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Longitudinal Analysis of Antiphospholipid Antibody Dynamics after Infection with SARS-CoV-2 or Vaccination with BNT162b2. Int J Mol Sci 2022; 24:ijms24010211. [PMID: 36613655 PMCID: PMC9820546 DOI: 10.3390/ijms24010211] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/25/2022] Open
Abstract
Antiphospholipid antibodies (aPL) comprise a group of autoantibodies that reflect prothrombotic risk in antiphospholipid syndrome (APS) but may also be present in a small proportion of healthy individuals. They are often transiently elevated in infections, including SARS-CoV-2, and may also be associated with vaccine-induced autoimmunity. Therefore, we aimed to investigate the dynamics of aPL in COVID-19 patients and in individuals (healthcare professionals-HCPs) after receiving BNT162b2 vaccine and to compare aPL levels and positivity with those found in APS patients. We measured solid-phase identifiable aPL, including anticardiolipin (aCL), anti-β2 glycoprotein I (anti-β2GPI), and anti-prothrombin/phosphatidylserine (aPS/PT) antibodies in 58 HCPs before and after vaccination (at 3 weeks, 3, 6, and 9 months after the second dose, and 3 weeks after the third booster dose), in 45 COVID-19 patients hospitalized in the ICU, in 89 COVID-19 patients hospitalized in the non-ICU (at admission, at hospital discharge, and at follow-up), and in 52 patients with APS. The most frequently induced aPL in COVID-19 patients (hospitalized in non-ICU) were aCL (50.6% of patients had positive levels at at least one time point), followed by anti-β2GPI (21.3% of patients had positive levels at at least one time point). In 9/89 COVID-19 patients, positive aPL levels persisted for three months. One HCP developed aCL IgG after vaccination but the persistence could not be confirmed, and two HCPs developed persistent anti-β2GPI IgG after vaccination with no increase during a 1-year follow-up period. Solid-phase aPL were detected in 84.6% of APS patients, in 49.4% of COVID-19 patients hospitalized in the non-ICU, in 33.3% of COVID-19 patients hospitalized in the ICU, and in only 17.2% of vaccinated HCPs. aPL levels and multiple positivity were significantly lower in both infected groups and in vaccinated individuals compared with APS patients. In conclusion, BNT162b2 mRNA vaccine may have induced aPL in a few individuals, whereas SARS-CoV-2 infection itself results in a higher percentage of aPL induction, but the levels, persistence, and multiple positivity of aPL do not follow the pattern observed in APS.
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El Hasbani G, Taher AT, Sciascia S, Uthman I. Antiphospholipid syndrome: the need for new international classification criteria. Expert Rev Clin Immunol 2021; 17:385-394. [PMID: 33682558 DOI: 10.1080/1744666x.2021.1900733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: As soon as the association of lupus anticoagulant (LAC) and anticardiolipin antibodies (aCL) with thrombosis and miscarriages was described in the 1980s, the definition of the antiphospholipid syndrome (APS) became a need. Early descriptions of the disease by members of the Graham Hughes team included broad categories and unexplained laboratory inclusions. Over time, new clinical and experimental data refined the criteria, especially the obstetric manifestations, as well as the laboratory criteria.Areas covered: The authors performed a review of the literature using the PubMed database, and the following keywords were used: 'antiphospholipid antibody', 'antiphospholipid syndrome', and 'criteria of antiphospholipid'. The history of antiphospholipid criteria, clinical and experimental advancements, and other expert opinions were included in this paper.Expert opinion: It has been 14 years since an international congress on antiphospholipid antibodies has generated new classification based on the recent extensive research performed in the field. Currently, there is a need to update the international APS classification taking into consideration the inclusion of new clinical criteria such as aPL-related nephropathy as well as new standardized antibody specificities (e.g., anti-phosphatidylserine/prothrombin antibodies) with the adoption of a standardized scoring system that can stratify APS patients.
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Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases and SCDU Nephrology and Dialysis, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Avidity of anti-phospholipid antibodies in relation to their levels. Cent Eur J Immunol 2021; 45:136-143. [PMID: 33456323 PMCID: PMC7792445 DOI: 10.5114/ceji.2020.97901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/07/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction The heterogeneity of anti-phospholipid antibodies can be manifested not only in different antigenic specificities, but also in their avidities. The aim of the study was to investigate the relationship between anti-cardiolipin antibody (aCL) IgG avidities and levels within the range of their titres, from very low to high ones. Material and methods We analyzed 78 serum samples from 60 patients by ELISA with chaotropic agents, using urea concentration of 6 and 8 mol/l and single diluted serum samples. The changes of aCL levels and avidities were explored during a long-term follow-up in 14 patients. Results The avidities of aCLs did not differ in the groups of patients classified according to aCL levels. The higher avidity antibodies predominated in our patients and the fluctuation of avidities in the longitudinal follow-up did not show significant differences. No relationship between aCL levels and their avidities was found. Conclusions aCL avidities seem to have no relationship with aCL levels and high-avidity aCLs; the potentially deleterious effects might be present also in patients with low and extremely low aCL levels. Avidity of aCLs belongs to stable characteristics with insignificant changes in time.
