Étude de l'influence d'une hypergammaglobulinémie sur le titre des anticorps antiphospholipides

PURPOSE

Antiphospholipid antibodies (aPL), anticardiolipin antibodies (aCL) or lupus anticoagulant (LA), are indispensable for the diagnosis of antiphospholipid syndrome (APS). However, antiphospholipid assays can generate false positive results.

MATERIALS

We have studied the influence of hypergammaglobulinemia (HG) on aPL antibodies titers in 232 patients twice as positive for aPL antibodies.

RESULTS

Out of 232 patients, 93 have an APS (76 primary APS, 17 secondary APS). Thrombosis occurred 138 times in APS patients. Of 139 patients without APS, 95 have an auto-immune disease, 28 have an isolated prolonged KCT and 16 an evolutive neoplasia. LA seems to be the best marker of APS. On the other hand aCL IgG and M, anti-beta2-GP1 IgM titers are significantly higher in patients without APS but with HG.

CONCLUSION

Those results suggest that biological APS diagnosis should be carefully performed in patients with HG. In this case, other additional risk factors must be considered for the etiological diagnosis of thrombosis.

Factor V Leiden mutation in Sneddon syndrome

Sneddon syndrome (SNS) is characterized by the association of ischaemic cerebrovascular events and widespread livedo racemosa. Its pathophysiology is still controversial. The aim of this study was to evaluate the prevalence of factor V Leiden mutation in consecutive patients referred for SNS according to antiphospholipid antibodies (aPL) status. Fifty-three Caucasian patients were enrolled from 1996 to 2001. Diagnosis of SNS was based on the presence of a widespread livedo racemosa and at least one clinical neurologic ischaemic event. The following investigations were performed: detection of antithrombin III, protein C and protein S deficiency, lupus anticoagulant, anticardiolipin and anti-beta2 glycoprotein I antibodies, biologic false-positive test for syphilis, and factor V Leiden mutation by direct genomic analysis. Fisher's test and t-test were used for statistics. Detection of aPL on multiple determinations was negative in 31 patients (group 1) and positive in 22 patients (group 2). Factor V Leiden mutation was detected in six patients (11.3%), heterozygous in all. The frequency of this mutation was statistically higher in group 1 (6/31, 19.3%) than in group 2 (0/22; P = 0.035). Within aPL-negative SNS, the comparison of patients with versus without factor V Leiden mutation showed no difference for clinical data or familial history of thrombosis. A high prevalence of heterozygous factor V mutation was found in aPL-negative patients with SNS. This finding adds further arguments to consider SNS as a heterogeneous entity.

The appearance and disappearance of antiphospholipid autoantibodies subsequent to oxidation–reduction reactions

The mechanisms that cause the appearance of autoantibodies are not understood. Compared to normal antibody production, factors responsible for autoantibody synthesis are more complex; they are thought to disrupt the normal mechanisms proposed to eliminate or down-regulate self-antibodies or to interfere with anti-self-receptor editing. Data presented show that autoantibodies exist in the blood of all normal individuals. The autoantibodies appear after simple oxidation-reduction (redox) reactions and react by ELISA, immunofluorescence, flow cytometry, Western blots, and in lupus anticoagulant (LA) assays. Antiphospholipid antibody (aPL) specificities detected after redox are cardiolipin (aCL), antiphosphatidylserine (aPS), antiphosphatidylethanolamine (aPE), antiphosphatidylcholine (aPC), and LA. These antibody activities were confirmed in several outside laboratories. The aPL isotypes detected in ELISA are plasma protein-dependent and include IgG, IgA, and IgM. Oxidizing agents tested to date include hemin, KMnO4, and NaIO4. Furthermore, aPL appear after exposure to direct current (DC)-mediated electromotive force. Alternating current (AC) is ineffective. Commercial IvIg preparations, also a source of IgG autoantibodies, provide a less complex milieu than plasma or serum for studying the biology of aPL redox-mediated mechanisms. Inhibition of hemin-mediated IvIg aPL conversion can be achieved by the addition of antioxidants, e.g., ascorbic acid, hemopexin, apotransferrin, and by addition of normal plasma or serum. Remarkably, the aPL specificities in the blood of autoimmunity patients disappear subsequent to application of redox reactions. These data document the hitherto unknown existence of redox-reactive autoantibodies in all normal individuals. The evolutionary persistence of these redox-sensitive antibodies raises interesting possibilities about their potentially beneficial role in immunological homeostasis.

