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Battistelli S, Stefanoni M, Petrioli R, Genovese A, Dell'Avanzato R, Donati G, Vittoria A, Roviello F. Antiphospholipid Antibodies and Acute-Phase Response in Non-Metastatic Colorectal Cancer Patients. Int J Biol Markers 2018. [DOI: 10.1177/172460080802300105] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim To investigate the plasma levels and prevalence of the most common antiphospholipid antibodies, as well as their relationships with several plasma markers of inflammation, in order to characterize some aspects of cancer thrombophilia. Materials and methods Eighty-three cancer patients with non-metastatic colorectal solid tumors and 94 control subjects were tested for the presence of IgG/IgM/IgA anti-cardiolipin and anti-β2-glycoprotein I antibodies and of several acute-phase reactants, i.e., fibrinogen, factor VIII:C and C4b-binding protein. Results In cancer patients the plasma levels of the acute-phase reactants and the IgA/IgG anti-cardiolipin and IgA anti-β2-glycoprotein I antibodies were significantly higher; the acute-phase reactants were significantly correlated with anti-cardiolipin antibodies; the prevalence of antiphospholipid antibodies was not significantly higher. Conclusions In patients with non-metastatic colorectal cancer the acute-phase response is associated with antiphospholipid generation. This could represent a further pathogenetic mechanism for the short-term post-surgery thrombotic complications of patients with colorectal cancer.
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Affiliation(s)
- S. Battistelli
- Department of General Surgery, Policlinico Le Scotte, Siena
| | - M. Stefanoni
- Department of Emergency Medicine, Ospedale Civile, Gorizia
| | - R. Petrioli
- Department of Human Pathology and Oncology, Policlinico Le Scotte, Siena
| | - A. Genovese
- Department of General Surgery, Policlinico Le Scotte, Siena
| | | | - G. Donati
- Department of Internal Medicine, Policlinico Le Scotte, Siena
| | - A. Vittoria
- Department of Clinical Medicine and Immunology, Policlinico Le Scotte, Siena - Italy
| | - F. Roviello
- Department of Human Pathology and Oncology, Policlinico Le Scotte, Siena
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Thrombin generation as marker to estimate thrombosis risk in patients with abnormal test results in lupus anticoagulant routine diagnostics. Thromb J 2013; 11:24. [PMID: 24219775 PMCID: PMC3842625 DOI: 10.1186/1477-9560-11-24] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 09/24/2013] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Lupus anticoagulant (LA) is known to inhibit thrombin generation although patients have an increased risk to develop thrombosis. We tried to determine whether thrombin generation is altered in plasma samples of patients with abnormal test results in LA routine diagnostics and whether its measurement may improve the risk assessment of thrombosis. METHODS Samples from 63 patients (39 with abnormal test results; 24 controls) were included in the study. Measurement of diluted Russel's viper venom time (dRVVT) was part of the initial guideline conform diagnostic procedure for detection of LA. In addition, measurement of anticardiolipin-IgM, -IgG and β2-glycoprotein-I-IgM, -IgG were performed. Thrombin generation was measured using two different phospholipid concentrations in the starting reagent. RESULTS Analyzing all samples by logistic regression, thrombin generation after induction with high phospholipid concentrations was the best predictor of thrombosis. After preselection of samples with alterations in dRVVT, specificity of selected thrombin generation derived parameters for the detection of previous thrombosis increased in this subgroup. CONCLUSIONS In patients with phospholipid-dependent prolongation of dRVVT, thrombin generation is variably inhibited and the degree of inhibition corresponds to the occurrence of previous thrombosis. Measuring thrombin generation in patients with phospholipid-dependent dRVVT prolongation may improve risk assessment of thrombosis.