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Ames PRJ, Merashli M, Tommaso B, Iannaccone L, Marottoli V, Ciampa A. Intensity of immune/clotting assays relate to multiple antiphospholipid antibody positivity in thrombotic primary antiphospholipid syndrome. Int J Hematol 2020; 113:183-189. [PMID: 33030632 DOI: 10.1007/s12185-020-03009-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/06/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
The dual positivity (DP) and triple positivity (TP) concepts bypass the poor comparability of immune/clotting assay for the laboratory classification of antiphospholipid syndrome (APS). To evaluate intensity of immune/clotting assays and DP/TP through different clinical severity groups (CSG) as follows: (1) non-thrombotic asymptomatic carriers of aPL (N-THR), thrombotic primary APS (THR), deceased (D) for recurrent and fatal thrombosis. Activated partial thromboplastin time ratio (aPTTr), dilute Russell viper venom time ratio (DRVVTr), IgG/IgM anticardiolipin (aCL) and anti β-2-glycoprotein-I (aβ2GPI). Participants: 33 N-THR, 64 THR and 11 D. The frequency of DP and TP (DRVVTr or aPTTr partnered with respective IgG aCL or aβ2GPI) increased across CSG (p = 0.006 and p = 0.003); mean DRVVTr and IgG aCL/aβ2GPI were always greater in TP versus non-TP within each CSG and progressively increased across the CSG. The intensity of individual lupus anticoagulants partnered with their corresponding IgG aPL related to the frequency of multiple positivity throughout CSG suggesting that of intensity of immune/clotting assays and multiple positivity are the different faces of the same diagnostic coin in our thrombotic PAPS cohort.
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Affiliation(s)
- Paul R J Ames
- Immune Response and Vascular Disease Unit, Cedoc, Nova Medical School/Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisbon, Portugal. .,Dumfries and Galloway Royal Infirmary, Dumfries, UK.
| | - Mira Merashli
- Department of Rheumatology, American University of Beirut, Beirut, Lebanon
| | - Bucci Tommaso
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy.,Department of Clinical, Internal, Anaesthesiologic and Cardiovascular Sciences, Atherothrombosis Centre, Prima Clinica Medica, Sapienza University of Rome, Rome, Italy
| | | | | | - Antonio Ciampa
- Haemostasis Unit, AORN "San Giuseppe Moscati", Avellino, Italy
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Comparison of the Therapeutic Effects of Rivaroxaban Versus Warfarin in Antiphospholipid Syndrome: A Systematic Review. Arch Rheumatol 2019; 35:107-116. [PMID: 32637926 DOI: 10.5606/archrheumatol.2020.7375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 05/13/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to review the studies evaluating the therapeutic effects of rivaroxaban versus those of warfarin in patients with antiphospholipid syndrome (APS). Materials and methods The study included randomized clinical trials, comparative studies, cross-sectional investigations, and case series that focused on the effects of warfarin and rivaroxaban and compared the effects of these anticoagulants in patients with APS. The relevant articles published until 2018 were searched in several databases, including PubMed, Scopus, ScienceDirect, Google Scholar, Embase, and Web of Science. Results The findings of the reviewed studies showed that rivaroxaban can be used as an effective and safe alternative to warfarin in APS patients. However, the effectiveness of rivaroxaban in the prevention of thrombosis in high-risk APS patients is suspected. Conclusion Given the high risk of using rivaroxaban in thrombotic APS patients with labile international normalized ratio (INR) or poor adherence to INR monitoring, it is not suggested to use this agent for these patients.
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High prevalence of inherited thrombophilia and antiphospholipid syndrome in myocardial infarction with non-obstructive coronary arteries: Comparison with cryptogenic stroke. Int J Cardiol 2019; 290:1-6. [PMID: 31133433 DOI: 10.1016/j.ijcard.2019.05.037] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/13/2019] [Accepted: 05/17/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND A role of thrombophilia in myocardial infarction with non-obstructive coronary arteries (MINOCA) is unclear. We investigated thrombophilic factors in MINOCA patients versus those following cryptogenic stroke (CS), a well-established indication for thrombophilia screening. METHODS In a prospective cross-sectional study, we assessed 84 consecutive patients (median age: 45.5 years) at least 3 months after MINOCA. Age-matched CS patients (n = 84) and published data on general population served as controls. Thrombophilia screening involved inherited thrombophilia (factor V Leiden, prothrombin G20210A mutation, deficiency of protein C, protein S or antithrombin), antiphospholipid syndrome (APS), along with factor VIII >150%, homocysteine ≥15 μM and lipoprotein (a) >30 mg/dl. RESULTS Compared to CS, MINOCA were more often males (60.7 vs 33.3%, P < 0.001), obese (34.5 vs 17.9%, P = 0.014), smokers (51.2 vs 35.7%, P = 0.043) and had family history of myocardial infarction (27.4 vs 6.0%, P < 0.001). Inherited thrombophilia occurred in 20 (23.8%) MINOCA patients and in 13 (15.5%) with CS (P = 0.17), without any difference in the parameters except for elevated lipoprotein (a) that was less common in MINOCA (21.4 vs 39.3%, P = 0.012). APS was found in 13 (15.5%) of MINOCA patients, mostly in a single-positive form. APS was diagnosed less frequently in STEMI (2.5 vs 27.3% for NSTEMI, P = 0.002) and MINOCA patients aged ≤50 years (5.7 vs 32.3% for older subjects, P = 0.003). CONCLUSIONS MINOCA patients exhibit high prevalence of thrombophilia including APS, similar to that in CS. Our first comprehensive thrombophilia testing in MINOCA supports its clinical relevance and the need for long-term anticoagulation for some abnormalities, especially APS.
