1
|
Žigon P, Boštic N, Ambrožič A, Rotar Ž, Blokar E, Ogrič M, Čučnik S. Establishment of ELISA-comparable moderate and high thresholds for anticardiolipin and anti-β2 glycoprotein I chemiluminescent immunoassays according to the 2023 ACR/EULAR APS classification criteria and evaluation of their diagnostic performance. Clin Chem Lab Med 2024; 0:cclm-2024-0570. [PMID: 39044613 DOI: 10.1515/cclm-2024-0570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 07/10/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVES Recently published 2023 ACR/EULAR APS classification criteria emphasize the importance of quantifying single-, double-, and triple-antiphospholipid antibody positivity, distinguishing between IgG and IgM isotypes, and delineating moderate/high levels of anticardiolipin (aCL) and anti-β2 glycoprotein I (anti-β2GPI) antibodies. We aimed to establish clinically important moderate/high thresholds for aCL and anti-β2GPI IgG/IgM chemiluminescent immunoassays (CLIA), in particular QUANTA Flash, comparable to our in-house ELISAs used for over two decades, and to evaluate their diagnostic performance. METHODS QUANTA Flash CLIA and in-house ELISAs were used to measure aCL and anti-β2GPI IgG/IgM. Moderate thresholds for QUANTA Flash CLIA were determined using a non-parametric approach, calculating a 99th percentile on serum samples from 139 blood donors, and by mirroring the diagnostic performance of in-house ELISA on 159 patient samples. RESULTS Thresholds for QUANTA Flash CLIA achieving diagnostic performance equivalent to in-house ELISAs were 40 CU for moderate and 80 CU for high levels for aCL and anti-β2GPI IgG and IgM. The assays showed good qualitative agreement, ranging from 76.10 to 91.19 %. When considering in-house ELISA results, 14 out of 80 (17.5 %) patients did not fulfill the new ACR/EULAR laboratory classification criteria, while 27 out of 80 (33.8 %) did not when considering QUANTA Flash CLIA results. CONCLUSIONS We determined moderate and high thresholds for aCL and anti-β2GPI IgG and IgM detected with QUANTA Flash CLIA, aligning with long-established in-house ELISA thresholds. These thresholds are crucial for seamlessly integrating of the new 2023 ACR/EULAR classification criteria into future observational clinical studies and trials.
Collapse
Affiliation(s)
- Polona Žigon
- Department of Rheumatology, 364687 University Medical Centre Ljubljana , Ljubljana, Slovenia
- FAMNIT, University of Primorska, Koper, Slovenia
| | - Nika Boštic
- Department of Rheumatology, 364687 University Medical Centre Ljubljana , Ljubljana, Slovenia
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Aleš Ambrožič
- Department of Rheumatology, 364687 University Medical Centre Ljubljana , Ljubljana, Slovenia
| | - Žiga Rotar
- Department of Rheumatology, 364687 University Medical Centre Ljubljana , Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Elizabeta Blokar
- Department of Rheumatology, 364687 University Medical Centre Ljubljana , Ljubljana, Slovenia
| | - Manca Ogrič
- Department of Rheumatology, 364687 University Medical Centre Ljubljana , Ljubljana, Slovenia
| | - Saša Čučnik
- Department of Rheumatology, 364687 University Medical Centre Ljubljana , Ljubljana, Slovenia
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
2
|
Xiang J, Pan Y, Bao R, Cai Z. Correlation of Anti-Phosphatidylserine/Prothrombin and Anti-Phosphatidylserine Antibodies with Pregnancy Outcomes. Am J Reprod Immunol 2024; 92:e13890. [PMID: 38958240 DOI: 10.1111/aji.13890] [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: 02/29/2024] [Revised: 05/26/2024] [Accepted: 06/03/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND The objective of this study was to investigate the clinical relevance of anti-prothrombin antibodies (aPT) and anti-phosphatidylserine/prothrombin antibodies (aPS/PT) in relation to pregnancy outcomes and coagulation parameters, as well as immune markers. METHODS We retrospectively analyzed 477 pregnant women with experienced at least one spontaneous miscarriage who were tested for aPT and aPS/PT antibodies, and compared their clinical characteristics, coagulation indicators, immune biomarkers, and pregnancy outcomes to assess the diagnostic accuracy of these antibodies. RESULTS We found that the aPT IgG and the aPS/PT IgM were independently associated with increased risk of pregnancy loss, with odds ratios (ORs) of 1.055 (95% confidence interval [CI]: 1.009-1.103, p = 0.017) and 1.041 (95% CI: 1.015-1.067, p = 0.002), respectively. Moreover, we found that the aPS/PT IgM had a higher diagnostic performance than the aPT IgG, as indicated by the AUC of 0.663 and 0.593, respectively. The pregnancy loss rate was positively correlated with the level of aPS/PT IgM, while the aPT IgG is not. We also found that in the pregnancy loss group, aPT IgG showed negative correlations with prothrombin time (PT); aPS/PT IgM showed positive correlations with aPS/PT IgG. However, none of aPT IgG, aPT IgM, aPS/PT IgM, or aPS/PT IgG was related to other adverse pregnancy outcomes, such as preterm delivery, fetal growth restriction (FGR), or preeclampsia (PE). CONCLUSION Our findings suggest that aPT IgG and aPS/PT IgM are independent risk factors for pregnancy loss, especially aPS/PT IgM, which has a positive linear correlation with pregnancy loss.
Collapse
Affiliation(s)
- Junmiao Xiang
- Department of Gynecology and Obstetrics, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yundong Pan
- Department of Gynecology and Obstetrics, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ruru Bao
- Department of Gynecology and Obstetrics, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhuhua Cai
- Department of Gynecology and Obstetrics, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| |
Collapse
|
3
|
Mu F, Wang M, Zeng X, Liu L, Wang F. Preconception Non-criteria Antiphospholipid Antibodies and Risk of Subsequent Early Pregnancy Loss: a Retrospective Study. Reprod Sci 2024; 31:746-753. [PMID: 37932551 PMCID: PMC10912122 DOI: 10.1007/s43032-023-01388-5] [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: 08/13/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
The aim of this study was to investigate the subsequent early pregnancy outcomes in women positive for non-criteria antiphospholipid antibodies (NC-aPLs) before pregnancy. A total of 273 patients who had experienced sporadic or recurrent pregnancy loss and had been screened for 13 NC-aPLs at preconception were recruited in this study from September 2019 to February 2022. Serum levels of NC-aPLs were measured by ELISA using specific kits. The primary outcome was early pregnancy loss, and the secondary outcomes were biochemical pregnancy, clinically confirmed pregnancy loss, and ongoing pregnancy. Among these subjects, 56 patients had one previous pregnancy loss, and 217 had recurrent pregnancy loss (RPL). The NC-aPLs (+) and NC-aPLs (-) groups had similar rates of early pregnancy loss (EPL) after adjustment, regardless of the number of positive NC-aPLs (aOR = 1.054, 95% CI 0.602-1.846). Other outcomes were comparable in both groups, including the rates of biochemical pregnancy (aOR = 1.344, 95% CI 0.427-4.236), clinically confirmed pregnancy loss (aOR = 0.744, 95% CI 0.236-2.344), and ongoing pregnancy (aOR = 0.949, 95% CI 0.542-1.660). Based on sensitivity analysis, the NC-aPLs (+) were not associated with adverse early pregnancy outcomes in women with RPL. Furthermore, the difference in gestational weeks of pregnancy loss between the two groups was also insignificant. This study found no evidence linking preconception NC-aPL positivity to early pregnancy outcomes but offers a reference for future research to clarify NC-aPLs' potential clinical impact.
Collapse
Affiliation(s)
- Fangxiang Mu
- Department of Reproductive Medicine, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, China
| | - Mei Wang
- Department of Reproductive Medicine, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, China
| | - Xianghui Zeng
- Department of Reproductive Medicine, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, China
| | - Ling Liu
- Department of Reproductive Medicine, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, China
| | - Fang Wang
- Department of Reproductive Medicine, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, China.
| |
Collapse
|
4
|
Noubissi FK, Odubanjo OV, Ogle BM, Tchounwou PB. Mechanisms of Cell Fusion in Cancer. Results Probl Cell Differ 2024; 71:407-432. [PMID: 37996688 PMCID: PMC10893907 DOI: 10.1007/978-3-031-37936-9_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Cell-cell fusion is a normal physiological mechanism that requires a well-orchestrated regulation of intracellular and extracellular factors. Dysregulation of this process could lead to diseases such as osteoporosis, malformation of muscles, difficulties in pregnancy, and cancer. Extensive literature demonstrates that fusion occurs between cancer cells and other cell types to potentially promote cancer progression and metastasis. However, the mechanisms governing this process in cancer initiation, promotion, and progression are less well-studied. Fusogens involved in normal physiological processes such as syncytins and associated factors such as phosphatidylserine and annexins have been observed to be critical in cancer cell fusion as well. Some of the extracellular factors associated with cancer cell fusion include chronic inflammation and inflammatory cytokines, hypoxia, and viral infection. The interaction between these extracellular factors and cell's intrinsic factors potentially modulates actin dynamics to drive the fusion of cancer cells. In this review, we have discussed the different mechanisms that have been identified or postulated to drive cancer cell fusion.