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Hoxha A, Ruffatti A, Pittoni M, Bontadi A, Tonello M, Salvan E, Plebani M, Punzi L. The clinical significance of autoantibodies directed against prothrombin in primary antiphospholipid syndrome. Clin Chim Acta 2012; 413:911-3. [DOI: 10.1016/j.cca.2012.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 01/31/2012] [Accepted: 02/04/2012] [Indexed: 11/30/2022]
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4
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Systemic lupus erythematosus in the pregnant patient and neonatal lupus. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00133-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Erkan D, Barbhaiya M, George D, Sammaritano L, Lockshin M. Moderate versus high-titer persistently anticardiolipin antibody positive patients: are they clinically different and does high-titer anti-beta 2-glycoprotein-I antibody positivity offer additional predictive information? Lupus 2009; 19:613-9. [PMID: 19934177 DOI: 10.1177/0961203309355300] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The association between antiphospholipid antibodies (aPL) and clinical events is stronger with a positive lupus anticoagulant (LA) test, higher anticardiolipin antibody (aCL) titers, and/or higher anti-beta(2)-glycoprotein-I antibody (abeta( 2)GPI) titers. The objective of this study was to determine the clinical characteristics of persistently high-titer (> or =80 U) aCL-positive patients compared with those with persistent moderate aCL titers (40-79 U). Second, we analyzed whether high-titer abeta(2)GPI test adds predictive information in persistently moderate-to-high titer aCL-positive patients. In this cross-sectional study, the primary analysis compared the clinical and aPL characteristics of 58 patients with at least two moderate-titer aCL results to another 85 patients with at least two high-titer aCL results. In the secondary analysis of patients with at least two abeta(2)GPI test results, we compared 29 patients with 'aCL 40-79 U and abeta( 2)GPI < 80 U' profiles with 8 patients with 'aCL 40-79U and abeta(2)GPI > or = 80 U', and also compared 27 patients with 'aCL > 80 U and abeta(2)GPI < 80 U' with 32 patients with 'aCL > 80 U and abeta(2)GPI > or = 80 U'. Although aPL-related vascular and pregnancy events were similar between the moderate- and high-titer aCL groups, the number of patients with positive LA tests (RR 2.06, CI 1.38-3.08, p < 0.01) and with at least one non-criteria aPL manifestation (RR 1.66, CI 1.20-2.30, p = 0.0005) were significantly higher in the high-titer aCL group. While magnetic resonance imaging (MRI) white matter changes were statistically more common in the high-titer aCL group (RR 2.03, CI 1.04-3.94, p = 0.02), there was a trend towards increased prevalence of livedo reticularis, cardiac valve disease, and cognitive dysfunction occurring in the high-titer aCL group. The secondary analysis showed that MRI white matter changes, cardiac valve disease, and cognitive dysfunction were proportionally more common in the high-titer abeta( 2)GPI groups, suggesting a linear relationship between non-criteria aPL manifestations and aPL titers. Our results suggest that patients with high aCL titers, compared with those with moderate titers, are more likely to have a positive LA test and a higher prevalence of non-criteria aPL manifestations. Furthermore, high-titer abeta(2)GPI positivity may further increase the prevalence of non-criteria aPL manifestations in moderate- or high-titer aCL-positive patients.
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Affiliation(s)
- D Erkan
- Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA.
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Ruffatti A, Olivieri S, Tonello M, Bortolati M, Bison E, Salvan E, Facchinetti M, Pengo V. Influence of different IgG anticardiolipin antibody cut-off values on antiphospholipid syndrome classification. J Thromb Haemost 2008; 6:1693-6. [PMID: 18680541 DOI: 10.1111/j.1538-7836.2008.03121.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND While medium to high titers of anticardiolipin (aCL) antibodies, defined as >40 GPL units or >99th percentile, is a laboratory criteria for the 'definite' diagnosis of antiphospholipid syndrome (APS), agreement between the two cut-offs has not been validated. OBJECTIVE To validate the current aCL laboratory criterion by verifying the effect of the two cut-offs on APS classification. PATIENTS/METHODS Ninety aCL positive APS patients were selected on the basis of their GPL values above the 99th percentile (17.4 GPL), which was calculated by testing 100 age- and sex-matched healthy subjects. RESULTS A significant difference in the IgG positivity (P < 0.0001) was found between the APS laboratory profiles as 20 out of the 24 (83.3%) patients with single positivity (aCL alone), six out of the 23 (26.1%) with double positivity (aCL plus lupus anticoagulant or anti-beta(2)glycoprotein I), and none out of the 43 with triple positivity (aCL plus lupus anticoagulant and anti-beta(2)glycoprotein I) had titers between the 99th percentile and 40 GPL units. Moreover, the rate of aCL values between the 99th percentile and 40 GPL units was significantly higher (P < 0.0001) in patients with pregnancy morbidity (73.7%) as compared to those with vascular thrombosis (16.9%) and those with both conditions (16.7%). CONCLUSION The 99th percentile cut-off level seems more sensitive than the >40 GPL value for APS classification, as it includes subjects with aCL positivity alone as well as patients with pregnancy morbidity.
