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Ding Z, Pan H, Yang Z, Yang C, Shi H. Beyond the classics: The emerging value of anti-phosphatidylserine/prothrombin antibodies in antiphospholipid syndrome. Clin Immunol 2023; 256:109804. [PMID: 37838215 DOI: 10.1016/j.clim.2023.109804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/24/2023] [Accepted: 10/05/2023] [Indexed: 10/16/2023]
Abstract
Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by the presence of antiphospholipid antibodies (aPLs), which can lead to thrombosis and pregnancy complications. Within the diverse range of aPLs, anti-phosphatidylserine/prothrombin antibodies (aPS/PT) have gained significance in clinical practice. The detection of aPS/PT has proven valuable in identifying APS patients and stratifying their risk, especially when combined with other aPL tests like lupus anticoagulant (LA) and anti-β2-glycoprotein I (aβ2GPI). Multivariate analyses have confirmed aPS/PT as an independent risk factor for vascular thrombosis and obstetric complications, with its inclusion in the aPL score and the Global Anti-Phospholipid Syndrome Score (GAPSS) aiding in risk evaluation. However, challenges remain in the laboratory testing of aPS/PT, including the need for assay standardization and its lower sensitivity in certain patient populations. Further research is necessary to validate the clinical utility of aPS/PT antibodies in APS diagnosis, risk stratification, and management.
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Affiliation(s)
- Zetao Ding
- Department of Rheumatology and Immunology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Haoyu Pan
- Department of Rheumatology and Immunology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhixia Yang
- Department of Rheumatology and Immunology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chengde Yang
- Department of Rheumatology and Immunology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Shi
- Department of Rheumatology and Immunology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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2
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Suenaga A, Sawa N, Oshima Y, Ikuma D, Oba Y, Yamanouchi M, Hasegawa E, Mizuno H, Sekine A, Suwabe T, Kono K, Kinowaki K, Ohashi K, Takemura T, Yamaguchi Y, Miyazono M, Atsumi T, Ubara Y. Antiphospholipid Syndrome Nephropathy Related Disease Diagnosed by Assessing Phosphatidylserine-dependent Antiprothrombin Antibodies. Intern Med 2023; 62:757-761. [PMID: 35908966 PMCID: PMC10037018 DOI: 10.2169/internalmedicine.0302-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 42-year-old Japanese woman was admitted for the evaluation of proteinuria. She had a history of four habitual abortions and valvular heart disease, including severe mitral regurgitation and moderate tricuspid regurgitation. A kidney biopsy showed fibrointimal thickening of interlobular arteries, fibrin thrombosis, and associated focal segmental sclerosis. Although the standard test for antiphospholipid (aPL) antibodies was negative, the patient was diagnosed with antiphospholipid syndrome (APS)-related disease by testing for phosphatidylserine dependent anti-prothrombin anticardiolipin antibody, a non-criterial aPL antibody. A kidney biopsy may lead to a diagnosis of APS in patients with negative laboratory test findings for APS.