Collapse
Affiliation(s)
- Felicite K Noubissi
- Department of Biology, Jackson State University, Jackson, MS, USA.
- Research Centers in Minority Institutions (RCMI), Center for Health Disparity Research (RCMI-CHDR), Jackson State University, Jackson, MS, USA.
| | - Oluwatoyin V Odubanjo
- Department of Biology, Jackson State University, Jackson, MS, USA
- Research Centers in Minority Institutions (RCMI), Center for Health Disparity Research (RCMI-CHDR), Jackson State University, Jackson, MS, USA
| | - Brenda M Ogle
- Department of Biomedical Engineering, University of Minnesota-Twin Cities, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota-Twin Cities, Minneapolis, MN, USA
- Stem Cell Institute, University of Minnesota-Twin Cities, Minneapolis, MN, USA
| | - Paul B Tchounwou
- Department of Biology, Jackson State University, Jackson, MS, USA
- Research Centers in Minority Institutions (RCMI), Center for Health Disparity Research (RCMI-CHDR), Jackson State University, Jackson, MS, USA
| |
Collapse
|
5
|
Lambert JR, Ueno J, Fernandes CE, Pompei LM. Prophylactic low-molecular-weight heparin in women with thrombophilia undergoing in vitro fertilization. Int J Gynaecol Obstet 2024; 164:242-248. [PMID: 37491876 DOI: 10.1002/ijgo.15005] [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: 04/02/2023] [Revised: 06/25/2023] [Accepted: 07/04/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE To verify whether low-molecular-weight heparin (LMWH) could increase pregnancy rates and/or decrease abortion rates in women with thrombophilia undergoing assisted reproduction cycles. METHODS Cross-sectional study with patients undergoing in vitro fertilization (IVF) (N = 104). Women without thrombophilia (control group, n = 20), women with thrombophilia who did not receive LMWH (untreated group, n = 30), and women with thrombophilia, treated with daily enoxaparin from the day of embryo transfer until week 36 of gestation (treated group, n = 54). All women underwent controlled ovarian hyperstimulation. IVF was performed by intracytoplasmic sperm injection, and embryos were transferred on day 3. Pregnancy was detected by β-human chorionic gonadotropin (biochemical pregnancy) and fetal heartbeat at week 5 to 6. Ongoing pregnancy was determined by ultrasound on week 12. RESULTS Patients in the untreated thrombophilia group presented with significantly lower ongoing pregnancy rates and live birth rates and significantly higher early pregnancy loss and abortion rates when compared with the control and the treated thrombophilia groups. CONCLUSIONS In women with diagnosed coagulation disorders, use of LMWH is important to avoid miscarriages.
Collapse
Affiliation(s)
- José Roberto Lambert
- Faculdade de Medicina do ABC, Santo Andre, Brazil
- Ami Lambert Clinic, Santo Andre, Brazil
| | - Joji Ueno
- Instituto GERA de Medicina Reprodutiva, São Paulo, Brazil
| | | | | |
Collapse
|
6
|
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.
Collapse
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.
| |
Collapse
|
7
|
Kasano S, Kuwabara Y, Ogawa S, Yokote R, Yonezawa M, Ouchi N, Ichikawa T, Suzuki S, Takeshita T. Superfertility and subfertility in patients with recurrent pregnancy loss: A comparative analysis of clinical characteristics and etiology based on differences in fertile ability. J Reprod Immunol 2023; 159:104129. [PMID: 37598542 DOI: 10.1016/j.jri.2023.104129] [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: 06/15/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023]
Abstract
This study aimed to elucidate the etiologies of and risk factors for recurrent pregnancy loss (RPL) according to fertile ability, focusing on the differences between superfertile and subfertile patients. This retrospective observational study included 828 women with RPL between July 2017 and February 2020. Patients were divided into three groups based on time to pregnancy (TTP): superfertile (SUP) (TTP ≤3 months for all previous pregnancies), subfertile (SUB) (previous TTP ≥12 months and use of assisted reproductive technology [ART]), and Normal (N) (TTP >3 or <12 months without ART). All patients were assessed for uterine anatomy, antiphospholipid antibodies (APAs), thyroid function, and thrombophilia. Of the 828 patients, 22%, 44%, and 34% were assigned to the SUP, SUB, and N groups, respectively. The mean ages were 33.9, 38.2, and 35.9 years in the SUP, SUB, and N groups, respectively, revealing a significant difference (P < 0.001). The anti-CL β2GPI antibody positivity rate was significantly higher in the SUP group (4.6%) than in the N group (0.8%; P = 0.016). The prevalence of APA positivity was lowest in the N group. Overall, the clinical characteristics and etiologies of RPL associated with superfertility and subfertility were strikingly similar, with comparable positivity rates after adjusting for maternal age. Further investigation including chromosomal analysis of products of conception is needed to elucidate the clinical impact of differences in fertility on patients with RPL.
Collapse
Affiliation(s)
- Sayuri Kasano
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Yoshimitsu Kuwabara
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
| | - Shingo Ogawa
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Ryoko Yokote
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Mirei Yonezawa
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Nozomi Ouchi
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Tomoko Ichikawa
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Shunji Suzuki
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Toshiyuki Takeshita
- Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| |
Collapse
|
8
|
Li Y, Niu Y, Liu M, Lan X, Qin R, Ma K, Zhao HJ. First-trimester serum antiphosphatidylserine antibodies serve as candidate biomarkers for predicting pregnancy-induced hypertension. J Hypertens 2023; 41:1474-1484. [PMID: 37382157 DOI: 10.1097/hjh.0000000000003498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
OBJECTIVE The aim of this study was to explore whether antiphosphatidylserine (aPS) antibodies play roles in the early prediction of pregnancy-induced hypertension (PIH). METHODS The serum levels of different isotypes of aPS antibodies were compared in women diagnosed with PIH (PIH group, n = 30) and 1 : 1 matched normotensive controls (control group, n = 30). All patients underwent frozen embryo transfer (FET) cycles, and all serum samples were collected during 11-13 weeks of gestation. Receiver operating characteristic (ROC) curves were drawn to analyze the predictive values of aPS antibodies for PIH. RESULTS The women who developed PIH after FET had higher serum optical density values (450 nm) of aPS immunoglobulin (Ig) A (1.31 ± 0.43 vs. 1.02 ± 0.51, P = 0.022), aPS IgM (1.00 ± 0.34 vs. 0.87 ± 0.18, P = 0.046), and aPS IgG (0.50 ± 0.12 vs. 0.34 ± 0.07, P < 0.001) compared with the normotensive controls. The serum concentration of total IgG [48.29 ± 10.71 (g/dl) vs. 34.39 ± 11.62 (g/dl), P < 0.001] was also higher in the PIH group compared with that in the control group. The aPS IgG alone [area under the curve (AUC): 0.913, 95% confidence interval (CI): 0.842-0.985, P < 0.001] and the combined analysis of aPS IgA, aPS IgM, aPS IgG, and total IgG (AUC: 0.944, 95% CI: 0.888-1.000, P < 0.001) had high predictive values for PIH. CONCLUSION Serum aPS autoantibody levels during the first trimester of pregnancy are positively associated with the development of PIH. Further validation is needed to clearly identify the distinct contributions and underlying mechanisms for diagnostic applications of aPS autoantibodies in PIH prediction.