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Affiliation(s)
- A Ruffatti
- Rheumatology Unit, University of Padua, Padua, Padova, Italy.
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Shovman O, Gilburd B, Barzilai O, Langevitz P, Shoenfeld Y. Novel Insights Into Associations of Antibodies Against Cardiolipin and beta2-glycoprotein I with Clinical Features of Antiphospholipid Syndrome. Clin Rev Allergy Immunol 2007; 32:145-52. [DOI: 10.1007/s12016-007-0001-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/1999] [Revised: 11/30/1999] [Accepted: 11/30/1999] [Indexed: 11/28/2022]
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Antiphospholipid Antibodies and Antiphospholipid Syndrome: Diagnosis and Management. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s1578-2190(07)70385-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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9
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García-García C. Anticuerpos antifosfolípido y síndrome antifosfolípido: actitudes diagnósticas y terapéuticas. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s0001-7310(07)70004-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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10
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Neville C, Rauch J, Kassis J, Solymoss S, Joseph L, Belisle P, Subang R, Chang ER, Fortin PR. The persistence of anticardiolipin antibodies is associated with an increased risk of the presence of lupus anticoagulant and anti-beta2-glycoprotein I antibodies. Rheumatology (Oxford) 2006; 45:1116-20. [PMID: 16510527 PMCID: PMC3435425 DOI: 10.1093/rheumatology/kel050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE We studied antiphospholipid antibodies (aPL) in blood samples from a cohort of individuals followed for thrombosis to determine whether the persistent presence of anticardiolipin antibodies (aCL) is associated with a greater likelihood of having lupus anticoagulant and/or anti-beta2-glycoprotein I antibodies (LA/abeta2GPI). METHODS Blood samples from 353 individuals who had been tested for aCL on at least two occasions were tested for abeta2GPI and LA. Two groups were defined: aCL-persistent, who tested aCL-positive on at least two occasions, and aCL non-persistent, who tested aCL-positive on fewer than two occasions. Multivariate logistic regressions were performed using LA/abeta2GPI, LA and abeta2GPI as outcome variables and the percentage of aCL-positive tests as the predictor variable, adjusted for age, gender, family history of cardiovascular disease (CVD), systemic lupus erythematosus (SLE), smoking and number of venous (VT) and arterial thromboses (AT). RESULTS Sixty-eight (19%) individuals were aCL persistent and 285 (81%) were aCL non-persistent. LA/abeta2GPI was found in 36 (53%) of the aCL persistent group and 38 (13%) of the aCL non-persistent group. The two groups were similar for age, gender and smoking. Family history of CVD, SLE, VT and AT were more frequent in the aCL persistent group. Multivariate analyses revealed that odds ratios for LA/abeta2GPI, LA and abeta2GPI were 1.34 [95% confidence interval (CI) = 1.22-1.47], 1.36 (95% CI = 1.24-1.50) and 1.47 (95% CI = 1.31-1.65) respectively for each 10% increase in aCL-positive tests vs 0% positive tests. CONCLUSION Persistence of aCL positivity is associated with an increased risk of LA/abeta2GPI.