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Affiliation(s)
- Atsuhiko Suenaga
- Department of Nephrology and Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
- Department of Nephrology, Saga University School of Medicine, Japan
| | - Naoki Sawa
- Department of Nephrology and Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Yoichi Oshima
- Department of Internal Medicine, Division of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Japan
| | - Daisuke Ikuma
- Department of Nephrology and Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Yuki Oba
- Department of Nephrology and Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Masayuki Yamanouchi
- Department of Nephrology and Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Eiko Hasegawa
- Department of Internal Medicine, Division of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Japan
| | - Hiroki Mizuno
- Department of Nephrology and Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Akinari Sekine
- Department of Nephrology and Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Tatsuya Suwabe
- Department of Nephrology and Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Japan
| | | | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Japan
- Department of Human Pathology, Tokyo Medical Dental University, Japan
| | - Tamiko Takemura
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Japan
| | | | - Motoaki Miyazono
- Department of Nephrology, Saga University School of Medicine, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine, Hokkaido University, Japan
| | - Yoshifumi Ubara
- Department of Nephrology and Rheumatology and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Japan
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4
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Amengual O, Forastiero R, Sugiura-Ogasawara M, Otomo K, Oku K, Favas C, Delgado Alves J, Žigon P, Ambrožič A, Tomšič M, Ruiz-Arruza I, Ruiz-Irastorza G, Bertolaccini ML, Norman GL, Shums Z, Arai J, Murashima A, Tebo AE, Gerosa M, Meroni PL, Rodriguez-Pintó I, Cervera R, Swadzba J, Musial J, Atsumi T. Evaluation of phosphatidylserine-dependent antiprothrombin antibody testing for the diagnosis of antiphospholipid syndrome: results of an international multicentre study. Lupus 2016; 26:266-276. [PMID: 27510605 DOI: 10.1177/0961203316660203] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective A task force of scientists at the International Congress on Antiphospholipid Antibodies recognized that phosphatidylserine-dependent antiprothrombin antibodies (aPS/PT) might contribute to a better identification of antiphospholipid syndrome (APS). Accordingly, initial and replication retrospective, cross-sectional multicentre studies were conducted to ascertain the value of aPS/PT for APS diagnosis. Methods In the initial study (eight centres, seven countries), clinical/laboratory data were retrospectively collected. Serum/plasma samples were tested for IgG aPS/PT at Inova Diagnostics (Inova) using two ELISA kits. A replication study (five centres, five countries) was carried out afterwards. Results In the initial study ( n = 247), a moderate agreement between the IgG aPS/PT Inova and MBL ELISA kits was observed ( k = 0.598). IgG aPS/PT were more prevalent in APS patients (51%) than in those without (9%), OR 10.8, 95% CI (4.0-29.3), p < 0.0001. Sensitivity, specificity, positive (LR+) and negative (LR-) likelihood ratio of IgG aPS/PT for APS diagnosis were 51%, 91%, 5.9 and 0.5, respectively. In the replication study ( n = 214), a moderate/substantial agreement between the IgG aPS/PT results obtained with both ELISA kits was observed ( k = 0.630). IgG aPS/PT were more prevalent in APS patients (47%) than in those without (12%), OR 6.4, 95% CI (2.6-16), p < 0.0001. Sensitivity, specificity, LR + and LR- for APS diagnosis were 47%, 88%, 3.9 and 0.6, respectively. Conclusions IgG aPS/PT detection is an easily performed laboratory parameter that might contribute to a better and more complete identification of patients with APS.
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Affiliation(s)
- O Amengual
- 1 Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - R Forastiero
- 2 Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro-CONICET, Departamento de Fisiologia, Hemostasia y Trombosis, Buenos Aires, Argentina
| | - M Sugiura-Ogasawara
- 3 Department of Obstetrics and Gynecology, Nagoya City University, Graduated School of Medical Sciences, Nagoya, Japan
| | - K Otomo
- 1 Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - K Oku
- 1 Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - C Favas
- 4 Department of Medicine IV, Fernando Fonseca Hospital, Amadora and CEDOC/NOVA Medical School, Lisbon, Portugal
| | - J Delgado Alves
- 4 Department of Medicine IV, Fernando Fonseca Hospital, Amadora and CEDOC/NOVA Medical School, Lisbon, Portugal
| | - P Žigon
- 5 Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - A Ambrožič
- 5 Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - M Tomšič
- 5 Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - I Ruiz-Arruza
- 6 Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Spain
| | - G Ruiz-Irastorza
- 6 Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Spain
| | - M L Bertolaccini
- 7 Academic Department of Vascular Surgery, Cardiovascular Division, King's College London, UK