Collapse
Affiliation(s)
- Yan Li
- Center for Reproductive Medicine, Shandong University
- Medical Integration and Practice Center, Shandong University, Jinan, Shandong
- Suzhou Research Institute, Shandong University, Suzhou, Jiangsu
| | - Yue Niu
- Center for Reproductive Medicine, Shandong University
- Medical Integration and Practice Center, Shandong University, Jinan, Shandong
| | - Mingxi Liu
- Center for Reproductive Medicine, Shandong University
- Medical Integration and Practice Center, Shandong University, Jinan, Shandong
| | - Xiangxin Lan
- Center for Reproductive Medicine, Shandong University
- Medical Integration and Practice Center, Shandong University, Jinan, Shandong
| | - Rencai Qin
- Centre for Infection and Immunity Studies, School of Medicine, The Sun Yat-sen University, Shenzhen, Guangdong
| | - Kongyang Ma
- Centre for Infection and Immunity Studies, School of Medicine, The Sun Yat-sen University, Shenzhen, Guangdong
| | - Hong-Jin Zhao
- Department of Cardiology, Shandong Provincial Hospital affiliated to Shandong First Medical University
- Department of Cardiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| |
Collapse
|
9
|
Abstract
Antiphospholipid syndrome (APS) is an autoimmune prothrombotic disease characterized by thrombosis and/or pregnancy complications caused by antiphospholipid antibodies (aPL). The history of APS can be traced back to observations made during screening programs for syphilis conducted in the mid-20th century, with identification of patients with the so-called biological false-positive serological reactions for syphilis. Initial observation linking aPL with recurrent miscarriages was first reported more than 40 years ago. Since then, our understanding of the pathogenesis and management of APS has evolved markedly. Although APS is an autoimmune disease, anticoagulation mainly with vitamin K antagonists (VKAs) rather than immunomodulation, is the treatment of choice for thrombotic APS. Direct acting oral anticoagulants are inferior to VKAs, especially those with triple-positive APS and arterial thrombosis. Inflammation, complement activation, and thrombosis in the placenta may contribute to pathogenesis of obstetric APS. Heparin, mainly low-molecular-weight heparin, and low-dose aspirin represent the treatments of choice for women with obstetric complications. Increasingly, immunomodulatory agents such as hydroxychloroquine for thrombotic and obstetric APS are being used, especially in patients who are refractory to present standard treatment.
Collapse
Affiliation(s)
- Deepa R J Arachchillage
- Department of Immunology and Inflammation, Centre for Haematology, Imperial College London, London, United Kingdom
- Department of Haematology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Charis Pericleous
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| |
Collapse
|
10
|
Noble H, Crossette-Thambiah C, Odho Z, Karawitage N, Logan K, Pericleous C, Laffan M, Arachchillage DJ. Frequency and Clinical Significance Anti-PS/PT Antibodies in Patients with Antiphospholipid Syndrome - Single Centre Observational Study in the United Kingdom. Semin Thromb Hemost 2022. [PMID: 36318961 DOI: 10.1055/s-0042-1757633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Hithin Noble
- Department of Immunology and Inflammation, Centre for Haematology, Imperial College London, London, United Kingdom
| | - Christina Crossette-Thambiah
- Department of Immunology and Inflammation, Centre for Haematology, Imperial College London, London, United Kingdom
- Department of Haematology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Zain Odho
- Department of Laboratory medicine, Royal Brompton Hospital, London, United Kingdom
| | - Nilanthi Karawitage
- Department of Immunology and Inflammation, Centre for Haematology, Imperial College London, London, United Kingdom
| | - Karen Logan
- Department of Immunology and Inflammation, Centre for Haematology, Imperial College London, London, United Kingdom
| | - Charis Pericleous
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Mike Laffan
- Department of Immunology and Inflammation, Centre for Haematology, Imperial College London, London, United Kingdom
- Department of Haematology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Deepa J Arachchillage
- Department of Immunology and Inflammation, Centre for Haematology, Imperial College London, London, United Kingdom
- Department of Haematology, Imperial College Healthcare NHS Trust, London, United Kingdom
| |
Collapse
|
11
|
Renaud SJ, Jeyarajah MJ. How trophoblasts fuse: an in-depth look into placental syncytiotrophoblast formation. Cell Mol Life Sci 2022; 79:433. [PMID: 35859055 PMCID: PMC11072895 DOI: 10.1007/s00018-022-04475-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/07/2022] [Accepted: 07/06/2022] [Indexed: 11/24/2022]
Abstract
In humans, cell fusion is restricted to only a few cell types under normal conditions. In the placenta, cell fusion is a critical process for generating syncytiotrophoblast: the giant multinucleated trophoblast lineage containing billions of nuclei within an interconnected cytoplasm that forms the primary interface separating maternal blood from fetal tissue. The unique morphology of syncytiotrophoblast ensures that nutrients and gases can be efficiently transferred between maternal and fetal tissue while simultaneously restricting entry of potentially damaging substances and maternal immune cells through intercellular junctions. To maintain integrity of the syncytiotrophoblast layer, underlying cytotrophoblast progenitor cells terminate their capability for self-renewal, upregulate expression of genes needed for differentiation, and then fuse into the overlying syncytium. These processes are disrupted in a variety of obstetric complications, underscoring the importance of proper syncytiotrophoblast formation for pregnancy health. Herein, an overview of key mechanisms underlying human trophoblast fusion and syncytiotrophoblast development is discussed.
Collapse
Affiliation(s)
- Stephen J Renaud
- Department of Anatomy and Cell Biology and Children's Health Research Institute, University of Western Ontario, London, ON, N6A5C1, Canada.
| | - Mariyan J Jeyarajah
- Department of Anatomy and Cell Biology and Children's Health Research Institute, University of Western Ontario, London, ON, N6A5C1, Canada
| |
Collapse
|
12
|
Inefficient development of syncytiotrophoblasts in the Atp11a-deficient mouse placenta. Proc Natl Acad Sci U S A 2022; 119:e2200582119. [PMID: 35476530 PMCID: PMC9170144 DOI: 10.1073/pnas.2200582119] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Plasma membranes are composed of a lipid bilayer in which phosphatidylserine (PtdSer) is confined to the inner leaflet by the action of flippase that translocates PtdSer from the outer to inner leaflets. Two P4-ATPases (ATP11A and ATP11C) work as flippase at plasma membranes. Here, we report that the mouse placenta expresses only ATP11A, and Atp11a-deficient mouse embryos die during embryogenesis due to inefficient formation of syncytiotrophoblasts in the placental labyrinth. The flippase-null mutation inactivates human choriocarcinoma BeWo cells to translocate PtdSer into the inner leaflet and undergo cell fusion. These findings highlight the importance of flippase to regulate the distribution of phospholipids for cell fusion, at least in trophoblast fusion. The P4-ATPases ATP11A and ATP11C function as flippases at the plasma membrane to translocate phosphatidylserine from the outer to the inner leaflet. We herein demonstrated that Atp11a-deficient mouse embryos died at approximately E14.5 with thin-walled heart ventricles. However, the cardiomyocyte- or epiblast-specific Atp11a deletion did not affect mouse development or mortality. ATP11C may have compensated for the function of ATP11A in most of the cell types in the embryo. On the other hand, Atp11a, but not Atp11c, was expressed in the mouse placenta, and the Atp11a-null mutation caused poor development of the labyrinthine layer with an increased number of TUNEL-positive foci. Immunohistochemistry and electron microscopy revealed a disorganized labyrinthine layer with unfused trophoblasts in the Atp11a-null placenta. Human placenta-derived choriocarcinoma BeWo cells expressed the ATP11A and ATP11C genes. A lack of ATP11A and ATP11C eliminated the ability of BeWo cells to flip phosphatidylserine and fuse when treated with forskolin. These results indicate that flippases at the plasma membrane play an important role in the formation of syncytiotrophoblasts in placental development.
Collapse
|
13
|
Egri N, Bentow C, Rubio L, Norman GL, López-Sañudo S, Mahler M, Pérez-Isidro A, Cervera R, Viñas O, Espinosa G, Ruiz-Ortiz E. Anti-Phosphatidylserine/Prothrombin Antibodies at Two Points: Correlation With Lupus Anticoagulant and Thrombotic Risk. Front Immunol 2021; 12:754469. [PMID: 34790198 PMCID: PMC8592011 DOI: 10.3389/fimmu.2021.754469] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/29/2021] [Indexed: 01/18/2023] Open
Abstract
Antibodies to phospholipids (aPL) and associated proteins are a hallmark in the diagnosis of anti-phospholipid syndrome (APS). Those included in the classification criteria are the lupus anticoagulant (LA) and the IgG and IgM isotypes of anticardiolipin (aCL) and anti-beta-2 glycoprotein I (β2GPI) antibodies. Non-classification criteria markers such as autoantibodies that recognize the phosphatidylserine/prothrombin (aPS/PT) complex have been proposed as biomarkers for APS. Studies of aPS/PT antibodies have shown a strong correlation to clinical manifestations and LA. We aimed to study the value and the persistence of aPS/PT IgG and IgM antibodies in a cohort of consecutive patients with clinical suspicion of APS and their utility as thrombotic risk markers. Our study, with 103 patients, demonstrates that persistently positive results for aPS/PT IgG antibodies were significantly associated with APS classification, thrombosis, triple aPL positivity, LA positive result, and the Global APS Score (GAPSS) > than 9 points (p < 0.01, for each condition). On the other hand, no association was seen with pregnancy morbidity (p = 0.56) and SLE (p = 0.07). Persistence of aPS/PT antibodies, defined according to the current laboratory classification criteria, likely improves the diagnosis and clinical assessment of patients with APS.