Patients with primary antiphospholipid syndrome and coronary microvascular dysfunction--a distinct clinical subset

Morbidity of patients with cardiac syndrome X (CSX) is high. Impairment of microvascular endothelial function has been suggested to be a mechanism of the disease. The study was undertaken to assess some of the characteristics of patients with primary antiphospholipid syndrome (pAPS) and CSX.

METHODS

We studied 36 patients with CSX, 14 patients having pAPS and 10 healthy controls. Patients evaluation included: clinical examination, 12-lead ECG, effort treadmill test (protocol Bruce modified), determination of plasma triglycerides, cholesterol, antiphospholipid antibodies (APLA). There were determined as markers of the inflammatory state: serum phospholipase (PL-A2) and peripheral neutrophils activity.

RESULTS

Patients with pAPS presented normal values of serum cholesterol and triglycerides levels, normal PL-A2 activity, moderate superoxide anion generation. Patients without APLA presented hyperlipidemia, increased PL-A2 activity, increased superoxide anion generation. During the follow-up period we found a correlation between P1-A2 activity and ischemic episodes, but only in patients with CSX and pAPS there were registered cardiovascular events.

CONCLUSION

Patients with SCX and pAPS represent a distinct clinical subset, being characterized by minimal inflammation, absence of usual risk factors for coronary heart disease, more severe prognosis related to recurrent thromboses and the need for early anticoagulant therapy.

Anti-β2-glycoprotein I antibodies—When and how should they be measured?

The biological criteria of the antiphospholipid syndrome defined at the Sapporo meeting in 1998 included the presence of lupus anticoagulant (LA) and/or anticardiolipin antibodies at medium and high titers. During the 48th SSC meeting held in Boston July 2002, it was proposed to modify these criteria. Four patient groups were defined, the first one comprising LA and anti-beta2glycoprotein I antibodies (abeta2GPI), the second one LA only, the third one abeta2GPI only and the fourth one other antiphospholipid antibodies such as antiprothrombin, anticardiolipin, antiphosphatidylethanolamine, etc. This proposition raised the issue of the association of abeta2GPI with APS clinical criteria (thrombosis and pregnancy morbidity). In some studies, a strong association between IgG abeta2GPI and thrombosis was found, whereas in others this association could not be demonstrated. In the obstetrical field, few studies are available and no clear conclusion can be drawn yet. However, for thrombosis or pregnancy morbidity, it has been shown that in up to 10% of patients, abeta2GPI are the sole antibodies present and therefore the diagnosis of APS would be missed in these patients. In addition, some studies suggest that the severity of disease is dependent on the number of positive tests and on their titers. We recommend abeta2GPI assays to be included in the panel of antiphospholipid screening tests. However, the standardisation of abeta2GPI assays has to be improved in order to ensure better comparability between the studies.

An adapted ELISA method for differentiating pathogenic from nonpathogenic aPL by a beta 2 glycoprotein I dependency anticardiolipin assay

With the currently available commercial kits, as well as homemade assays for detecting anticardiolipin antibodies (aCL), it is not possible to discriminate nonpathogenic, beta 2 glycoprotein (GPI)-independent, infection-related antibodies from those of patients with the true autoimmune thrombotic syndrome, known as antiphospholipid syndrome (APS). We devised an assay that is able to differentiate these two types of antibodies by determining the beta 2 GPI requirements to bind in a cardiolipin ELISA. Beta 2 GPI was purified by perchloric acid precipitation, and fixed amounts were used in the dilution solutions of the tested samples that were also tested with no source of beta 2 GPI. The ELISA plates were coated with cardiolipin, as usual, and blocked with a chicken ovalbumin solution. The serum samples had to be highly diluted in order not to have beta 2 GPI from the patient serum. The reaction was detected with alkaline phosphate tablets and developed with pNp in diethanolamine buffer. The adapted ELISA aCL assay described here was able to discriminate infectious [syphilis, hepatitis C virus (HCV), dengue fever, human immunodeficiency virus (HIV) and leprosy] and autoimmune [primary APS and systemic lupus erythematosus (SLE) related APS]. Further testing should be performed to demonstrate that this method consistently differentiates pathogenic antibodies that bind in an aCL ELISA only in the presence of beta 2 GPI.