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Alijotas-Reig J, Esteve-Valverde E, Ferrer-Oliveras R, LLurba E, Ruffatti A, Tincani A, Lefkou E, Bertero MT, Espinosa G, de Carolis S, Rovere-Querini P, Lundelin K, Picardo E, Mekinian A. Comparative study between obstetric antiphospholipid syndrome and obstetric morbidity related with antiphospholipid antibodies. Med Clin (Barc) 2017; 151:215-222. [PMID: 29274674 DOI: 10.1016/j.medcli.2017.11.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 11/07/2017] [Accepted: 11/09/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES To compare clinical, laboratory, treatment and live birth rate data between women with aPL-related obstetric complications (OMAPS) not fulfilling the Sydney criteria and women fulfilling them (OAPS). MATERIALS AND METHODS Retrospective and prospective multicentre study. Data comparison between groups from The European Registry on Antiphospholipid Syndrome included within the framework of the European Forum on Antiphospholipid Antibody projects. RESULTS 338 women were analysed: 247 fulfilled the Sydney criteria (OAPS group) and 91 did not (OMAPS group). In the OMAPS group, 24/91 (26.37%) fulfilled laboratory Sydney criteria (subgroup A) and 67/91 (74.63%) had a low titre and/or non-persistent aPL-positivity (subgroup B). Overall, aPL laboratory categories in OAPS vs. OMAPS showed significant differences: 34% vs. 11% (p<0.0001) for category I, 66% vs. 89% (p<0.0001) for category II. No differences were observed when current obstetric complications were compared (p=0.481). 86.20% of OAPS women were treated vs. 75.82% of OMAPS (p=0.0224), particularly regarding the LDA+LMWH schedule (p=0.006). No differences between groups were observed in live births, gestational, puerperal arterial and/or venous thrombosis. CONCLUSIONS Significant differences were found among aPL categories between groups. Treatment rates were higher in OAPS. Both OAPS and OMAPS groups had similarly good foetal-maternal outcomes when treated. The proposal to modify OAPS classification criteria, mostly laboratory requirements, is reinforced by these results.
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Affiliation(s)
- Jaume Alijotas-Reig
- Systemic Autoimmune Disease Unit, Department of Internal Medicine, Vall d'Hebron University Hospital, Department of Medicine, Universitat Autonoma, Barcelona, Spain.
| | - Enrique Esteve-Valverde
- Internal Medicine Department, Althaia Healthcare Network of Manresa, Rheumatology Unit, Barcelona, Spain
| | - Raquel Ferrer-Oliveras
- Obstetrics and Gynaecology Department, High Risk Unit, Vall d'Hebron University Hospital, Universitat Autonoma, Barcelona, Spain.
| | - Elisa LLurba
- Obstetrics and Gynaecology Department, High Risk Unit, University Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Amelia Ruffatti
- Rheumatology Unit, Department of Clinical and Experimental Medicine Azienda Ospedaliera, University of Padua, Padua, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Ospedale Civile, Brescia, Italy
| | - Elmina Lefkou
- Haematology Unit, Hippokration Hospital of Thessaloniki, Greece
| | - Mª Tiziana Bertero
- Department of Clinical Immunology, A.O. Mauriziano-Umberto I, Turin, Italy
| | - Gerard Espinosa
- Systemic Autoimmune Diseases Service, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Sara de Carolis
- Department of Gynaecology, Gemmeli Hospital, Catholic University, Roma, Italy
| | - Patrizia Rovere-Querini
- Scuola di Specializzazione in Allergologia e Immunolofia Clinica, U.O. Medicina ad indrizzo Immunlogico Clinico-Ospedale San Raffaele, Milano, Lab, Autoimminità e inflammazione vascolare - San Raffaele DIBIT, Milano, Italy
| | - Krista Lundelin
- Internal Medicine Department, Hospital Universitario La Paz, Universidad Autònoma, Madrid, Spain
| | - Elisa Picardo
- Department of Obstetrics and Gynaecology, University of Turin, Turin, Italy
| | - Arsene Mekinian
- AP-HP, Hôpital Saint-Antoine, service de médecine interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ Paris 06, F-75012, Paris, France
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Comarmond C, Jego P, Veyssier-Belot C, Marie I, Mekinian A, Elmaleh-Sachs A, Leroux G, Saadoun D, Oziol E, Fraisse T, Hyvernat H, Thiercein-Legrand MF, Sarrot-Reynauld F, Ferreira-Maldent N, de Menthon M, Goujard C, Khau D, Nguen Y, Monnier S, Michon A, Castel B, Decaux O, Piette JC, Cacoub P. Cessation of oral anticoagulants in antiphospholipid syndrome. Lupus 2017; 26:1291-1296. [DOI: 10.1177/0961203317699285] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objective To study the outcome of patients with antiphospholipid syndrome (APS) after oral anticoagulant treatment cessation. Methods We performed a retrospective study of patients with APS experiencing cessation of oral anticoagulant and enrolled in a French multicentre observational cohort between January 2014 and January 2016. The main outcome was the occurrence of recurrent thrombotic event after oral anticoagulation cessation. Results Forty four APS patients interrupted oral anticoagulation. The median age was 43 (27–56) years. The median duration of anticoagulation was 21 (9–118) months. Main causes of oral anticoagulant treatment cessation were switch from vitamin K antagonists to aspirin in 15 patients, prolonged disappearance of antiphospholipid antibodies in ten, bleeding complications in nine and a poor therapeutic adherence in six. Eleven (25%) patients developed a recurrent thrombotic event after oral anticoagulation cessation, including three catastrophic APS and one death due to lower limb ischemia. Antihypertensive treatment required at time of oral anticoagulants cessation seems to be an important factor associated with recurrent thrombosis after oral anticoagulant cessation (15.2% in patients with no relapse versus 45.5% in patients with recurrent thrombosis, p = 0.038). Oral anticoagulant treatment was re-started in 18 (40.9%) patients. Conclusion The risk of a new thrombotic event in APS patients who stopped their anticoagulation is high, even in those who showed a long lasting disappearance of antiphospholipid antibodies. Except for the presence of treated hypertension, this study did not find a particular clinical or biological phenotype for APS patients who relapsed after anticoagulation cessation. Any stopping of anticoagulant in such patients should be done with caution.