Collapse
Affiliation(s)
- Natalia Egri
- Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Chelsea Bentow
- Headquarters & Technology Center, Autoimmunity, Werfen, San Diego, CA, United States
| | - Laura Rubio
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Gary L. Norman
- Headquarters & Technology Center, Autoimmunity, Werfen, San Diego, CA, United States
| | | | - Michael Mahler
- Headquarters & Technology Center, Autoimmunity, Werfen, San Diego, CA, United States
| | - Albert Pérez-Isidro
- Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ricard Cervera
- Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Autoimmune Diseases, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Odette Viñas
- Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Gerard Espinosa
- Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Autoimmune Diseases, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Estíbaliz Ruiz-Ortiz
- Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Barcelona, Spain
| |
Collapse
|
14
|
Hu C, Li S, Xie Z, You H, Jiang H, Shi Y, Qi W, Zhao J, Wang Q, Tian X, Li M, Zhao Y, Zeng X. Evaluation of the Diagnostic Value of Non-criteria Antibodies for Antiphospholipid Syndrome Patients in a Chinese Cohort. Front Immunol 2021; 12:741369. [PMID: 34567005 PMCID: PMC8461188 DOI: 10.3389/fimmu.2021.741369] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/20/2021] [Indexed: 11/17/2022] Open
Abstract
Objective Although specific anti-phospholipid antibodies (aPLs) have been used in the diagnosis of the antiphospholipid syndrome (APS) for years, new biomarkers are required to increase its diagnostic and risk-predictive power. This study aimed to explore the value of several non-criteria aPLs in a Chinese cohort. Methods A total of 312 subjects, namely, 100 patients diagnosed with primary APS, 51 with APS secondary to SLE, 71 with SLE, and 90 healthy controls, were recruited. Serum anticardiolipin (aCL) IgG/IgM/IgA, anti-β2-glycoprotein I (aβ2GPI) IgG/IgM/IgA, anti-phosphatidylserine/prothrombin antibodies (aPS/PT) IgG/IgM, and anti-annexin A5 antibodies (aAnxV) IgG/IgM were tested using ELISA kits. Results Of the total number of patients, 30.46% and 6.62% with APS were positive for aCL or aβ2GPI IgA, respectively, while 39.07% and 24.50% were positive for aAnxV or aPS/PT for at least one antibody (IgG or IgM). The addition test of aCL IgA and aAnxV IgM assists in identifying seronegative APS patients, and IgG aPS/PT was linked to stroke. Conclusion Detection of aCL IgA, aβ2GPI IgA, aAnxV IgG/M, and aPS/PT IgG/M as a biomarker provides additive value in APS diagnosis and would help in risk prediction for APS patients in medical practice.
Collapse
Affiliation(s)
- Chaojun Hu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Siting Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Zhijuan Xie
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Hanxiao You
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Hui Jiang
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Yu Shi
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Wanting Qi
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Jiuliang Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Qian Wang
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Xinping Tian
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Yan Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| |
Collapse
|
15
|
Kaneko K, Ozawa N, Murashima A. Obstetric anti-phospholipid syndrome: from pathogenesis to treatment. Immunol Med 2021; 45:79-93. [PMID: 34470570 DOI: 10.1080/25785826.2021.1969116] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Antiphospholipid syndrome (APS) is an autoimmune disease characterized by clinical manifestations such as thrombosis and obstetric complications with documented persistence of antiphospholipid antibodies (aPLs). Recent studies have revealed that the cause of aPL-related obstetric complications is dysfunction of placental trophoblasts and inflammation of the maternal-fetal interface induced by aPLs, not thrombosis. Although aPLs are associated with recurrence of serious complications during pregnancy, appropriate combination therapy with heparin and low-dose aspirin can improve the course of 70-80% of subsequent pregnancies. Preconception counseling and patient-tailored treatment are fundamental to improving maternal and fetal outcomes. Non-anticoagulant treatments such as hydroxychloroquine and statins are being developed for cases refractory to conventional treatment. Risk factors for thrombosis after pregnancy complications were identified based on the analysis of large databases of obstetric APS.
Collapse
Affiliation(s)
- Kayoko Kaneko
- Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Nobuaki Ozawa
- Division of Reproductive Medicine and Maternal Care/Immunology, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Atsuko Murashima
- Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
16
|
Abisror N, Nguyen Y, Marozio L, Esteve Valverde E, Udry S, Pleguezuelo DE, Billoir P, Mayer-Pickel K, Urbanski G, Zigon P, De Moreuil C, Hoxha A, Bezanahary H, Carbillon L, Kayem G, Bornes M, Yelnik C, Johanet C, Nicaise-Roland P, Lambert M, Salle V, Latino OJ, Hachulla E, Benedetto C, Bourrienne MC, Benhamou Y, Alijotas-Reig J, Fain O, Mekinian A. Obstetrical outcome and treatments in seronegative primary APS: data from European retrospective study. RMD Open 2021; 6:0. [PMID: 32848089 PMCID: PMC7507995 DOI: 10.1136/rmdopen-2020-001340] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/27/2020] [Accepted: 07/23/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To compare characteristics, pregnancies and treatments during pregnancies of seronegative and seropositive antiphospholipid syndrome (APS), to analyse factors associated with obstetrical outcome. PATIENTS AND METHODS Inclusion criteria were: (1) thrombotic and/or obstetrical APS (Sydney criteria); (2) absence of conventional antiphospholipid antibodies (APL); (3) at least one persistent non-conventional APL among IgA anticardiolipin antibodies, IgA anti-B2GPI, anti-vimentin G/M, anti-annexin V G/M, anti-phosphatidylethanolamine G/M and anti-phosphatidylserine/prothrombin G/M antibodies. The exclusion criteria were: (1) systemic lupus erythematosus ( SLE) or SLE-like disease; and (2) other connective tissue disease. RESULTS A total of 187 women (mean 33±5 years) with seronegative APS were included from 14 centres in Austria, Spain, Italy, Slovenia and France and compared with 285 patients with seropositive APS. Seronegative APS has more obstetrical rather than thrombotic phenotypes, with only 6% of venous thrombosis in comparison to seropositive APS. Cumulative incidence of adverse obstetrical events was similar in seronegative and seropositive APS patients, although higher rates of intrauterine deaths (15% vs 5%; p=0.03), of preeclampsia (7% vs 16%, p=0.048) and lower live birth term (36±3 vs 38±3 weeks of gestation; p=0.04) were noted in seropositive APS. The cumulative incidence of adverse obstetrical events was significantly improved in treated versus untreated seronegative APS (log rank<0.05), whereas there was no difference between patients who received aspirin or aspirin-low-molecular weighted heparin combination. CONCLUSION Several non-criteria APL can be detected in patients with clinical APS features without any conventional APL, with various rates. The detection of non-criteria APL and thus the diagnosis of seronegative APS could discuss the therapeutic management similar to seropositive APS, but well-designed controlled studies are necessary.