[Antiphospholipid syndrome and pregnancy]

The antiphospholipid antibody syndrome (APLS) is multisystem, autoimmune disease, which is characterized by: thrombosis, obstetrics complications and thrombocytopenia. The two most clinically significant antiphospholipid antibodies (APLa) that are associated with recurrent pregnancy loss and thrombosis are anticardiolipin antibodies (ACL) and lupus anticoagulant (LA). The laboratory diagnosis is based on the presence of moderate to high positive ACL and/or LA. The inhibitory effect of antiphospholipid antibodies /APLa/ on trophoblast intercellular fusion, hormone production and invasion may cause pregnancy loss. Once placentation is established their thrombogenic action leads to decreased placental perfusion and subsequent infarction. The APLa--mediated inhibition of trophoblastic invasion and APLa--mediated vasculopathy in the placental bed arteries result in abnormal uterine artery /UA/ Doppler waveforms. The association between APLa and high resistance index /RI/ and/or diastolic notch /DN/ in the Doppler waveforms is high predictive for adverse pregnancy outcome, including pre-eclampsia/eclampsia, intrauterine growth retardation, placental abruption, intrauterine fetal death. Maternal treatment and careful monitoring of fetal well-being are mandatory in the management of these high-risk pregnancies.

Increased titer of anti-β2-glycoprotein I IgG antibody among factor V Leiden carriers during oral contraceptive use

The risk of thromboembolism during oral contraceptive (OC) use is increased among factor V Leiden (FVL) carriers compared to women with wild-type genotype of the gene for coagulation factor V (FV). The carrier frequency in the general population is too high for FVL alone to be responsible for the reported association. Additional risk factors may be required to explain the increased risk of thromboembolism of carriers during OC use. We conducted a case-control study to compare the titer of anti-beta2-glycoprotein I immunoglobulin G (IgG) and the frequency of elevated titer of IgG type anti-beta2-glycoprotein I antibody between FVL carriers and individuals with FV wild-type genotype with and without pill use. An asymptomatic population of 313 unrelated nonpregnant women were screened for FVL and for the presence of anti-beta2-glycoprotein I IgG antibody. Sixty-six women were FVL carriers and 247 had normal genotype. One-hundred and thirty-five women used OC at the time of screening and 178 did not. Among FVL carriers, OC pill users had a higher mean anti-beta2-glycoprotein I IgG titer than nonusers (9.2 SGU/mL vs. 4.7 SGU/mL, p = 0.0485). Among women with FV wild-type genotype, there was no significant difference in anti-beta2-glycoprotein I IgG titers between users and nonusers of OCs (6.4 SGU/mL and 6.0 SGU/mL, respectively; p = 0.7010). The odds of an elevated anti-beta2-glycoprotein I IgG titer during OC use in FVL heterozygous women was 2.41 (95% confidence interval: 0.79-7.39) relative to users with-type genotype. FVL may contribute to the development of elevated titer of IgG type anti-beta2-glycoprotein I antibody during OC use. The elevated titer of IgG type anti-beta2-glycoprotein I antibody may select women among FVL carriers during OC use with an increased risk of thromboembolism.

The prevalence of anti-phospholipid antibodies in a selected population of Kenyan women and development of a non-human primate model

The mechanisms by which anti-phospholipid antibodies (aPLs) may induce pregnancy losses, intrauterine growth retardation and pregnancy-induced hypertension are not clearly understood. Moreover, there is a controversy regarding the possible direct effects of these antibodies on the physiology of the placenta since the target antigens of these antibodies are intracellular antigens and are potentially inaccessible to the antibody. Also, controversy exists regarding the usefulness of the treatment regimens currently available. In this study, we present preliminary data on the prevalence of aPLs in a selected population (n = 80) of Kenyan women visiting Kenyatta National Hospital, Nairobi, Kenya for obstetrical complications including recurrent pregnancy losses. Our results showed approximately 13.8% of the patients were positive for anti-cardiolipin antibodies whereas 33.8% were positive for aPS. Additionally, we screened 72 non-human primates for presence of aPLs and our results showed that the olive baboon (Papio anubis) had the highest prevalence rate (52.2%, n = 23). Overall, our results suggest that the olive baboon may be a suitable animal model for studying the mechanism of action of the anti-phospholipid antibody and pregnancy complications associated with aPLs.