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Affiliation(s)
- C Comarmond
- Département de Médecine Interne et Immunologie Clinique, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Département Hospitalo-Unviversitaire I2B, UPMC Univ Paris 06, Paris, France
- INSERM UMR 7211, F-75005, Paris, France
- CNRS, UMR 7211, F-75005, Paris, France
| | - P Jego
- Service de Médecine Interne, CHU Rennes, France
| | | | - I Marie
- Service de Médecine Interne, CHU Rouen, France
| | - A Mekinian
- Service de Médecine Interne, CHU Saint-Antoine, Paris, France
| | - A Elmaleh-Sachs
- Département de Médecine Interne et Immunologie Clinique, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - G Leroux
- Département de Médecine Interne et Immunologie Clinique, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Département Hospitalo-Unviversitaire I2B, UPMC Univ Paris 06, Paris, France
| | - D Saadoun
- Département de Médecine Interne et Immunologie Clinique, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Département Hospitalo-Unviversitaire I2B, UPMC Univ Paris 06, Paris, France
- INSERM UMR 7211, F-75005, Paris, France
- CNRS, UMR 7211, F-75005, Paris, France
| | - E Oziol
- Service de Médecine Interne, CH Béziers, France
| | - T Fraisse
- Service de Médecine Interne, CH Ales, France
| | - H Hyvernat
- Service de Médecine Interne, CHU Nice, France
| | | | | | | | - M de Menthon
- Service de Médecine Interne, CHU Saint-Louis, Paris, France
| | - C Goujard
- Service de Médecine Interne et d'Immunologie Clinique, CHU Bicêtre, Le Kremlin-Bicêtre, France
| | - D Khau
- Service de Médecine Interne, CH Versailles, France
| | - Y Nguen
- Département de Médecine Interne et Immunologie Clinique, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - S Monnier
- Service de Médecine Interne, CH Versailles, France
| | - A Michon
- Service de Médecine Intern, CHU Georges Pompidou, Paris, France
| | - B Castel
- Département de Médecine Interne et Immunologie Clinique, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - O Decaux
- Service de Médecine Interne, CHU Rennes, France
| | - J-C Piette
- Département de Médecine Interne et Immunologie Clinique, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Département Hospitalo-Unviversitaire I2B, UPMC Univ Paris 06, Paris, France
| | - P Cacoub
- Département de Médecine Interne et Immunologie Clinique, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Département Hospitalo-Unviversitaire I2B, UPMC Univ Paris 06, Paris, France
- INSERM UMR 7211, F-75005, Paris, France
- CNRS, UMR 7211, F-75005, Paris, France
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Thaler MA, Bietenbeck A, Yin MX, Steigerwald U, Holmes AB, Lindhoff-Last E, Luppa PB. Evaluation of antiphospholipid antibody assays using latent class analysis to address the lack of a reference standard. Clin Chem Lab Med 2017; 54:1929-1937. [PMID: 27227709 DOI: 10.1515/cclm-2016-0116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/14/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Method evaluation of new assays for the detection of antiphospholipid antibodies (aPL) such as anti-cardiolipin (aCL) or anti-β2-glycoprotein I (aβ2-GPI) is challenging, as no internationally accepted reference material is available yet. Besides a lack of standardization, unacceptable inter-laboratory comparability of established tests is regularly observed. Owing to the absence of a commonly accepted reference standard, the evaluation of two research surface plasmon resonance (SPR) biosensor assays was performed using statistical methods from latent class analysis (LCA). METHODS aCL and aβ2-GPI IgG and IgM were measured in sera from 63 antiphospholipid syndrome patients, fulfilling the Sydney criteria, and in 34 healthy controls with four commercial assays. LCA was performed on the results and sera were assigned to the antibody-positive or antibody-negative group. Sera were subsequently evaluated in the SPR assays for aCL and aβ2-GPI. Optimal cutoffs and diagnostic performances of the research systems were established employing the LCA-derived gold standard. RESULTS With area under the curve results of 0.96 and 0.89 for the detection of aCL and aβ2-GPI, the research SPR assays discriminated well between antibody-positive and antibody-negative sera. Their sensitivities and specificities were comparable to the investigated commercial immunoassays. CONCLUSIONS SPR assays are a suitable tool for the detection of aCL and aβ2-GPI with diagnostic performances not different from currently available commercial tests. LCA enabled the calculation of sensitivities and specificities for aPL assays in absence of a reference standard.