Collapse
Affiliation(s)
- Noemie Abisror
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Paris, France
| | - Yann Nguyen
- Department of Internal Medicine, AP-HP Nord, Beaujon Hospital, Paris University,Clichy, France
| | - Luca Marozio
- Department of Surgical Sciences, Obstetrics and Gynecology, University of Torino, Turin, Italy
| | | | - Sebastian Udry
- 5Autoimmune, Thrombophilic Diseases and Pregnancy Section, Acute Hospital "Dr Carlos G Durand", Buenos Aires, Argentina
| | | | - Paul Billoir
- Department of Internal Medicine, Vascular and Thrombosis Unit, Rouen University Hospital, Normandie University, UNIROUEN, INSERM, Rouen, France
| | | | - Geoffrey Urbanski
- Service Department of internal medicine, CHU d'Angers, Angers, France
| | - Polona Zigon
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Claire De Moreuil
- Département de Médecine Vasculaire, Médecine Interne et Pneumologie, CHU de Brest, Hôpital La Cavale Blanche, Brest Cedex, France.,EA 3878, GETBO, Université Bretagne Loire, Brest Cedex, France
| | - Ariela Hoxha
- Department of Medicine-DIMED, Rheumatology Unit, University of Padua, Padua, Italy
| | - Holy Bezanahary
- Department of Internal Medicine, University Hospital of Limoges, Limoges, France
| | - Lionel Carbillon
- Department of Obstetrics, Gynecology and Reproductive Medicine Centers, Hôpitaux Universitaires Paris Seine Saint-Denis, Assistance Publique-Hôpitaux de Paris, Bondy, France.,University of Paris 13, Sorbonne University,Bobigny, France
| | - Gilles Kayem
- Service de Gynécologie Obstétrique, Hôpital Trousseau, AP-HP, Paris, France.,Sorbonne Université,Paris, France
| | - Marie Bornes
- Department of Gynaecology and Obstetrics and Reproductive Medicine, Tenon Hospital, Assistance Publique - Paris Hospitals,Paris, France
| | - Cecile Yelnik
- Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest (CeRAINO), Univ. Lille, CHU Lille, Lille, France
| | | | | | - Marc Lambert
- Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest (CeRAINO), Univ. Lille, CHU Lille, Lille, France
| | - Valéry Salle
- Department of Internal Medicine, University Hospital of Amiens, Amiens, France
| | - Omar Jose Latino
- 5Autoimmune, Thrombophilic Diseases and Pregnancy Section, Acute Hospital "Dr Carlos G Durand", Buenos Aires, Argentina
| | - Eric Hachulla
- Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest (CeRAINO), Univ. Lille, CHU Lille, Lille, France
| | - Chiara Benedetto
- Department of Surgical Sciences, Obstetrics and Gynecology, University of Torino, Turin, Italy
| | - Marie Charlotte Bourrienne
- Université de Paris, INSERM UMR_S1148, Paris cedex 18, France.,Laboratoire d'Hématologie, AP-HP, Hôpital Bichat, Paris cedex 18, France
| | - Ygal Benhamou
- Department of Internal Medicine, Vascular and Thrombosis Unit, Rouen University Hospital, Normandie University, UNIROUEN, INSERM, Rouen, France
| | - Jaume Alijotas-Reig
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine-1, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Medicine, Faculty of Medicine, Universitat Autönoma de Barcelona, Barcelona, Spain
| | - Olivier Fain
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Paris, France
| | - Arsène Mekinian
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Paris, France
| | | |
Collapse
|
17
|
Pleguezuelo DE, Cabrera-Marante O, Abad M, Rodriguez-Frias EA, Naranjo L, Vazquez A, Villar O, Gil-Etayo FJ, Serrano M, Perez-Rivilla A, de la Fuente-Bitaine L, Serrano A. Anti-Phosphatidylserine/Prothrombin Antibodies in Healthy Women with Unexplained Recurrent Pregnancy Loss. J Clin Med 2021; 10:jcm10102094. [PMID: 34068095 PMCID: PMC8152729 DOI: 10.3390/jcm10102094] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/21/2021] [Accepted: 05/10/2021] [Indexed: 12/17/2022] Open
Abstract
Recurrent pregnancy loss (RPL) affects up to 6% of couples. Although chromosomal aberrations of the embryos are considered the leading cause, 50% of cases remain unexplained. Antiphospholipid Syndrome is a known cause in a few cases. Antiphospholipid antibodies (aPL) anticardiolipin, anti-Beta-2-Glycoprotein-I and Lupus Anticoagulant (criteria aPL) are recommended studies in RPL workup. We tested healthy women with unexplained RPL for criteria aPL and anti-Phosphatidylserine/Prothrombin antibodies (aPS/PT). Patients were classified into three groups according to the number and pregnancy week of RPL: Extra-Criteria (EC), with 2 miscarriages, Early Miscarriage (EM), with ≥3 before pregnancy at week 10 and Fetal Loss (FL), with ≥1 fetal death from pregnancy at week 10. Circulating criteria aPL were absent in 98.1% of EM, 90.9% of FL and 96.6% of EC groups. In contrast, aPS/PT were positive in 15.4% of EM, 15.1% of FL, 16.6% of EC patients and 2.9% in controls. aPS/PT posed a risk for RPL, with an odds ratio of 5.96 (95% confidence interval (CI): 1.85-19.13. p = 0.002) for EM, 7.28 (95% CI: 2.07-25.56. p = 0.002) for FL and 6.56. (95% CI: 1.77-24.29. p = 0.004) for EC. A successful live birth was achieved in all pregnant patients positive for aPS/PT who received treatment with heparin, aspirin and/or hydroxychloroquine.
Collapse
Affiliation(s)
- Daniel E. Pleguezuelo
- Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (O.C.-M.); (E.A.R.-F.); (L.N.); (F.J.G.-E.); (A.S.)
- Correspondence: ; Tel.: +34-917792756
| | - Oscar Cabrera-Marante
- Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (O.C.-M.); (E.A.R.-F.); (L.N.); (F.J.G.-E.); (A.S.)
| | - Magdalena Abad
- Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (M.A.); (A.V.); (O.V.); (L.d.l.F.-B.)
| | - Edgard Alfonso Rodriguez-Frias
- Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (O.C.-M.); (E.A.R.-F.); (L.N.); (F.J.G.-E.); (A.S.)
| | - Laura Naranjo
- Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (O.C.-M.); (E.A.R.-F.); (L.N.); (F.J.G.-E.); (A.S.)
| | - Alicia Vazquez
- Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (M.A.); (A.V.); (O.V.); (L.d.l.F.-B.)
| | - Olga Villar
- Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (M.A.); (A.V.); (O.V.); (L.d.l.F.-B.)
| | - Francisco Javier Gil-Etayo
- Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (O.C.-M.); (E.A.R.-F.); (L.N.); (F.J.G.-E.); (A.S.)
| | - Manuel Serrano
- Healthcare Research Institute, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
| | - Alfredo Perez-Rivilla
- Department of Microbiology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
| | - Laura de la Fuente-Bitaine
- Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (M.A.); (A.V.); (O.V.); (L.d.l.F.-B.)
| | - Antonio Serrano
- Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (O.C.-M.); (E.A.R.-F.); (L.N.); (F.J.G.-E.); (A.S.)
| |
Collapse
|
18
|
Flagging fusion: Phosphatidylserine signaling in cell-cell fusion. J Biol Chem 2021; 296:100411. [PMID: 33581114 PMCID: PMC8005811 DOI: 10.1016/j.jbc.2021.100411] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 02/06/2023] Open
Abstract
Formations of myofibers, osteoclasts, syncytiotrophoblasts, and fertilized zygotes share a common step, cell–cell fusion. Recent years have brought about considerable progress in identifying some of the proteins involved in these and other cell-fusion processes. However, even for the best-characterized cell fusions, we still do not know the mechanisms that regulate the timing of cell-fusion events. Are they fully controlled by the expression of fusogenic proteins or do they also depend on some triggering signal that activates these proteins? The latter scenario would be analogous to the mechanisms that control the timing of exocytosis initiated by Ca2+ influx and virus-cell fusion initiated by low pH- or receptor interaction. Diverse cell fusions are accompanied by the nonapoptotic exposure of phosphatidylserine at the surface of fusing cells. Here we review data on the dependence of membrane remodeling in cell fusion on phosphatidylserine and phosphatidylserine-recognizing proteins and discuss the hypothesis that cell surface phosphatidylserine serves as a conserved “fuse me” signal regulating the time and place of cell-fusion processes.
Collapse
|
19
|
Abstract
The anti-phospholipid syndrome (APS) is defined by the laboratory detection of at least one of three anti-phospholipid autoantibodies (lupus anticoagulant, or anti-cardiolipin or anti-β2-glycoprotein I antibodies) in the clinical setting of thrombosis or pregnancy morbidity in a patient. Recognising APS and administering appropriate secondary thromboprophylaxis is important to reduce risk of recurrent thrombosis and/or pregnancy morbidity. In some instances, patients having clinical manifestations highly suggestive of APS are persistently negative for these antibodies but instead have other autoantibodies. Autoantibodies directed against prothrombin (PT) have been associated with increased thrombotic risk and comprise anti-prothrombin (aPT) and anti-phosphatidylserine/prothrombin (aPS/PT) antibodies. Detection of aPT and aPS/PT may help stratify patients for more effective treatment, however, their prevalence among patients with unprovoked venous thromboembolism (VTE) is unknown and determination of their frequencies is the objective of this study. Sera from 148 patients with unprovoked VTE were analysed. Autoantibodies directed against PT collectively, aPT and aPS/PT were present in 24.3%, 14.9% and 13.5%, respectively. Prevalence of these autoantibodies in unprovoked VTE is much lower compared to cohorts comprising mainly patients with systemic autoimmune disorders. Detection of these autoantibodies in unprovoked VTE has potential therapeutic implications for patients including the duration of anticoagulation and administration, or otherwise, of direct oral anticoagulants. Data from this study will assist in the design of future clinical studies to estimate risk of recurrent VTE and to determine optimal management.
Collapse
|
20
|
Funke A, Staub HL, Monticielo OA, Balbi GGM, Danowski A, Santiago MB, Andrade DCOD, Rêgo J. Non-criteria Antiphospholipid Antibodies: a narrative review. Rev Assoc Med Bras (1992) 2020; 66:1595-1601. [DOI: 10.1590/1806-9282.66.11.1595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/11/2020] [Indexed: 12/20/2022] Open
Abstract
SUMMARY The 2006 Revised Sapporo Classification Criteria for Definite Antiphospholipid Syndrome included as laboratory criteria the tests for antiphospholipid antibodies whose accuracy was regarded as satisfactory according to the evidence available at that time. In practice, however, the sensitivity and specificity of these “criteria” of antiphospholipid antibodies are sometimes insufficient for identifying or ruling out antiphospholipid syndrome. It has been studied whether the accuracy of the laboratory diagnosis of the syndrome could be improved by testing for non-criteria antiphospholipid antibodies. In this work, we review evidence on the clinical associations and diagnostic value of the most commonly studied non-criteria antibodies, namely: antiphosphatidylethanolamine, anti-annexin A5, anti-prothrombin, anti-phosphatidylserine/prothrombin complex, IgA anticardiolipin, and IgG anti-domain I of the β2 glycoprotein antibodies.