Antiphospholipid antibodies bind to activated but not resting endothelial cells: is an independent triggering event required to induce antiphospholipid antibody-mediated disease?

INTRODUCTION

Antiphospholipid antibodies (aPL) cause thrombotic disease and recurrent pregnancy loss. Despite their name it is now clear that the antigen for most antiphospholipid antibodies is the phospholipid-binding protein beta(2) glycoprotein I (beta(2)GPI). However, beta(2) glycoprotein I is only antigenic for antiphospholipid antibodies when the protein is immobilised on a suitable surface such as phosphatidyl serine. It has been suggested that antiphospholipid antibodies bind to beta(2) glycoprotein I on the surface of resting endothelial cells and this in turn leads to endothelial activation and the initiation of thrombosis. However, as phosphatidyl serine is absent from resting endothelial cell membranes, we questioned this hypothesis.

MATERIALS AND METHODS

The ability of human antiphospholipid antibody-containing sera and monoclonal antiphospholipid antibodies to interact with endothelial cells was examined using cell-based ELISAs employing human umbilical vein endothelial cells (HUVECs) as the antigen. The expression of adhesion molecules in response to treatment with antiphospholipid antibodies was also measured by a cell-based ELISA. Activation of NF kappa beta was examined using electrophoretic mobility shift assays (EMSAs).

RESULTS

Neither monoclonal antiphospholipid antibodies nor human sera containing antiphospholipid antibodies bound to resting endothelial cells. In contrast, one monoclonal antiphospholipid antibody did bind to both activated and apoptotic endothelial cells.

CONCLUSIONS

Antiphospholipid antibodies do not bind to resting endothelial cells nor do antiphospholipid antibodies activate resting endothelial cells. Rather, an independent triggering event is required to activate endothelial cells and subsequently some antiphospholipid antibodies may then bind to the activated endothelial cells and initiate a thrombogenic process.

Pregnancy Outcome in Patients with a History of Recurrent Spontaneous Miscarriages and Documented Thrombophilias

The aim of this study was to evaluate the effect of treatment in patients analyzed for recurrent spontaneous miscarriage with a diagnosis of a hereditary thrombophilia, the presence of antiphospholipid and/or autoimmune antibodies, and/or hyperhomocystinemia (HHC) with or without methylenetetrahydrofolate reductase (MTHFR) polymorphisms. In total, 76 women with 2 or more embryonic or fetal losses were analyzed. Of these, 49 (64.4%) women were found to have one or more thrombophilias and/or autoimmune antibodies, and 33 (43.4%) women were found to have a MTHFR polymorphism and/or HHC. Since completion of the recurrent miscarriage analysis, 39 women conceived again. All women with a thrombophilia were treated with low-dose aspirin plus low molecular weight heparin. All women with previously diagnosed HHC and/or MTHFR polymorphisms were treated with folate and vitamin B(6) and B(12) supplementation. In the thrombophilia group, 27 women conceived resulting in 20 successful pregnancies (74.1%) and 7 pregnancy losses (2 trisomy 16, 1 ectopic pregnancy and 4 unexplained miscarriages), i.e. an unexplained pregnancy loss rate of 14.8%. In the HHC/MTHFR group 22 women conceived, resulting in 17 successful pregnancies (77.3%) and 5 pregnancy losses (1 trisomy 16, 1 Turner syndrome and 3 unexplained miscarriages), i.e. an unexplained pregnancy loss rate of 13.6%.

