune Diseases”. Corrado Betterle. Ed. Piccin.
• M.C Sacchi et al.The onset of de novo autoantibodies in healthcare workers after mRNA based 2023, Vol. 56, No. 1, 2229072; https://doi.org/10.1080/08916934.2023.2229072
• M.C. Sacchi et al. SARS-CoV-2 infection as a trigger of autoimmune response. Clin Transl Sci 14 (2021): 898-907
• Bonometti R, Sacchi MC, Stobbione P, et al. The first case of systemic lupus erythematous (SLE) trigger by COVID19 infection. Eur Rev Med Pharmacol Sci 24 (2020): 9695-9697.
• European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. Abdulbaqi Al-Toma, Umberto Volta, Renata Auricchio, et al. United European Gastroenterology Journal: (2019) Volume 7 issue: 5, page(s): 583-613 https://journals.sagepub.com/doi/full/10.1177/2050640619844125

The student acquires the fundamental principles for the understanding of the logic that underlies the autoimmune response, the autoimmune diseases and the laboratory tests performed in an autoimmunology laboratory in daily practice.
Ability to apply knowledge and understanding: it is expected that the student acquires at the end of the course a critical orientation also on the organizational, technical and managerial aspects that represent the real life of the Autoimmunity laboratory.
Making judgment: the student is expected to express himself consciously and critically on the choice of the most appropriate technologies and diagnostic tests; ability to interpret laboratory data for the evaluation of autoimmune diseases.
Communication skills: it is necessary to know how to communicate effectively both orally and in writing; demonstrate ability to summarize and present information; demonstrate to present effectively and objectively, using appropriate scientific language, information and results obtained and to draw appropriate conclusions from them.
Learning skill: ability to read, understand and comment on an autoimmunology scientific article.

The course does not require particular skills, except those derived from previous courses of study, but a good knowledge of general pathology and immunology facilitate the training course.
An adeguate property of language and a mastery of scientific terminology is needed.

Traditional frontal lessons, work groups and laboratory experiences. The course lessons involve the use of slides, scientific articles, recommended readings, discussion of clinical cases. In the lectures will be presented some diagnostic paths and tecnologies mainly used.
On-site lectures are planned with the aim of getting to the bottom of the professional reality and highlighting how the most important aspect characterising autoimmunology is transversality, i.e. multidisciplinarity, and how fundamental the collaboration between clinical immunologist and laboratory autoimmunologist is within a second level hospital centre for autoimmune diseases.

Moment of confrontation, discussion and resumption of complex topics are planned with the aim of evaluating the degree of ongoing learning, analyzing more in detail some aspects not sufficiently developed.Students with physical disabilities, Learning Disabilities or Special Education Needs can request specific services and tools via the Staff Sviluppo e Coordinamento Carriere e Servizi alle Studentesse
e agli Studenti, consulting the University webpage: https://www.uniupo.it/en/services/services-students-physical-or-learning-disabilities. Students with disabilities, learning disabilities or special education needs, once they have contacted the University Staff, can refer to the tutor in charge of the course to define the examination modalities, concerning academic aspects."

The objective of the exam consists in verifying the level of knowledge and deepening of the topics of the program and the reasoning capacity developed by the student. The final exam consists of a oral exam and includes the development of a diagnostic path in one of the areas covered by the course program. To achieve sufficient, the student will have to demonstrate knowledge of the basics of the exam topics: the basic of the laboratory test applied for and what autoantibodies are recognized. For excellence the student must know all the laboratory tests for the detection of autoantibodies in patient with suspected autoimmune disease and propose solutions to address critical issues and diagnostic inappropriateness in autoimmunity, with adequate terminology, sinthesis skills and specific knowledge. The outcome of the exam test, espressed out of thirty, will be communicated at the end of exam.

Introduction to the course “The role of a hospital laboratory in the diagnosis of autoimmune diseases’ (2 hours)
• Definition of autoimmune disease
• Outlines of pathophysiology, classification, epidemiology and genetic diagnosis of autoimmune diseases: systemic and organ-specific

Laboratory methods for the detection of systemic and organ-specific autoantibodies (2 hours)
• Evolution of diagnostic methods and technologies for autoantibody testing

Systemic autoantibodies (4 hours):
• Intracellular anti-antigen autoantibodies: the role of ANAs
• ICAP nomenclature (The International Consensus on ANA Patterns) and interpretation of fluroscopic patterns
• The antibodies: chromatin, nuclear, non-chromatin, nucleolar, cytoplasmic, anti-citrullinated peptides. Rheumatoid factors. Anti-phospholipid autoantibodies. The anti-neutrophil cytoplasmic autoantibodies: fluorescence pattern and antigenic specificity in ANCA-associated diseases.

Laboratory diagnosis of systemic autoimmune diseases (4 hours)
• Systemic lupus erythematosus: presentation of a case report
• Focus on myositis: generalities and discussion of a case report
• Progressive systemic sclerosis: the role of the autoimmunity laboratory in the diagnosis and prognosis of systemic sclerosis
• Sjogren's syndrome
• The anti-phospholipid antibody syndromes
• Vasculitites

Laboratory diagnosis of organ-specific diseases (4 hours)
• Laboratory diagnosis in autoimmune liver diseases: identification and role of autoantibodies. Diagnostic strategy and interpretation of fluoroscopic pictures.
• Autoantibodies in autoimmune diabetes
• The chronic inflammatory bowel diseases: anti-Saccharomyces cerevisiae (ASCA) and anti-neutrophil cytoplasmic antibodies (ANCA )
• Gastric autoimmunity: generalities, predictive role of autoantibody tests in autoimmune gastritis
• Coeliac disease: diagnostic strategy, IFA pattern interpretation
• Autoantibodies directed against glycoprotein phospholipase A2 receptor (PLA2R) and THSD7A (thrombospondin type 1 7A) protein: markers for the serological diagnosis of primary membranous glomerulonephritis (pMGN)

Neuroimmunology: Autoantibodies in neurological diseases (2 hours)
• Paraneoplastic neurological syndromes
• Autoimmune encephalitis
• Diseases of the central and peripheral nervous system: demyelinating diseases, autoimmune neuropathies, myasthenia gravis

Clinical and laboratory autoimmunology (4 hours)
• Diagnostic appropriateness in autoimmunity: presentation of the handbook ‘The search for appropriateness in autoimmunity testing’.
• The interpretative report
• The collaboration between the laboratory autoimmunologist and the clinical autoimmunologist

SARS CoV-2: an autoimmune virus (2 hours)
• Presentation of clinical studies conducted at the Autoimmunity laboratory
• Field training: some lectures will be carried out ‘in the field’ at the Autoimmunity laboratory with ‘on site’ activities.

Acquisition of in-depth knowledge of concepts related to diagnostic pathways. Acquisition of mastery of technical and organizational elements in the field of Autoimmunity Laboratory.
Ability to apply knowledge and understanding by grasping the essential elements to satisfy the diagnostic request by using resources at best.
Autonomy of judgment. Acquisition of independent judgment in the evaluation of data in the first and second level scientific literature.
Communication skills. Demonstrate ability to extract and synthesize relevant information, refinement of the disciplinary vocabulary and the ability to describe, with clarity and a critical sense, the decision-making processes.
Demonstrate ability to summarize and present information also with graphs.
Learning skills. Acquisition of the ability to deepen and critically update objectives and/or the results of a diagnostic process according to a quantitative and qualitative approach.