Collapse
|
21
|
Beltagy A, Trespidi L, Gerosa M, Ossola MW, Meroni PL, Chighizola CB. Anti-phospholipid antibodies and reproductive failures. Am J Reprod Immunol 2020; 85:e13258. [PMID: 32347616 DOI: 10.1111/aji.13258] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/16/2022] Open
Abstract
Anti-phospholipid syndrome (APS) recapitulates the link between autoimmunity and pregnancy failure: Acquired anti-phospholipid antibodies (aPL) play a pathogenic role in pregnancy complications. The diagnosis of obstetric APS can easily be pursued when women present with laboratory and clinical features fulfilling the international classification criteria. Standard therapeutic approach to obstetric APS consists in the association of anti-platelet agents and anticoagulants. Most patients achieve a live birth thanks to conventional treatment; however, approximately 20% fail to respond and are managed with additional therapeutic tools added on the top of conventional treatment. Surely, a refinement of risk stratification tools would allow early identification of high-risk pregnancies that warrant tailored treatment. In real life, obstetricians and rheumatologists face complex diagnostic scenarios including women with pregnancy morbidities other than those mentioned in classification criteria such as one or two early losses and premature birth after 34 weeks due to preeclampsia or placental insufficiency, women with low-titer aPL not fulfilling criteria laboratory requirements, women with positive non-criteria aPL, asymptomatic aPL carriers, and infertile women found to be aPL-positive. This review focuses on some of the several unanswered questions related to diagnostic, prognostic, and therapeutic aspects in obstetric APS.
Collapse
Affiliation(s)
- Asmaa Beltagy
- Experimental Laboratory of Immunological and Rheumatologic Researches, Istituto Auxologico Italiano, IRCCS, Cusano Milanino, Milan, Italy.,Immunology and Rheumatology Unit, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Rheumatology and Clinical Immunology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Laura Trespidi
- Department of Obstetrics and Gynaecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Gerosa
- Division of Clinical Rheumatology, Research Center for Adult and Pediatric Rheumatic Diseases, ASST G. Pini & CTO, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Manuela Wally Ossola
- Department of Obstetrics and Gynaecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Pier Luigi Meroni
- Experimental Laboratory of Immunological and Rheumatologic Researches, Istituto Auxologico Italiano, IRCCS, Cusano Milanino, Milan, Italy.,Immunology and Rheumatology Unit, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Cecilia B Chighizola
- Experimental Laboratory of Immunological and Rheumatologic Researches, Istituto Auxologico Italiano, IRCCS, Cusano Milanino, Milan, Italy.,Immunology and Rheumatology Unit, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| |
Collapse
|
22
|
Pignatelli P, Ettorre E, Menichelli D, Pani A, Violi F, Pastori D. Seronegative antiphospholipid syndrome: refining the value of "non-criteria" antibodies for diagnosis and clinical management. Haematologica 2020; 105:562-572. [PMID: 32001534 PMCID: PMC7049333 DOI: 10.3324/haematol.2019.221945] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 12/18/2019] [Indexed: 11/16/2022] Open
Abstract
Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by arterial and venous thrombotic manifestations and/or pregnancy-related complications in patients with persistently high antiphospholipid antibodies (aPL), the most common being represented by anticardiolipin antibodies (aCL), anti-beta 2 glycoprotein-I (aβ2GPI), and lupus anticoagulant (LAC). A growing number of studies have showed that, in some cases, patients may present with clinical features of APS but with temporary positive or persistently negative titers of aPL. For these patients, the definition of seronegative APS (SN-APS) has been proposed. Nevertheless, the negativity to classic aPL criteria does not imply that other antibodies may be present or involved in the onset of thrombosis. The diagnosis of SN-APS is usually made by exclusion, but its recognition is important to adopt the most appropriate anti-thrombotic strategy to reduce the rate of recurrences. This research is in continuous development as the clinical relevance of these antibodies is far from being completely clarified. The most studied antibodies are those against phosphatidylethanolamine, phosphatidic acid, phosphatidylserine, phosphatidylinositol, vimentin/cardiolipin complex, and annexin A5. Moreover, the assays to measure the levels of these antibodies have not yet been standardized. In this review, we will summarize the evidence on the most studied non-criteria aPL, their potential clinical relevance, and the antithrombotic therapeutic strategies available in the setting of APS and SN-APS.
Collapse
Affiliation(s)
- Pasquale Pignatelli
- I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome.,Mediterranea Cardiocentro, Naples
| | - Evaristo Ettorre
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Division of Gerontology, Sapienza University, Rome
| | - Danilo Menichelli
- I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome
| | - Arianna Pani
- Department of Oncology and Onco-Hematology, University of Milan, Milan.,Clinical Pharmacology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Violi
- I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome.,Mediterranea Cardiocentro, Naples
| | - Daniele Pastori
- I Clinica Medica, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome
| |
Collapse
|
23
|
Zhu H, Wang M, Dong Y, Hu H, Zhang Q, Qiao C, Xie X, Fan F, Zeng J, Jia Y, Chen L, Liu J, Li L, Zhai Y, Zhao Z, Shen M, Cao Z. Detection of non-criteria autoantibodies in women without apparent causes for pregnancy loss. J Clin Lab Anal 2019; 33:e22994. [PMID: 31402484 PMCID: PMC6868457 DOI: 10.1002/jcla.22994] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/12/2019] [Accepted: 07/16/2019] [Indexed: 01/08/2023] Open
Abstract
Background Some of the non‐criteria autoantibodies, especially non‐conventional antiphospholipid (aPL) antibodies, were present with high prevalence in sporadic miscarriages and recurrent pregnant loss. However, whether these autoantibodies are associated with miscarriage patients without apparent causes remain unclear. Methods The subjects were recruited from the female patients visiting the Infertility Center at the Beijing Obstetrics and Gynecology Hospital from January 2017 to March 2018. The women who experienced one sporadic miscarriage (n = 89) or recurrent pregnancy loss (n = 125) were enrolled. The control participants (n = 59) were those women with normal pregnancy history and with no miscarriage or thrombosis experience. The collected serum specimens from above patients and controls were subjected to the 13 non‐criteria autoantibody examinations, targeting non‐conventional phospholipids, thyroid, sperm, endometrial, and anti‐nuclear antigens. Results When compared with the controls, the following non‐criteria antibodies stood out in present study with significantly increased frequency and were listed in the order of decreasing positive rates: aPE IgM (40.0%), ANA (15.2%), aEM IgG (13.6%), aPE IgG (12.8%), and aPT IgM (10.4%). Except for ANA, the presence of aPE IgM, aEM IgG, aPE IgG, and aPT IgM was not associated with positivity of LA tests. In receiver operating characteristic analyses, the combined aPE IgG and aEM IgG biomarker panel had the best discriminating power between miscarriage patients and healthy controls. Conclusion Our findings suggested that the non‐criteria could be included as part of the pregnancy loss evaluation when apparent causes are absent, and the conventional aPLs tests failed to provide interpretations.
Collapse
Affiliation(s)
- Hongyuan Zhu
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Meng Wang
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Ying Dong
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Honghai Hu
- Guangzhou Kangrun Biotech Co. Ltd., Guangdong, China
| | - Qiaoli Zhang
- Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Chen Qiao
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Xin Xie
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Fei Fan
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Jiazi Zeng
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yan Jia
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Lu Chen
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Jingrui Liu
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Lin Li
- Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yanhong Zhai
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Zhen Zhao
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Min Shen
- Reference Laboratory, MedicalSystem Biotechnology Co., Ltd., Ningbo, China
| | - Zheng Cao
- Department of Laboratory Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
24
|
Nakamura H, Oku K, Amengual O, Ohmura K, Fujieda Y, Kato M, Bohgaki T, Yasuda S, Atsumi T. First-Line, Non-Criterial Antiphospholipid Antibody Testing for the Diagnosis of Antiphospholipid Syndrome in Clinical Practice: A Combination of Anti-β 2 -Glycoprotein I Domain I and Anti-Phosphatidylserine/Prothrombin Complex Antibodies Tests. Arthritis Care Res (Hoboken) 2019; 70:627-634. [PMID: 28686816 DOI: 10.1002/acr.23310] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 06/20/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the value of a combination of anti-β2 -glycoprotein I (anti-β2 GPI) domain I antibody and anti-phosphatidylserine/prothrombin complex (anti-PS/PT) antibody tests for the diagnosis of antiphospholipid syndrome (APS). METHODS This cross-sectional study involved a cohort of the patients who visited our clinic from April 2005 to March 2013. Tests for anti-β2 GPI domain I antibodies, IgG anti-PS/PT antibodies, and IgM anti-PS/PT antibodies, together with tests for criteria-defined antiphospholipid antibodies (aPL), were performed in all patients. The total antiphospholipid score (aPL-S) was calculated for each patient according to titers of and positivity for aPL. RESULTS The study enrolled 157 patients (51 patients with APS and 106 with non-APS autoimmune diseases). All 21 patients positive for both anti-β2 GPI domain I antibodies and IgG and/or IgM (IgG/IgM) anti-PS/PT antibodies had APS with a high total aPL-S (median 46, range 26-76), as did all of the 10 patients who were positive for anti-β2 GPI domain I antibodies but negative for IgG/IgM anti-PS/PT antibodies (median 22, range 4-39). Of the 14 patients who were positive for IgG/IgM anti-PS/PT antibodies but negative for anti-β2 GPI domain I antibodies, 11 (79%) had APS; these individuals also had high total aPL-S values (median 23, range 11-60). In contrast, only 9 of the 112 patients (8%) with none of these antibodies had APS. CONCLUSION The combination of the IgG anti-β2 GPI domain I antibody and IgG/IgM anti-PS/PT antibody tests shows a high positive predictive value for the diagnosis of APS and a strong correlation with the aPL-S. This combination as the first-line test for aPL may contribute to the simple and definite identification of APS with a high risk of thrombosis in clinical practice.