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Affiliation(s)
- C. Neville
- Division of Clinical Epidemiology, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec
| | - J. Rauch
- Division of Rheumatology, Montreal General Hospital, Research Institute of the McGill University Health Centre, Montreal, Quebec
| | - J. Kassis
- Laboratoire de Coagulation, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec
| | - S. Solymoss
- Department of Hematology, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec
| | - L. Joseph
- Division of Clinical Epidemiology, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec
| | - P. Belisle
- Division of Clinical Epidemiology, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec
| | - R. Subang
- Division of Rheumatology, Montreal General Hospital, Research Institute of the McGill University Health Centre, Montreal, Quebec
| | - E. R. Chang
- Division of Outcomes and Population Health, University Health Network Research Institute, Toronto, Ontario, Canada
| | - P. R. Fortin
- Division of Outcomes and Population Health, University Health Network Research Institute, Toronto, Ontario, Canada
- Division of Rheumatology, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Martínez F, Forner MJ, Ruano M, Abdilla N, Oltra R, García-Fuster MJ. Factores relacionados con el riesgo de trombosis en pacientes con lupus y positividad para anticuerpos antifosfolipídicos. Med Clin (Barc) 2006; 127:405-8. [PMID: 17020683 DOI: 10.1157/13092765] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Antiphospholipid antibodies (aPL) are frequently associated with eritematosus systemic lupus (SLE) and increases the risk of thrombosis. The aim of the study was to analize risk factors of thrombosis and its temporal profile in subjects with SLE. PATIENTS AND METHOD One hundred and two SLE patients -mean age: 37.5 years (range: 8-85); 90 women; mean of follow-up: 72 months (range: 9-324); 41 (40.2%) with aPL positive- were included in the study. Actuarial Kaplan-Meier curves were used to assess the thrombosis risk and Cox proportional hazard model was used to evaluate factors associated with the risk. RESULTS 13 thrombotic events occurred in the group with aPL positive (mean of follow up: 83.5 months) and 5 events in aPL negative group (mean of follow up: 72 months). The event-rates were 3.93 and 0.96/100 patients/year for each group, respectively. Survival curves showed a significantly higher risk of thrombotic events in the patients with positive aPL as compared to the aPL negative group, and the risk still present throughout the observational time. Activated partial thromboplastine time up to 37 s was significantly associated with thrombosis risk (p = 0.003). Furthermore, positivity of lupus anticoagulant and proteinuria > 2.5 g/day tended to increase thrombotic risk, although they did not achieve statistical significance. CONCLUSIONS In patients with SLE and aPL, risk of first thrombosis remains over the years, and a large activated partial thromboplastine time was the most important risk factor.
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Affiliation(s)
- Fernando Martínez
- Servicio de Medicina Interna, Hospital Clínico Universitario, Universidad de Valencia, Valencia, España
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Erkan D, Derksen WJM, Kaplan V, Sammaritano L, Pierangeli SS, Roubey R, Lockshin MD. Real world experience with antiphospholipid antibody tests: how stable are results over time? Ann Rheum Dis 2005; 64:1321-5. [PMID: 15731290 PMCID: PMC1755632 DOI: 10.1136/ard.2004.031856] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the stability and the degree of variation of antiphospholipid antibody (aPL) results over time in a large cohort of well evaluated aPL positive patients; and to analyse factors contributing to aPL variation and the validity of aPL in a real world setting in which aPL tests are done in multiple laboratories. METHODS The clinical characteristics, drug treatment, and 1652 data points for lupus anticoagulant (LA), anticardiolipin antibodies (aCL), and anti-beta2 glycoprotein I antibodies (anti-beta2GPI) were examined in 204 aPL positive patients; 81 of these met the Sapporo criteria for antiphospholipid syndrome (APS) and 123 were asymptomatic bearers of aPL. RESULTS 87% of initially positive LA results, 88% of initially negative to low positive aCL results, 75% of initially moderate to high positive aCL results, 96% of initially negative to low positive anti-beta2GPI results, and 76% of initially moderate to high positive anti-beta2GPI results subsequently remained in the same range regardless of the laboratory performing the test. Aspirin, warfarin, and hydroxychloroquine use did not differ among patients whose aCL titres significantly decreased or increased or remained stable. On same day specimens, the consistency of aCL results among suppliers ranged from 64% to 88% and the correlation ranged from 0.5 to 0.8. Agreement was moderate for aCL IgG and aCL IgM; however, for aCL IgA agreement was marginal. CONCLUSIONS aPL results remained stable for at least three quarters of subsequent tests, regardless of the laboratory performing the test; the small amount of variation that occurred did not appear to be caused by aspirin, warfarin, or hydroxychloroquine use.
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Affiliation(s)
- D Erkan
- Department of Rheumatology, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 E70th Street, New York, NY 10021, USA.
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