| | - G L Norman
- 8 Inova Diagnostics Inc., San Diego, CA, USA
| | - Z Shums
- 8 Inova Diagnostics Inc., San Diego, CA, USA
| | - J Arai
- 9 Medical and Biological Laboratories, Co. Ltd, Nagano, Japan
| | - A Murashima
- 10 Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - A E Tebo
- 11 Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, UT, USA
| | - M Gerosa
- 12 Department of Clinical Sciences and Community Health, Istituto Auxologico Italiano, University of Milan, Milan, Italy
| | - P L Meroni
- 12 Department of Clinical Sciences and Community Health, Istituto Auxologico Italiano, University of Milan, Milan, Italy
| | - I Rodriguez-Pintó
- 13 Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - R Cervera
- 13 Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
| | - J Swadzba
- 14 Department of Medicine Jagiellonian University, Cracow, Poland
| | - J Musial
- 14 Department of Medicine Jagiellonian University, Cracow, Poland
| | - T Atsumi
- 1 Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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5
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Peterson LK, Willis R, Harris EN, Branch WD, Tebo AE. Antibodies to Phosphatidylserine/Prothrombin Complex in Antiphospholipid Syndrome: Analytical and Clinical Perspectives. Adv Clin Chem 2016; 73:1-28. [PMID: 26975968 DOI: 10.1016/bs.acc.2015.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by thrombosis and/or pregnancy-related morbidity accompanied by persistently positive antiphospholipid antibodies (aPL). Current laboratory criteria for APS classification recommend testing for lupus anticoagulant as well as IgG and IgM anticardiolipin, and beta-2 glycoprotein I (anti-β2GPI) antibodies. However, there appears to be a subset of patients with classical APS manifestations who test negative for the recommended criteria aPL tests. While acknowledging that such patients may have clinical features that are not of an autoimmune etiology, experts also speculate that these "seronegative" patients may test negative for relevant autoantibodies as a result of a lack of harmonization and/or standardization. Alternatively, they may have aPL that target other antigens involved in the pathogenesis of APS. In the latter, autoantibodies that recognize a phosphatidylserine/prothrombin (PS/PT) complex have been reported to be associated with APS and may have diagnostic relevance. This review highlights analytical and clinical attributes associated with PS/PT antibodies, taking into consideration the performance characteristics of criteria aPL tests in APS with specific recommendations for harmonization and standardization efforts.
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Affiliation(s)
- Lisa K Peterson
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Rohan Willis
- Rheumatology/Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | | | - Ware D Branch
- Maternal Fetal Medicine, University of Utah and Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Anne E Tebo
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA; ARUP Laboratories, Institute of Clinical and Experimental Pathology, Salt Lake City, Utah, USA.
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Mulliez SMN, De Keyser F, Verbist C, Vantilborgh A, Wijns W, Beukinga I, Devreese KMJ. Lupus anticoagulant-hypoprothrombinemia syndrome: report of two cases and review of the literature. Lupus 2014; 24:736-45. [PMID: 25391540 DOI: 10.1177/0961203314558859] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 10/10/2014] [Indexed: 11/16/2022]
Abstract
Lupus anticoagulant-hypoprothrombinemia syndrome (LA-HPS) is a rare acquired disorder caused by prothrombin antibodies. The disease is most common in the pediatric age group (<16 years), and more prevalent in women. There are well-established clinical diseases associated with LA-HPS, most notably systemic lupus erythematosus (SLE) and viral infections. The clinical manifestation of LA-HPS varies greatly in severity and it may cause severe life-threatening bleeding diathesis. LA-HPS is to be suspected when a patient presents with bleeding and a prolonged activated partial thromboplastin and prothrombin time, in combination with a lupus anticoagulant. The diagnosis is confirmed in the laboratory by identification of reduced prothrombin levels. There are no standardized recommendations for treatment of the hemorrhage associated with the syndrome; corticosteroids are used as first-line treatment. This review summarizes what is currently known about the pathogenesis, clinical features, diagnosis, treatment and prognosis of LA-HPS, and presents two case reports.
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Affiliation(s)
- S M N Mulliez
- Coagulation Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University Hospital, Ghent, Belgium
| | - F De Keyser
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - C Verbist
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - A Vantilborgh
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
| | - W Wijns
- Department of Hematobiology, Erasme Hospital, Brussels, Belgium
| | - I Beukinga
- Department of Hematobiology, Erasme Hospital, Brussels, Belgium
| | - K M J Devreese
- Coagulation Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University Hospital, Ghent, Belgium
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