Collapse
Affiliation(s)
| | - Kenji Oku
- Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Olga Amengual
- Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazumasa Ohmura
- Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuichiro Fujieda
- Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaru Kato
- Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | | | - Shinsuke Yasuda
- Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tatsuya Atsumi
- Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| |
Collapse
|
25
|
Study of clinical utility of antibodies to phosphatidylserine/prothrombin complex in Asian-Indian patients with suspected APS. Clin Rheumatol 2018; 38:545-553. [DOI: 10.1007/s10067-018-4301-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/09/2018] [Accepted: 09/14/2018] [Indexed: 10/28/2022]
|
26
|
Added value of non-criteria antiphospholipid antibodies for antiphospholipid syndrome: lessons learned from year-long routine measurements. Clin Rheumatol 2018; 38:371-378. [PMID: 30099654 DOI: 10.1007/s10067-018-4251-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 07/30/2018] [Indexed: 12/17/2022]
Abstract
The international classification criteria for definite antiphospholipid syndrome (APS) include three laboratory measurements: lupus anticoagulant (LA), IgG and IgM isotypes of anti-cardiolipin (aCL) and anti-β2glycoprotein I antibodies (anti-β2GPI). When persistently elevated, they are specific for APS; however, many patients that fulfil clinical criteria may exhibit negative serological results. These "seronegative" APS (SN-APS) are exposed to an increased thrombotic risk. The aims of our cross-sectional, retrospective study of consecutive autoimmune patients' samples were to evaluate the association of non-criteria antiphospholipid antibodies (aPL) with thrombosis and obstetric events, to calculate the risk score for adverse events and to assess the specific contribution of single aPL positivity in SN-APS. LA, aCL, anti-β2GPI and anti-phosphatidylserine/prothrombin antibodies (aPS/PT) of IgG, IgM, and IgA isotypes were determined in sera of 323 patients with autoimmune disorders. Medical records of all patients were carefully analyzed. aCL, anti-β2GPI and aPS/PT of IgG and IgA isotypes were significantly associated with thrombosis while none of the IgM aPL showed such association. aPS/PT of all isotypes, aCL and anti-β2GPI of IgG and IgA isotype showed significant correlation to obstetric events. When considering results of aPS/PT ELISA, we could additionally identify 3% of thrombotic patients and 2% of obstetric patients. Thrombotic and obstetric risk scores were calculated showing significantly higher association to clinical events, as compared to evaluating individual risk factors. aPS/PT could represent an additional biomarker in SN-APS patients. IgA aPL are associated with thrombosis and obstetric complications. Risk scores accounting different aPL and conventional risk factors, better assesses risk for adverse event, as compared to evaluating individual factors alone.
Collapse
|
27
|
Truglia S, Capozzi A, Mancuso S, Recalchi S, Spinelli FR, Perricone C, De Carolis C, Manganelli V, Riitano G, Garofalo T, Longo A, De Carolis S, Alessandri C, Misasi R, Valesini G, Sorice M, Conti F. A Monocentric Cohort of Obstetric Seronegative Anti-Phospholipid Syndrome. Front Immunol 2018; 9:1678. [PMID: 30079071 PMCID: PMC6062588 DOI: 10.3389/fimmu.2018.01678] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/09/2018] [Indexed: 11/30/2022] Open
Abstract
The present study was conducted to diagnose obstetric anti-phospholipid syndrome (OAPS) in patients with clinical signs suggestive of anti-phospholipid syndrome (APS), but persistently negative for conventional anti-phospholipid antibodies (aPL). Sera from 61 obstetrical seronegative APS (SN-APS) patients were analyzed for anti-cardiolipin antibodies (aCL) using thin-layer chromatography (TLC)-immunostaining, for anti-cardiolipin/vimentin antibodies (aCL/Vim), anti-phosphatidylserine/prothrombin antibodies, IgA anti-β2glycoprotein I antibodies (aβ2GPI), and IgA aCL antibodies by enzyme-linked immunosorbent assay. Taken together, our findings show that in 50 out of 61 SN-APS (81.9%) at least one aPL/cofactor antibody was detected using the assays under test. Results revealed that 76% of SN-APS patients resulted positive for aCL by TLC-immunostaining, 54% for aCL/Vim, 12% for aPS/PT, 4% for IgA aβ2GPI, and 2% for IgA aCL. Thirty-five out of 61 patients were followed up and the tests were repeated on two occasions, at least 12 weeks apart. Twenty-six out of 35 SN-APS (74.3%) were positive at least one non-conventional test; only 2 patients (5.7%) did not confirm the positivity to the second test. These findings suggest that non-conventional tests, mainly aCL/Vim and aCL detected by TLC-immunostaining, seem to be the most sensitive approaches for finding out aPL in patients with obstetric SN-APS. The use of these tests can be useful for accurate and timely diagnosis of patients with obstetrical APS who are negative for conventional laboratory criteria markers.
Collapse
Affiliation(s)
- Simona Truglia
- Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università Roma, Rome, Italy
| | - Antonella Capozzi
- Dipartimento di Medicina Sperimentale, Sapienza Università di Roma, Rome, Italy
| | - Silvia Mancuso
- Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università Roma, Rome, Italy
| | - Serena Recalchi
- Dipartimento di Medicina Sperimentale, Sapienza Università di Roma, Rome, Italy
| | - Francesca Romana Spinelli
- Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università Roma, Rome, Italy
| | - Carlo Perricone
- Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università Roma, Rome, Italy
| | - Caterina De Carolis
- Centro Polimedico per la Prevenzione dell'Aborto Spontaneo Ricorrente, Rome, Italy
| | - Valeria Manganelli
- Dipartimento di Medicina Sperimentale, Sapienza Università di Roma, Rome, Italy
| | - Gloria Riitano
- Dipartimento di Medicina Sperimentale, Sapienza Università di Roma, Rome, Italy
| | - Tina Garofalo
- Dipartimento di Medicina Sperimentale, Sapienza Università di Roma, Rome, Italy
| | - Agostina Longo
- Dipartimento di Medicina Sperimentale, Sapienza Università di Roma, Rome, Italy
| | - Sara De Carolis
- Dipartimento di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristiano Alessandri
- Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università Roma, Rome, Italy
| | - Roberta Misasi
- Dipartimento di Medicina Sperimentale, Sapienza Università di Roma, Rome, Italy
| | - Guido Valesini
- Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università Roma, Rome, Italy
| | - Maurizio Sorice
- Dipartimento di Medicina Sperimentale, Sapienza Università di Roma, Rome, Italy
| | - Fabrizio Conti
- Dipartimento di Medicina Sperimentale, Sapienza Università di Roma, Rome, Italy
| |
Collapse
|
28
|
Canti V, Del Rosso S, Tonello M, Lucianò R, Hoxha A, Coletto LA, Vaglio Tessitore I, Rosa S, Manfredi AA, Castiglioni MT, Ruffatti A, Rovere-Querini P. Antiphosphatidylserine/prothrombin Antibodies in Antiphospholipid Syndrome with Intrauterine Growth Restriction and Preeclampsia. J Rheumatol 2018; 45:1263-1272. [PMID: 30008452 DOI: 10.3899/jrheum.170751] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Antibodies that recognize the phosphatidylserine/prothrombin complex (antiphosphatidylserine/prothrombin antibodies; aPS/PT) might reveal enhanced thrombotic risk in patients with systemic lupus erythematosus. Little is known about their association with pregnancy complications in the antiphospholipid syndrome (APS). METHODS We enrolled 55 patients with APS who were seeking pregnancy in 2 Italian hospitals. Antiphospholipid antibodies (aPL), including anticardiolipin antibodies, anti-β2-glycoprotein I antibodies, lupus-like anticoagulant, and aPS/PT antibodies were assessed, and the patients were prospectively followed for 24 months. RESULTS There were 65% (36/55) of the APS patients who had aPS/PT antibodies. Forty-seven pregnancies were followed, including 33 of aPS/PT+ patients. Forty-one of the 47 patients (87%) who initiated a pregnancy eventually gave birth to a child. The pregnancy duration and the mean newborn weight at delivery were significantly lower in aPS/PT+ than in aPS/PT- patients (33.1 ± 4.7 vs 36.2 ± 3.4 wks of gestation, respectively, and 2058 ± 964 g vs 2784 ± 746 g, respectively, p < 0.05). Late pregnancy complications, including intrauterine fetal death, preterm delivery, preeclampsia, and intrauterine growth restriction (IUGR), were more frequent in aPS/PT+ patients, independent of the therapy. Titers of aPS/PT IgG were significantly inversely correlated with the neonatal weight at delivery. Vascular injury, as reflected by thrombosis, fibrinoid necrosis, ischemic and hemorrhagic areas, and presence of chorangiomas characterized the IUGR placentas in the presence of aPS/PT. CONCLUSION The aPS/PT antibodies might represent markers of aPL-related pregnancy complications, IUGR/preeclampsia in particular, and could help identify beforehand patients who may require additional treatment.