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Ahluwalia J, Sreedharanunni S. The Laboratory Diagnosis of the Antiphospholipid Syndrome. Indian J Hematol Blood Transfus 2016; 33:8-14. [PMID: 28194050 DOI: 10.1007/s12288-016-0739-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/13/2016] [Indexed: 01/04/2023] Open
Abstract
The Antiphospholipid Syndrome (APS) is classified based on the presence of both clinical and laboratory criteria. Both sets of criteria are subject to much review and intense research as it is becoming increasingly clear that no single test is specific for defining this autoimmune disorder. A number of leading international bodies have released guidelines in an attempt to improve the laboratory testing and reporting. The current review is an appraisal of some of the literature pertaining to the laboratory testing.
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Affiliation(s)
- Jasmina Ahluwalia
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sreejesh Sreedharanunni
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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11
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De Craemer AS, Musial J, Devreese KMJ. Role of anti-domain 1-β2 glycoprotein I antibodies in the diagnosis and risk stratification of antiphospholipid syndrome. J Thromb Haemost 2016; 14:1779-87. [PMID: 27314634 DOI: 10.1111/jth.13389] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 05/12/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED Essentials Antibodies to domain 1 of β2 glycoprotein I (aD1) are a subset of antiphospholipid antibodies. We evaluated the added diagnostic value of an automated aD1 assay in antiphospholipid syndrome. AD1 IgG correctly classifies patients at risk for thrombosis. Agreement between aD1 and aβ2GPI IgG is high, limiting the added value of aD1 in our setting. Click to hear Professor de Groot's perspective on new mechanistic understanding in antiphospholipid syndrome SUMMARY Background Laboratory diagnosis of antiphospholipid syndrome (APS) includes lupus anticoagulant (LAC), anticardiolipin (aCL) or anti-β2 glycoprotein I (aβ2 GPI) antibodies. Antibodies targeting domain 1 of β2 GPI (aD1) constitute a pathogenic subset of autoantibodies. Objectives In this cohort study, we determined the clinical performance characteristics, additional diagnostic value and the contribution to APS risk stratification of an automated aD1 assay. Patients/Methods LAC, aCL, aβ2 GPI and aD1 IgG were measured in 101 APS patients, 123 patients with autoimmune disorders, 82 diseased controls and 120 healthy controls. aD1 antibodies were detected by QUANTA Flash(®) Beta2GPI-Domain 1 chemiluminescence immunoassay. Results With a cut-off value of 20.0 CU, the aD1 IgG assay identifies APS patients in a clinically affected patient cohort with a sensitivity of 53.5% and specificity of 98.8%. It implied a high odds ratio (OR) for clinical events (OR, 17.0; 95% confidence interval [CI], 7.1-40.5). aD1 IgG did not add diagnostic value to the formal aPL panel because aβ2 GPI IgG was nearly as specific but more sensitive for APS (sensitivity 56.4%) with a higher OR for clinical events (36.2; 95% CI, 11.1-117.9). High aD1 titers identify triple-positive patients and patients with thrombosis in a β2 GPI-dependent LAC-positive population. Agreement between aD1 IgG and aβ2 GPI IgG was high (positive and negative agreement 91.7% and 98.4%, respectively). Conclusion Detection of aD1 IgG correctly classifies patients at risk of thrombosis. However, the contribution of aD1 IgG to APS diagnosis and risk stratification depends upon the solid phase assays used for aCL and aβ2 GPI detection.
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Affiliation(s)
- A-S De Craemer
- Coagulation Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University Hospital, Ghent, Belgium
| | - J Musial
- Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - K M J Devreese
- Coagulation Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University Hospital, Ghent, Belgium.
