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Romanian Journal of Internal Medicine

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Extended Antiphospholipid Antibodies Screening in Systemic Lupus Erythematosus Patients

Alina Dima
  • Corresponding author
  • “Carol Davila” University of Medicine and Pharmacy, Bucharest
  • “Colentina” Research Center, Colentina Clinical Hospital, Bucharest
  • Email:
/ Simona Caraiola
  • “Carol Davila” University of Medicine and Pharmacy, Bucharest
  • “Colentina” Research Center, Colentina Clinical Hospital, Bucharest
/ C. Jurcut
  • “Dr. Carol Davila” Central University Emergency Military Hospital, Bucharest
/ Eugenia Balanescu
  • “Colentina” Research Center, Colentina Clinical Hospital, Bucharest
/ P. Balanescu
  • “Carol Davila” University of Medicine and Pharmacy, Bucharest
  • “Colentina” Research Center, Colentina Clinical Hospital, Bucharest
/ Doina Ramba
  • “Carol Davila” University of Medicine and Pharmacy, Bucharest
  • “Colentina” Research Center, Colentina Clinical Hospital, Bucharest
/ Camelia Badea
  • “Carol Davila” University of Medicine and Pharmacy, Bucharest
  • “Colentina” Research Center, Colentina Clinical Hospital, Bucharest
/ V. Pompilian
  • “Carol Davila” University of Medicine and Pharmacy, Bucharest
  • “Colentina” Research Center, Colentina Clinical Hospital, Bucharest
/ R. Ionescu
  • “Carol Davila” University of Medicine and Pharmacy, Bucharest
  • “Colentina” Research Center, Colentina Clinical Hospital, Bucharest
/ Anda Baicus
  • “Carol Davila” University of Medicine and Pharmacy, Bucharest
  • “Cantacuzino” National Institute of Research and Development in Microbiology-Immunology, Bucharest, Romania
/ C. Baicus
  • “Carol Davila” University of Medicine and Pharmacy, Bucharest
  • “Colentina” Research Center, Colentina Clinical Hospital, Bucharest
/ G. A. Dan
  • “Carol Davila” University of Medicine and Pharmacy, Bucharest
  • “Colentina” Research Center, Colentina Clinical Hospital, Bucharest
Published Online: 2015-12-10 | DOI: https://doi.org/10.1515/rjim-2015-0041

Abstract

Background. The antiphospholipid syndrome (APS) is one of the most encountered autoimmunity in systemic lupus erythematosus (SLE) patients and pathogenesis of these two seems to be intricate.

Aim. To investigate the association of antiphospholipid antibodies (APLAs) titer with the presence of secondary APS diagnosis in SLE patients.

Methods. 65 patients fulfilling the 2012 Systemic Lupus Collaborating International Clinics (SLICC) SLE’s criteria were included. The APS diagnosis was sustained according to the 2006 Sydney APS’s criteria. Three groups of patients were defined: SLE patients with secondary APS, SLE with history of positive “criteria” APLAs but without APS clinical features, respectively SLE patients without positive APLAs or clinical APS criteria. An extended APLAs panel was searched in all cases: both IgM and IgG of anticardiolipin antibodies (aCL), anti-β2 glycoprotein I antibodies (aβ2GPI), antiphosphatidylethanolamine antibodies (aPE), antiphosphatidylserine antibodies (aPS), respectively antiprothrombin antibodies (aPT).

Results. Only the aβ2GPI, both IgM and IgG serotypes, had significantly higher titers in patients with SLE and secondary APS compared to no APS (with/without positive APLAs): median (min; max) 7.0 (0.0-300.0) vs. 1.0 (0.0-28.0) vs. 1.0 (0.0-12.0), respectively 3.0 (0.0-79.0) vs. 1.0 (0.0-3.0) vs. 1.0 (0.0-12.0) (p<0.001, Kruskal-Wallis test)]. Also, in regression logistic models, only the aβ2 GPI (IgG and IgM) were identified as risk factors for secondary APS diagnosis in the SLE patients: OR(95%CI) 5.9 (2.2-15.7), respectively 1.3 (1.1-1.5). In regard with the SLE markers, the IgG serotypes of the “non-criteria” APLAs analyzed (aPS, aPT, aPE) were correlated with the antiDNA titers while the IgM serotypes inversely associated with the complement C3 levels.