Collapse
Affiliation(s)
- Valentina Canti
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Stefania Del Rosso
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Marta Tonello
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Roberta Lucianò
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Ariela Hoxha
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Lavinia A Coletto
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Isadora Vaglio Tessitore
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Susanna Rosa
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Angelo A Manfredi
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Maria Teresa Castiglioni
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Amelia Ruffatti
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Patrizia Rovere-Querini
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy. .,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University.
| |
Collapse
|
29
|
An ever-challenging relationship: lupus and pregnancy. Reumatologia 2017; 55:29-37. [PMID: 28386140 PMCID: PMC5380770 DOI: 10.5114/reum.2017.66685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 02/11/2017] [Indexed: 11/17/2022] Open
Abstract
Systemic lupus erythematous (SLE) is a chronic inflammatory disease with an unknown etiology and an autoimmune pathogenesis, and its clinical manifestations can involve multiple organs through polymorphic biological changes. Nowadays, pregnancy is possible for most patients with SLE, and good outcomes can be expected for both mother and child. This became possible as a consequence of increasingly better monitoring and treatment of pregnant women with SLE. The following article outlines the problems associated with fertility, course of pregnancy, and breastfeeding in women with SLE.
Collapse
|
30
|
Wei S, Lai K, Yang Z, Zeng K. Systemic lupus erythematosus and risk of preterm birth: a systematic review and meta-analysis of observational studies. Lupus 2017; 26:563-571. [PMID: 28121241 DOI: 10.1177/0961203316686704] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We performed a meta-analysis to identify the association between systemic lupus erythematosus (SLE) and preterm birth. In this study, we studied the effects of SLE, SLE disease activity, a history of nephritis and active nephritis on preterm birth. Searches were conducted before 20 May 2016 of PubMed, Embase, Medline and Cochrane Library of literature and article reference lists. Eleven observational case-control studies and thirteen cohort studies met the inclusion criteria. The pooled relative risk (RR) for the risk of preterm birth in SLE patients versus controls was 2.05 (95% confidence interval (CI): 1.72-3.32); for active SLE patients versus inactive was 2.98 (95% CI: 2.32-3.83); for SLE patients with a history of lupus nephritis versus those without nephritis it was 1.62 (95% CI: 1.35-1.95); and for SLE patients with active nephritis versus those with quiescent nephritis it was 1.78 (95% CI: 1.17-2.70). In summary, this study identified a significant association in the above results. This association was more significant in active SLE patients versus inactive. With respect to SLE itself, active inflammation (such as disease activity) may be more hazardous for the management of the pregnancy. This suggests that it is essential to control disease activity in order to achieve a better outcome of SLE pregnancy.
Collapse
Affiliation(s)
- S Wei
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - K Lai
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Z Yang
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - K Zeng
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| |
Collapse
|
31
|
Zhu L, Li C, Liu N, Yang X, Jia RL, Mu R, Su Y, Li ZG. Diagnostic value of antibodies to phosphatidylserine/prothrombin complex for antiphospholipid syndrome in Chinese patients. Clin Rheumatol 2017; 36:401-406. [PMID: 28050648 DOI: 10.1007/s10067-016-3498-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/20/2016] [Accepted: 11/27/2016] [Indexed: 11/30/2022]
Abstract
To evaluate the diagnosis value of antibodies to phosphatidylserine/prothrombin complex (aPS/PT) in patients with antiphospholipid syndrome (APS) and to determine the clinical features of APS patients with avidity of aPS/PT. Serum samples were collected from 108 APS patients. Sixty patients with pregnancy morbidity, 37 patients with thrombosis without a history of autoimmune diseases, and 89 healthy blood donors were included as the control group. The enzyme-linked immunosorbent assay (ELISA) test was performed to detect the concentration of aPS/PT, including IgG/M, IgG, and IgM forms, in the same serum sample. The chi-square (χ2) test was used to examine the difference of frequencies of antibodies in APS patients and patients with other diseases. Spearman correlation analysis was performed to investigate the relationship between aPS/PT and other clinical/laboratory parameters. aPS/PT was detectable in 68 (63.0%) of the 108 APS patients, 12 (13.2%) of the 91 disease control patients and 1 (1.1%) of the healthy controls. It was strongly correlated with the activity of lupus anticoagulant (LA) (OR 15.952, 95% CI 7.132-35.678; P < 0.001). The frequency of aPS/PT was 56.9% in anti-cardiolipid antibody (aCL)-negative, 60.5% anti-β2 glycoprotein I antibody (aβ2GPI)-negative, and 50.0% in both aCL and aβ2GPI negative APS patients. The IgG aPS/PT was significantly associated with arterial and venous thrombosis. The aPS/PT antibody could play an important role in the diagnosis of APS, especially in patients with negative aCL and aβ2GPI. It was positively related to thrombotic events in APS.
Collapse
Affiliation(s)
- Lei Zhu
- Department of Rheumatology and Immunology, Peking University People's Hospital, 11 South Xizhimen Street, Western District, Beijing, 100044, China.,Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, 100044, China.,Peking-Tsinghua Center for Life Sciences, Beijing, 100044, China
| | - Chun Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, 11 South Xizhimen Street, Western District, Beijing, 100044, China.,Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, 100044, China.,Peking-Tsinghua Center for Life Sciences, Beijing, 100044, China
| | - Na Liu
- Department of Rheumatology and Immunology, Peking University People's Hospital, 11 South Xizhimen Street, Western District, Beijing, 100044, China.,Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, 100044, China.,Peking-Tsinghua Center for Life Sciences, Beijing, 100044, China
| | - Xin Yang
- Department of Rheumatology and Immunology, Peking University People's Hospital, 11 South Xizhimen Street, Western District, Beijing, 100044, China.,Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, 100044, China.,Peking-Tsinghua Center for Life Sciences, Beijing, 100044, China
| | - R L Jia
- Department of Rheumatology and Immunology, Peking University People's Hospital, 11 South Xizhimen Street, Western District, Beijing, 100044, China.,Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, 100044, China.,Peking-Tsinghua Center for Life Sciences, Beijing, 100044, China
| | - Rong Mu
- Department of Rheumatology and Immunology, Peking University People's Hospital, 11 South Xizhimen Street, Western District, Beijing, 100044, China. .,Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, 100044, China. .,Peking-Tsinghua Center for Life Sciences, Beijing, 100044, China.
| | - Yin Su
- Department of Rheumatology and Immunology, Peking University People's Hospital, 11 South Xizhimen Street, Western District, Beijing, 100044, China.,Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, 100044, China.,Peking-Tsinghua Center for Life Sciences, Beijing, 100044, China
| | - Z G Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, 11 South Xizhimen Street, Western District, Beijing, 100044, China.,Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, 100044, China.,Peking-Tsinghua Center for Life Sciences, Beijing, 100044, China
| |
Collapse
|
32
|
Mekinian A, Bourrienne MC, Carbillon L, Benbara A, Noémie A, Chollet-Martin S, Tigaizin A, Montestruc F, Fain O, Nicaise-Roland P. Non-conventional antiphospholipid antibodies in patients with clinical obstetrical APS: Prevalence and treatment efficacy in pregnancies. Semin Arthritis Rheum 2016; 46:232-237. [DOI: 10.1016/j.semarthrit.2016.05.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 04/16/2016] [Accepted: 05/20/2016] [Indexed: 11/29/2022]
|
33
|
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.
Collapse
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
| |
Collapse
|
34
|
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.
Collapse
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.
| |
Collapse
|