Revisiting antiphospholipid antibodies: from targeting phospholipids to phospholipid binding proteins

The antiphospholipid syndrome (APS) is a multi-system prothrombotic disorder associated with circulating auto-antibodies directed against various phospholipid-binding proteins. The major clinical manifestations are recurrent arterial or venous thrombosis, but due to its heterogeneity, atypical presentations can obscure the diagnosis. Decisions regarding when to attribute complications to aPL are difficult. The most established tests are lupus anticoagulant (LA) detected by clotting assays and anticardiolipin (aCL) detected by ELISA. Although LA and aCL assays are clinically useful, these tests do not clearly differentiate antibodies with different specificities. Antibodies to beta2GPI are associated with thrombosis in the APS. Although these antibodies are detected by aCL assay (e.g. beta2GPI-dependent aCL), some aCL are not associated with the syndrome (e.g. beta2GPI-independent aCL). Regarding LAs, more studies are needed to determine if it is clinically important to differentiate specificities against beta2GPI or prothrombin. The role of aPLs in the pathogenesis of thrombosis requires further and intensive investigation. If autoantibodies to particular phospholipid binding proteins are shown to be associated with different clinical presentations or to confer different risks, the availability of more accurate diagnostic techniques will be required for the recognition of pathogenic aPLs. By now, clinical judgement, careful exclusion of other etiologies and serial aPL levels are helpful in this regard.

Antiphospholipid antibodies are associated with an increased risk for chronic renal insufficiency in patients with lupus nephritis

BACKGROUND

Previous studies have documented the high frequency of thrombosis and fetal loss in patients with lupus nephritis and antiphospholipid (aPL) antibodies, but there is little information on the impact of aPL antibodies on the outcome of lupus nephritis. The aims of this study are to evaluate the prevalence of aPL antibodies in patients with lupus nephritis and assess their prognostic value for thrombosis and pregnancy morbidity and impact on long-term renal outcome.

METHODS

One hundred eleven patients with lupus nephritis followed up for a mean of 173 +/- 100 months were tested regularly for immunoglobulin G (IgG) and IgM anticardiolipin antibodies and lupus anticoagulant.

RESULTS

The overall prevalence of aPL antibodies was 26%. In follow-up, 79% of aPL antibody-positive patients experienced thrombotic events and/or fetal losses, and aPL antibodies were associated significantly with arterial or venous thrombosis (P = 0.00001), pregnancy morbidity (P = 0.045), thrombocytopenia (P = 0.0015), and persistent arterial hypertension (P = 0.028). aPL antibodies were significantly more frequent in patients with biopsy-proven membranous lupus nephritis (P = 0.01). A strong association between aPL antibodies and the development of chronic renal insufficiency in the long-term outcome also was found (P = 0.01). With multivariate analysis, aPL antibody positivity (P = 0.02), high plasma creatinine level at presentation (P = 0.01), and chronicity index (P = 0.00004) were independent predictors of chronic renal function deterioration.

CONCLUSION

Detection of aPL antibodies in patients with lupus nephritis is useful not only to identify patients at risk for vascular and obstetric manifestations, but also for their potential deleterious impact on renal outcome.

[Levels of antiphospholipid antibodies in the serum and aqueous humor of glaucoma patients]

PURPOSE

Evaluation of antiphospholipid antibodies in the serum and aqueous humor in patients with glaucoma.

MATERIAL AND METHODS

48 persons (38 women and 17 men), aged 30-86 (mean age 70), suffering from glaucoma was examined. There were 19 with POAG, 18 with PACG and 11 with PEXG. All patients have undergone trabeculectomia. The group of 20 operated, because of age-related cataracta patients (7 men and 13 women), aged 47-82 (mean age 65) constituted a control group. All patients agreed to samples collection. In plasma and anterior chamber fluid the level of antiphospholipids antibodies classes IgM and IgG were measured, using ELISA method (commercial kits produced by Euroimmun) according to producent's instruction. Statistical analysis was performed using U Mann-Whitney test.

RESULTS

The mean values of antiphospholipids in both group are put in the table. The significant differences between glaucoma and no-glaucoma patients were observed in levels of IgG in serum (p=0.014) and in levels of IgM antibodies in aqueous humor (p=0.013).

CONCLUSIONS

The presence of elevated levels of antiphospholipid antibodies in aqueous humor and serum may be a risk factor in progression of glaucomatous neuropathy.

Anticardiolipin, anti-beta(2)-glycoprotein I and antiprothrombin antibodies in black South African patients with infectious disease

OBJECTIVES

To investigate IgG, IgM, and IgA, antiphospholipid antibodies (aPL), against cardiolipin (aCL), beta(2)-glycoprotein I (anti-beta(2)GPI), and prothrombin (anti-PT), in black South African patients with infectious disease. Unlike patients with systemic lupus erythematosus (SLE) and the antiphospholipid syndrome (APS), raised levels of aPL in infectious diseases are not usually associated with thrombotic complications.