Conclusions. IgG aβ2 GPI are accompanied by almost 6-fold increase risk of secondary APS when screening SLE patients. On the contrary, the “non-criteria” APLAs do not seem associated with the APS diagnosis in SLE patients. Some correlates of the “non-criteria” APLAs with the antiDNA and complement C3 levels were also observed.

Introducere. Sindromul antifosfolipidic (SAFL) este unul dintre cele mai frecvente fenomene autoimune asociate lupusului eritematos sistemic (LES), iar patogeneza celor două entităţi pare a fi intricată.

Obiective. Investigarea asocierii dintre titrul anticorpilor antifosfolipidici (AAFL) şi prezenţa SAFL secundar în cadrul LES.

Material şi metode. Au fost incluşi în studiu 65 pacienţi ce au îndeplinit criteriile SLICC din 2012. Diagnosticul SAFL a fost susţinut conform criteriilor Sydney din 2006. Au fost definite trei grupuri: pacienţi cu LES şi SAFL secundar, pacienţi cu LES şi AAFL pozitivi însă fără manifestări clinice specifice SAFL şi pacienţi cu LES fără AAFL pozitivi sau manifestări clinice ale SAFL. Pacienţilor le-a fost analizat un panel extins de AAFL: anticorpi tip IgM şi IgG anti-cardiolipidici (aCL), anti-β2 glicoproteină I (aβ2GPI), anti fosfatidiletanolamină (aPE), antifosfatidilserină (aPS) şi antiprotrombină (aPT).

Rezultate. Numai anticorpii aβ2GPI (atât IgM cât şi IgG) au avut niveluri semnificativ mai mari la pacienţii cu SAFL secundar comparativ cu celelalte două grupuri [mediană (min; max) IgM: 7.0 (0.0-300.0) vs. 1.0 (0.0-28.0) vs. 1.0 (0.0-12.0), IgG: 3.0 (0.0-79.0) vs. 1.0 (0.0-3.0) vs. 1.0 (0.0-12.0) (p<0.001, test Kruskal-Wallis)]. În cadrul analizei regresiei logistice numai anticorpii aβ2GPI (IgM şi IgG) au fost identificaţi ca factor de risc pentru diagnosticul SAFL secundar la pacienţii cu LES [OR(95%CI) 5.9 (2.2-15.7) pentru IgM, respectiv 1.3 (1.1-1.5) pentru IgG]. Titrurile anticorpilor aPS, aPT şi aPE IgG s-au corelat pozitiv cu cel al anticorpilor anti DNAdc pe când concentraţia anticorpilor aPS, aPT şi aPE IgM a fost invers corelată cu nivelurile C3 ale complementului.

Concluzii. Anticorpii tip IgG aβ2GPI au crescut riscul de aproximativ 6 ori pentru dezvoltarea SAFL secundar. AAFL ce nu sunt incluşi în criteriile de diagnostic nu par să fie asociaţi cu diagnosticul SAFL secundar la pacienţii cu LES. Aceştia sunt însă corelaţi cu titrul anticorpilor anti DNAdc şi cu nivelurile serice ale componentei C3 a complementului seric.

Keywords: Anti-β2 glycoprotein I antibodies; antiphosphatidylethanolamine; antiprothrombine; antiphosphatidylserine; systemic lupus erythematosus; antiphospholipid syndrome

ABBREVIATIONS

Abs

– antibodies

APLAs

– antiphospholipid antibodies

APS

– antiphospholipid syndrome

aPL

– antiphospholipid

aCL

– anticardiolipin

aβ2GPI

– anti-β2 glycoprotein I

aPE

– antiphosphatidylethanolamine

aPS

– antiphosphatidylserine

aPS/PT

– anti-prothrombin in complex with phosphatidylserine

aPT

– antiprothrombin

APS

– antiphospholipid syndrome

CRP

– C-reactive protein

DVT

– deep vein thrombosis

ESR

– erythrocyte sedimentation rate

LAC

– lupus anticoagulant

SLE

– systemic lupus erythematosus

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About the article

Received: 2015-07-18

Published Online: 2015-12-10

Published in Print: 2015-12-01



Citation Information: Romanian Journal Of Internal Medicine, ISSN (Online) 1220-4749, DOI: https://doi.org/10.1515/rjim-2015-0041. Export Citation

© 2015 Alina Dima et al., published by De Gruyter Open. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License. (CC BY-NC-ND 3.0)

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