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12
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Bećarević M. The IgG and IgM isotypes of anti-annexin A5 antibodies: relevance for primary antiphospholipid syndrome. J Thromb Thrombolysis 2016; 42:552-7. [DOI: 10.1007/s11239-016-1389-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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13
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Islam MA, Alam F, Sasongko TH, Husin A, Abdullah S, Gan SH, Wong KK. Antiplatelet and anticoagulant agents for preventing recurrence of peripheral vascular thrombosis in patients with Antiphospholipid syndrome. Hippokratia 2016. [DOI: 10.1002/14651858.cd012198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Md. Asiful Islam
- Universiti Sains Malaysia; Human Genome Centre, School of Medical Sciences, Health Campus; Jalan Raja Perempuan Zainab II, Kubang Kerian Kota Bharu Kelantan Malaysia 16150
| | - Fahmida Alam
- Universiti Sains Malaysia; Human Genome Centre, School of Medical Sciences, Health Campus; Jalan Raja Perempuan Zainab II, Kubang Kerian Kota Bharu Kelantan Malaysia 16150
| | - Teguh H Sasongko
- Universiti Sains Malaysia; Human Genome Centre, School of Medical Sciences, Health Campus; Jalan Raja Perempuan Zainab II, Kubang Kerian Kota Bharu Kelantan Malaysia 16150
| | - Azlan Husin
- Universiti Sains Malaysia; Department of Internal Medicine, School of Medical Sciences, Health Campus; Jalan Raja Perempuan Zainab II, Kubang Kerian Kota Bharu Malaysia
| | - Sarimah Abdullah
- Universiti Sains Malaysia; Unit of Biostatistics and Research Methodology; Jalan Raja Perempuan Zainab II, Kubang Kerian Kota Bharu Kelantan Malaysia 16150
| | - Siew Hua Gan
- Universiti Sains Malaysia; Human Genome Centre, School of Medical Sciences, Health Campus; Jalan Raja Perempuan Zainab II, Kubang Kerian Kota Bharu Kelantan Malaysia 16150
| | - Kah Keng Wong
- Universiti Sains Malaysia; Department of Immunology, School of Medical Sciences, Health Campus; 16150 Kubang Kerian Kota Bharu Malaysia
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14
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Bećarević M, Stojanović L, Ignjatović S, Dopsaj V. The IgM isotype of anti-annexin A5 antibodies and multiple positivity of conventional antiphospholipid antibodies: increasing the number of clinical manifestations of primary antiphospholipid syndrome. Clin Rheumatol 2016; 35:1361-5. [PMID: 26971791 DOI: 10.1007/s10067-016-3230-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/24/2016] [Accepted: 03/03/2016] [Indexed: 11/26/2022]
Abstract
We evaluated the importance of anti-annexin A5 antibodies (aanxA5 Abs) for clinical (thrombosis and/or recurrent pregnancy loss) and serologic (presence of antiphospholipid antibodies: lupus anticoagulant (LA), anticardiolipin (aCL), and anti-β2 glycoprotein I (aβ2GPI) antibodies) features of patients with primary antiphospholipid syndrome (PAPS). Our study included 70 patients with PAPS according to the international consensus criteria for APS. The mean age of the analyzed patients was 45.97 ± 12.72. The disease duration above 5 years was present in 31/70 of patients. Concentrations of analyzed antibodies were measured by ELISA. Cutoff values were set in accordance to the manufacturers' recommendations. History of recurrent pregnancy loss was associated with double positivity for aanxA5 IgM and LA (χ (2) = 4.000, P = 0.046) and triple positivity for aanxA5 IgM + LA + aβ2GPI IgM (χ (2) = 4.168, P = 0.041). Venous thromboses were associated with triple positivity for aanxA5 IgM + aCLIgG + aβ2GPI IgM (χ (2) = 3.965, P = 0.046). The IgG isotype of aanxA5 Abs was in positive correlation with aCL Abs of the IgG (r = 0.310, P = 0.009) and IgM (r = 0.254, P = 0.034) isotype. The presence of the clinical manifestations of PAPS is increasing with the number of positive conventional aPL and the IgM aanxA5 Abs tests. This new combination of Abs is beneficial even when the number of patients with positivity for aanxA5 Abs is low. This is important in further detection of patients prone to recurrence of thrombotic episodes.
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Affiliation(s)
- Mirjana Bećarević
- Department of Pharmacy, Medical Faculty, University of Novi Sad, Serbia Hajduk Veljkova 3, 21000, Novi Sad, Serbia.
- Institute for Medical Biochemistry, Clinical Center of Serbia, Višegradska 26, 11000, Belgrade, Serbia.
| | - Ljudmila Stojanović
- University Medical Center "Bežanijska Kosa," University of Belgrade, Belgrade, Serbia
| | - Svetlana Ignjatović
- Institute for Medical Biochemistry, Clinical Center of Serbia, Višegradska 26, 11000, Belgrade, Serbia
- Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Violeta Dopsaj
- Institute for Medical Biochemistry, Clinical Center of Serbia, Višegradska 26, 11000, Belgrade, Serbia
- Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
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15
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Bazzan M, Vaccarino A, Stella S, Sciascia S, Montaruli B, Bertero MT, Carignola R, Roccatello D. Patients with antiphosholipid syndrome and thrombotic recurrences: A real world observation (the Piedmont cohort study). Lupus 2015; 25:479-85. [PMID: 26657216 DOI: 10.1177/0961203315617538] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 10/23/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND Patients with antiphospholipid syndrome (APS) often have thrombotic recurrences, sometimes despite appropriate ongoing anticoagulant treatment. Identifying APS vascular patients at high risk for thrombotic recurrences is still an unsolved issue. OBJECTIVES To report the real-life experience of thrombotic recurrences in APS patients included in the Piedmont observational cohort study, and evaluate clinical and laboratory risk factors for thrombotic recurrences. PATIENTS A multi-centre observational study was performed by enrolling 177 patients with vascular APS (primary APS in 99 subjects (56%)); the median follow-up was five years (range 1-26 years). RESULTS The observed thrombotic recurrence rate was about 7.5/100 patient years in the first five years after the first thrombotic event. While the first recurrence often occurred (45%) in patients who were not on oral anticoagulant therapy (OAT), the second recurrence mainly occurred despite ongoing OAT (80%). However, due to the real-life observational nature of this study, treatment was based on the treating physician's judgement, and no structured therapeutic protocol was applied. Moreover, compliance with OAT was not available. No differences in antiphospholipid antibodies (aPL) profile were observed between patients with or without thrombotic recurrences, but a high risk aPL profile (Miyakis type 1 and 2a) was present in 96% of our patients, 26% of whom had triple positivity. Diabetes (p < 0.01, OR 10), inherited thrombophilia (p < 0.0078, OR 4) and OAT withdrawal were independent risk factors for recurrences. CONCLUSIONS With the limit of a real-life observational cohort study, the thrombotic recurrence rate in APS was as high as 7.5/100 patient years in the first five years after the first thrombotic event. OAT discontinuation, diabetes and inherited thrombophilia, when associated with a high-risk aPL profile, are risk factors for thrombotic recurrences.