PATIENTS AND METHODS

Serum samples from 272 patients with a variety of infectious diseases (100 HIV positive, 112 leprosy, 25 syphilis, 25 malaria, and 10 HCV patients) were studied and compared with autoantibody levels in 100 normal controls. All three aPL were measured using commercial enzyme linked immunosorbent assay (ELISA) kits.

RESULTS

Raised levels of all three aPL were found in all patient groups studied: aCL in 7%, anti-beta(2)GPI in 6%, and aPT in 43% of 100 HIV patients, in 29%, 89%, and 21% of 112 patients with leprosy, in 8%, 8%, and 28% of 25 patients with syphilis, in 12%, 8%, and 28% of 25 patients with malaria, and in 20%, 30%, and 30% of 10 HCV patients studied, respectively.

CONCLUSIONS

The prevalence of aCL and anti-beta(2)GPI in black South African HIV positive patients, or those with syphilis, malaria, or hepatitis C virus is lower than reported for mixed race or white populations. aPT were the most prevalent aPL detected in these patient groups, except in patients with leprosy, for whom anti-beta(2)GPI was the most prevalent, and where the spectrum of aPL was similar to that seen in patients with SLE and APS.

[Combined therapy in pregnancy with primary antiphospholipid syndrome]

Patients with antiphospholipid syndrome have a high frequency of mid-pregnancy intrauterine growth retardation or fetal death. The authors report the case of a 28 year old pregnant woman with antiphospholipid syndrome with severe obstetrical complications (spontaneous abortion, missed abortion) in the past history. By means of the administration of combined immunomudulant (intravenous immunoglobulin, steroid), anticoagulant and antiplatelet therapy we could prevent a subsequent pregnancy loss of the patient. Apropos of this case the authors give an overview on the monitoring of the disease and the therapeutical recommendations of the literature.

Beta-2-glycoprotein I antibodies in patients with thrombosis

The laboratory diagnosis of antiphospholipid antibody syndrome currently requires two consecutive positive results in either lupus anticoagulant or anticardiolipin antibody assays. Antibodies against beta-2-glycoprotein I (abeta2-GPI) are suggested as a new marker for the syndrome. The inclusion of abeta2-GPI in the official diagnostic criteria has so far been precluded owing to lack of an international standard and also technical difficulties. Samples from 5367 consecutive patients sent to a national reference laboratory mainly because of various thrombotic events were studied. An IgG abeta2-GPI ELISA assay was performed in addition to lupus anticoagulant (dRVVT and PTT-LA) and IgG anticardiolipin antibody determinations to evaluate patient groups in which the new assay might be of value. From a total of 90 patients, 2.2% of the samples were abeta2-GPI positive; 51 patients had abeta2-GPI as the only positive antiphospholipid antibody marker; 20 patients had had a venous thrombosis and 14 an arterial thrombosis, 4 had pregnancy complications and 2 had thrombocytopenia. Relatively young patients with cerebrovascular ischaemic events seemed especially to present sole abeta2-GPI positivity. The abeta2-GPI positivity remained fairly constant in the 23 patients from whom follow-up samples were taken. It is concluded that the IgG abeta2-GPI assay seems to be a potentially important additional diagnostic tool for the antiphospholipid antibody syndrome.

The effects of antiphospholipid antibodies obtained from women with SLE/APS and associated pregnancy loss on rat embryos and placental explants in culture

