Antiphospholipid antibody profile: implications for the evaluation and management of patients

Abstract

According to the classification criteria of antiphospholipid syndrome, lupus anticoagulant, anticardiolipin and anti-β₂ glycoprotein I antibody assays are independent risk factors for the occurrence of vascular thrombosis and pregnancy loss. However, it is generally accepted that patients carrying multiple positivity have more a severe disease and higher recurrence rate despite treatment. On the other hand, the diagnostic value of a positive result in one only assay is more controversial, particularly in the presence of clinical manifestations such as deep vein thrombosis or early miscarriages, which are rather common in the general population. In this review we speculate on current and future strategies to interpret different antiphospholipid antibody profiles in the clinical practice. Lupus (2010) 19, 432—435.

Keywords

anti-β2 glycoprotein I anticardiolipin assay antiphospholipid antibody antiphospholipid syndrome lupus anticoagulant

Get full access to this article

View all access options for this article.

References

Miyakis S. , Lockshin MD , Atsumi T. , et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemostasis 2006; 4: 295-306.

Lee RM , Brown MA , Branch DW , Ward K. , Silver RM Anticardiolipin and anti-b2-glycoprotein-I antibodies in preeclampsia. Obstetrics Gynecol 2003; 102: 294-300.

Pengo V. , Ruffatti A. , Legnani C. , et al. Clinical course of high risk patients diagnosed with Antiphospholipid Syndrome (APS). J Thromb Haemostasis 2009; [Epub ahead of print].

Galli M. , Lucani D. , Bertolini G. , Barbui T. Lupus anticoagulants are stronger risk factors for thrombosis than anticardiolipin antibodies in the antiphospholipid syndrome: a systematic review of the literature . Blood 2003; 101: 1827-1832.

Pengo V. , Tripodi A. , Reber G. , et al. Update of the guidelines for lupus anticoagulant detection. J Thromb Haemostasis 2009; 7: 1737-1740.

Tincani A. , Filippini M. , Scarsi M. , Galli M. , Meroni P. European attempts for the standardisation of the antiphospholipid antibodies . Lupus 2009; 18: 913-919.

Galli M. , Reber G. , de Moerloose P. , de, Groot PG Invitation to a debate on the serological criteria that define the antiphospholipid syndrome. J Thromb Haemostasis 2008; 6: 399-401.

Sakai Y. , Atsumi T. , Ieko M. , et al. The effects of phosphatidylserine-dependent antiprothrombin antibody on thrombin generation. Arthritis Rheum 2009; 60: 2457-2467.

Tincani A. , Morozzi G. , Afeltra A. , et al. Forum Interdisciplinare per la Ricerca nelle Malattie Autoimmuni (FIRMA). Antiprothrombin antibodies: a comparative analysis of homemade and commercial methods. A collaborative study by the Forum Interdisciplinare per la Ricerca nelle Malattie Autoimmuni (FIRMA). Clin Exp Rheumatol 2007; 25: 268-274.

10.

de Laat B. , Derksen RH , Urbanus RT , de Groot PG IgG antibodies that recognize epitope Gly40-Arg43 in domain I of beta 2-glycoprotein I cause LAC, and their presence correlates strongly with thrombosis. Blood 2005; 105: 1540-1545.

11.

Tincani A. , Andreoli L. , Nalli C. , et al. Is it possible to differentiate natural antiphospholipid antibodies from ‘‘thrombophilic’’ ones? Analysis of the fine specificity against the domains of beta2glycoprotein I. Arthritis Rheum 2009; 60: S477-S478 (abstract 1273).

12.

twb38wArvieux J. , Renaudineau Y. , Mane I. , Perraut R. , Krilis SA , Youinou P. Distinguishing features of anti-beta2 glycoprotein I antibodies between patients with leprosy and the antiphospholipid syndrome . Thromb Haemostasis 2002; 87: 599-605.

13.

Ambrozic A. , Avcin T. , Ichikawa K. , et al. Anti-beta(2)-glycoprotein I antibodies in children with atopic dermatitis. Int Immunol 2002; 14: 823-830.

14.

Balasci J. , Carmona F. , Creus M. , Cervera R. Treatment of infertility and early pregnancy loss in the antiphospholipid syndrome. In: Cervera R , Reverter GC , Khamashta M (eds), Handbook of systemic autoimmune diseases. Amsterdam, The Netherlands: Elsevier; 2009. p. 193-201.

15.

Shoenfeld Y. , Twig G. , Katz U. , Sherer Y. Autoantibody explosion in antiphospholipid syndrome. J Autoimmun 2008; 30: 74-83.