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Affiliation(s)
- M Bazzan
- Haematology and Thrombosis Unit, San Giovanni Bosco Hospital, Torino, Italy
| | - A Vaccarino
- Haematology and Thrombosis Unit, San Giovanni Bosco Hospital, Torino, Italy
| | - S Stella
- Immunohematology and Transfusion Medicine, San Giovanni Bosco Hospital, Torino, Italy
| | - S Sciascia
- Immunopathology and Rare Diseases Unit, University of Turin; San Giovanni Bosco Hospital, Torino, Italy
| | - B Montaruli
- Haemostasis Laboratory, Umberto I Hospital, Torino, Italy
| | - M T Bertero
- Clinical Immunology, Umberto I Hospital, Torino, Italy
| | - R Carignola
- Internal Medicine, San Luigi Gonzaga Hospital, Torino, Italy
| | - D Roccatello
- Immunopathology and Rare Diseases Unit, University of Turin; San Giovanni Bosco Hospital, Torino, Italy
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16
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Averina M, Johannesen S, Brox J. Diagnostic accuracy of silica clotting time method for lupus anticoagulant in a clinical population with various symptoms of antiphospholipid syndrome. Lupus 2015; 25:418-22. [DOI: 10.1177/0961203315617540] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/14/2015] [Indexed: 12/28/2022]
Abstract
Introduction: Correct interpretation of lupus anticoagulant (LA) tests is crucial for diagnosis of antiphospholipid syndrome (APS). This study assessed diagnostic accuracy of the SCT method in a clinical population with various symptoms of APS. Material and methods: Altogether 60 APS patients were consecutively recruited from a relevant clinical population. All cases had stable positivity of at least one of the reference tests (two other LA methods; anticardiolipin- and anti-β2-glycoprotein-I antibodies). Controls ( n = 62) with negative reference tests were also consecutively recruited from the same clinical population. Results and conclusions: Receiver operator characteristic (ROC) analysis for the SCT test to identify the APS cases showed area under the curve of 0.82 (95% CI 0.75–0.90). The positive cut-off defined by a non-parametric method (99 percentile in a healthy population) had specificity of 92%, but low sensitivity of 53%. The optimal cut-off corresponded to the 97.5 percentile (67% sensitivity and 92% specificity). Combined sensitivity of the positive diluted Russell Viper Venom time (dRVVT) and SCT tests was 73%, while specificity remained 92%. The sensitivity of the SCT method varied in different clinical subgroups and was highest in patients with rheumatic diseases and in patients with triple positivity of three reference methods.
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Affiliation(s)
- M Averina
- Department of Laboratory medicine, University Hospital of North Norway, Tromsø, Norway
- Department of Medical Biology, UiT – the Arctic University of Norway, Tromsø, Norway
| | - S Johannesen
- Department of Laboratory medicine, University Hospital of North Norway, Tromsø, Norway
| | - J Brox
- Department of Laboratory medicine, University Hospital of North Norway, Tromsø, Norway
- Department of Medical Biology, UiT – the Arctic University of Norway, Tromsø, Norway
- K.G. Jebsen – Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
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17
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González-Moreno J, Callejas-Rubio JL, Ríos-Fernández R, Ortego-Centeno N. Antiphospholipid syndrome, antiphospholipid antibodies and solid organ transplantation. Lupus 2015; 24:1356-63. [DOI: 10.1177/0961203315595129] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 06/17/2015] [Indexed: 11/16/2022]
Abstract
Antiphospholipid syndrome is considered a high risk factor for any kind of surgery. Considering that all solid organ transplants are critically dependent on the patency of vascular anastomosis, there is much concern about the consequences this pro-thrombotic condition may have on transplantation. Relatively little information is available in the literature assessing the real risk that antiphospholipid syndrome or the presence of antiphospholipid antibodies represent in solid organ transplantation. The aim of this article is to review the literature related to transplantation of solid organs in patients diagnosed with antiphospholipid syndrome or patients with positive antiphospholipid antibodies.