Recurrent fetal loss occurs in approximately 1% of women. Autoimmune causes have been suggested as a factor in some of these cases. High rates of intrauterine fetal growth retardation and increased incidence of prematurity is associated with systemic lupus erythematosus (SLE) and the antiphospholipid syndrome (APS). We found in previous studies that sera from SLE/APS patients when used as a culture medium for rat embryos were found to reduce embryonic growth and development, induce a high rate of embryonic anomalies and death and damage the yolk sac morphologically and functionally. In order to investigate the direct effect of IgG purified from women with SLE/APS on the growth and viability of embryos, we cultured 11.5-day-old rat embryos in their yolk sacs in the presence of IgG purified from SLE/APS patients with recurrent pregnancy loss (RPL). The IgG affected directly the embryo and yolk sac, reducing their growth. The purified IgG positive for anticardiolipin/anti-DNA antibodies reduced yolk sac and embryonic growth more than sera negative for these antibodies but positive for antiphosphatydilserine and for antilaminin. Monoclonal antiphosphatydilserine reduced yolk sac growth but the embryos remained intact. Following the observed damage to the yolk sac we cultured human placental explants at 5.5-8 weeks of pregnancy in sera from SLE/APS patients for 96 hours and found that these sera reduced placental trophoblastic cell growth, reduced their proliferation rate and increased their rate of apoptosis. Successful treatment of the women resulted in a correction of the damage induced in the cultured rat embryos and in the cultured placental explants.

Increased carotid artery intima-media thickness as an indicator of the onset of atherosclerosis in patients with connective tissue systemic diseases

BACKGROUND

Systemic connective tissue diseases have an autoimmunological background. Atherosclerosis is the main cause of ischaemic heart disease in patients with these disorders, particularly in young females. Atherosclerotic process begins in the intimal and medial layers of arterial wall. Early detection of these changes may have important clinical implications.

AIM

To assess the intima-media thickness (IMT) in carotid arteries in patients with connective tissue disorders and to correlate IMT with the presence of antiphospholipid (aPL) antibodies.

METHODS

The study group consisted of 74 patients (63 females, 11 males) with documented connective tissue disease and 75 (62 females, 13 males) control subjects without clinical symptoms suggesting atherosclerosis. The IMT values, measured using ultrasonography, and aPL (IgG and IgM) antibody titre were assessed in all subjects.

RESULTS

Mean aPL IgG and IgM values were significantly higher in patients than in controls (9.22 GMP/ml vs 6.59 GMP/ml, p<0.01; and 18.59 MPL/ml vs 12.05 MPL/ml, p<0.01, respectively). Patients with connective tissue diseases had significantly higher IMT values than controls (0.82 mm vs 0.57 mm, p<0.01). The IMT values positively correlated with age, presence of aPL antibodies, hypercholesterolemia and duration of the disease.

CONCLUSIONS

The presence of aPL antibodies and increased IMT may indicate atherosclerosis in young patients with connective tissue diseases, and identify those who need more intensive prophylactic treatment in order to decrease the risk of atherosclerosis-related complications and death.

Relationship between Skin Bacterial Colonization and the Occurrence of Allergen-specific and Non-Allergen-specific Antibodies in Sera of Children with Atopic Eczema/Dermatitis Syndrome

In this study we investigated skin bacterial colonization, allergen-specific IgE and antiphospholipid/antinuclear antibodies in 72 children with atopic eczema/dermatitis syndrome (age 2-17 years). Bacteria were found on the skin in 41 cases and serological allergen-specific IgE positivity in 37. The different forms of antibodies appeared in the ratio 21/72 (33 antibodies in 21 children). The occurrence of antiphospholipid antibodies was significantly higher in the patients than in the controls. There were significantly more allergens in the group with bacterial colonization than in the group without colonization. The SCORAD index showed a significant positive association with the skin colonization. We conclude that there are significant relationships between the occurrence of Staphylococcus aureus colonization and the levels of inhalant allergen-specific IgE in children with atopic eczema/dermatitis syndrome, and between the occurrence of antiphospholipid IgM positivity and atopic eczema/dermatitis syndrome.

Central retinal vein occlusion and renal cell carcinoma

PURPOSE

To document a case of central retinal vein occlusion (CRVO) associated with renal cell carcinoma and elevated levels of anticardiolipin and antiphospholipid antibodies.

DESIGN

Observational case report.

METHODS

History, clinical examination, chart review, and laboratory serologies were performed on a 63-year-old man with renal cell carcinoma with a 6-week history of decreased vision in his left eye.

RESULTS

Vision was 20/40 in the left eye. Dilated fundus examination revealed a CRVO. Laboratory serologies revealed markedly elevated levels of anticardiolipin and antiphospholipid antibodies.

CONCLUSION

This case illustrates an association between CRVO and renal cell carcinoma. A paraneoplastic process, consisting of both antiphospholipid and anticardiolipin antibodies, may be a mechanism for CRVO.