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Affiliation(s)
- J González-Moreno
- Internal Medicine Department, Hospital Son Llàtzer, Palma de Mallorca, Illes Balears, Spain
| | - J L Callejas-Rubio
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Granada, Spain
| | - R Ríos-Fernández
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Granada, Spain
| | - N Ortego-Centeno
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Granada, Spain
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18
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Alijotas-Reig J, Ferrer-Oliveras R, Ruffatti A, Tincani A, Lefkou E, Bertero MT, Coloma-Bazan E, de Carolis S, Espinosa G, Rovere-Querini P, Kuzenko A, Valverde EE, Robles A, Cervera R, Canti V, Fredi M, Gil-Aguado A, Lundelin K, Llurba E, Melnychuk T, Nalli C, Picardo E, Silvestro E, del Ross T, Farran-Codina I. The European Registry on Obstetric Antiphospholipid Syndrome (EUROAPS): A survey of 247 consecutive cases. Autoimmun Rev 2014; 14:387-95. [PMID: 25555817 DOI: 10.1016/j.autrev.2014.12.010] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 12/23/2014] [Indexed: 11/29/2022]
Abstract
AIM To analyse the clinical features, laboratory data, foetal-maternal outcomes, and follow-up in a cohort of 247 women with obstetric antiphospholipid syndrome (OAPS). METHODS The European Registry on APS became a Registry within the framework of the European Forum on Antiphospholipid Antibody projects and placed on a website in June 2010. Cases with obstetric complaints related to aPL who tested positive for aPL prospectively and retrospectively were included. The three-year survey results are reported. RESULTS 338 women with 1253 pregnancy episodes were included; 915 were historical and 338 were latest episodes. All these women tested positive for aPL. 247 of the 338 fulfilled the Sydney criteria. According to the laboratory categories, 84/247 were in category I, 42 in IIa, 66 in IIb and 55 in IIc. Obstetric complications other than foetal losses, appeared in 129 cases (52.2%). 192 (77.7%) had a live birth and 55 (22.3%) did not. The latter group of only 38 cases (69%) received adequate treatment and 17 (31%) did not. 177/247 (72%) women were put on heparin plus LDA. Thrombosis appeared in two during pregnancy and in 14 during the puerperium. 7 (3%) women evolved to complete SLE. CONCLUSIONS OAPS shows differential characteristics than classical APS. All laboratory test categories are needed to avoid false-negative diagnoses. In some cases, complement levels could act as a serological marker. OAPS has very good foetal-maternal outcomes when treated. Thrombosis and progression to SLE in mothers with OAPS are scarce compared with "classical APS", suggesting that they have different aPL-mediated pathogenic mechanisms.
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Affiliation(s)
- Jaume Alijotas-Reig
- Systemic Autoimmune Disease Unit, Department of Internal Medicine, Vall d'Hebron University Hospital; Department of Medicine, Universitat Autonòma, Barcelona, Spain.
| | - Raquel Ferrer-Oliveras
- Obstetric and Gynaecolgy Department, Vall d'Hebron University Hospital, Universitat Autonòma, Barcelona, Spain
| | - Amelia Ruffatti
- Rheumatology Unit, Department of Clinical and Experimental Medicine Azienda Ospedaliera, University of Padua, Padua, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Ospedale Civile, Brescia, Italy
| | - Elmina Lefkou
- Haematoly Unit, Hippokrateion Hospital of Thessaloniki, Greece
| | - Ma Tiziana Bertero
- Department of Clinical Immunology, A.O. Mauriziano-Umberto I, Turin, Italy
| | - Emmanuel Coloma-Bazan
- Systemic Autoimmune Diseases Service, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Sara de Carolis
- Department of Gynaecology, Gemmeli Hospital, Catholic University, Roma, Italy
| | - Gerard Espinosa
- Systemic Autoimmune Diseases Service, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | | | - Anna Kuzenko
- Department of Clinical Immunology, A.O. Mauriziano-Umberto I, Turin, Italy
| | - Enrique E Valverde
- Internal Medicine Department, Althaia Healthcare Network of Manresa, Barcelona, Spain
| | - Angel Robles
- Internal Medicine Department, Hospital Universitario La Paz, Universidad Autònoma, Madrid, Spain
| | - Ricard Cervera
- Systemic Autoimmune Diseases Service, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Valentina Canti
- Department of Clinical Immunology, A.O. Mauriziano-Umberto I, Turin, Italy
| | - Micaela Fredi
- Rheumatology and Clinical Immunology Unit, Ospedale Civile, Brescia, Italy
| | - Antonio Gil-Aguado
- Internal Medicine Department, Hospital Universitario La Paz, Universidad Autònoma, Madrid, Spain
| | - Krista Lundelin
- Current workplace: Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Elisa Llurba
- Obstetric and Gynaecolgy Department, Vall d'Hebron University Hospital, Universitat Autonòma, Barcelona, Spain
| | - Taisiya Melnychuk
- Obstetric and Gynaecolgy Department, Vall d'Hebron University Hospital, Universitat Autonòma, Barcelona, Spain
| | - Cecilia Nalli
- Rheumatology and Clinical Immunology Unit, Ospedale Civile, Brescia, Italy
| | - Elisa Picardo
- Department of Obstetrics and Gynaecology, University of Turin, Turin, Italy
| | - Erika Silvestro
- Department of Clinical Immunology, A.O. Mauriziano-Umberto I, Turin, Italy
| | - Teresa del Ross
- Rheumatology Unit, Department of Clinical and Experimental Medicine Azienda Ospedaliera, University of Padua, Padua, Italy
| | - Inmaculada Farran-Codina
- Obstetric and Gynaecolgy Department, Vall d'Hebron University Hospital, Universitat Autonòma, Barcelona, Spain
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