Walid Chayoua1,2, Hilde Kelchtermans1,2, Jean-Christophe Gris3,4, Gary W Moore5, Jacek Musiał6, Denis Wahl7, Philip G de Groot2, Bas de Laat1,2, Katrien M J Devreese8. 1. Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, the Netherlands. 2. Synapse Research Institute, Maastricht, the Netherlands. 3. Centre Hospitalier Universitaire de Nîmes et Université de Montpellier, Montpellier, France. 4. Ivan Sechenov First Moscow State Medical University, Moscow, Russia. 5. Department of Haemostasis & Thrombosis, Guy's & St. Thomas' Hospitals, London, UK. 6. Jagiellonian University Medical College, Krakow, Poland. 7. DCAC, Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, Inserm, Centre Hospitalier Regional Universitaire de Nancy, Université de Lorraine, Nancy, France. 8. Department of Diagnostic Sciences, Coagulation Laboratory, Ghent University Hospital, Ghent, Belgium.
Abstract
BACKGROUND: The antiphospholipid syndrome (APS) is characterized by thrombosis and/or pregnancy morbidity with the persistent presence of lupus anticoagulant (LAC), anti-cardiolipin (aCL) and/or anti-β2glycoprotein I (aβ2GPI) antibodies of the immunoglobulin G/immunoglobulin M (IgG/IgM) isotype. However, the role of aCL and aβ2GPI IgM as a serologic marker in APS is debated. OBJECTIVES: We aimed to assess the diagnostic and clinical value of IgM antiphospholipid antibodies (aPL) in APS within the classification criteria. PATIENTS/ METHODS: Our multicenter study comprised 1008 patients, including APS patients and controls. Anti-CL and aβ2GPI IgG and IgM antibodies were detected with four commercially available solid phase assays. RESULTS: Positivity for aCL and/or aβ2GPI antibodies was significantly correlated with thrombosis and pregnancy morbidity, independent of the isotype and solid phase assay. Higher odds ratios were obtained for IgG compared to IgM positivity. Isolated IgM was rare in thrombotic APS, but more frequent in obstetric APS, ranging from 3.5% to 5.4% and 5.7% to 12.3%, respectively, dependent on the solid phase assay. In a multivariate logistic regression analysis of aPL, IgM positivity was found to be associated with pregnancy morbidity. However, detection of IgM was not independently associated with thrombosis. Combined positivity for LAC, IgG, and IgM was highly associated with thrombosis and pregnancy morbidity. CONCLUSIONS: Our data support testing for aCL and aβ2GPI IgM in women suspected of obstetric APS. However, no added value was found for testing IgM in patients suspected of thrombotic APS. Still, IgM aPL might be useful as a second-line test to improve thrombotic risk stratification.
BACKGROUND: The antiphospholipid syndrome (APS) is characterized by thrombosis and/or pregnancy morbidity with the persistent presence of lupus anticoagulant (LAC), anti-cardiolipin (aCL) and/or anti-β2glycoprotein I (aβ2GPI) antibodies of the immunoglobulin G/immunoglobulin M (IgG/IgM) isotype. However, the role of aCL and aβ2GPI IgM as a serologic marker in APS is debated. OBJECTIVES: We aimed to assess the diagnostic and clinical value of IgM antiphospholipid antibodies (aPL) in APS within the classification criteria. PATIENTS/ METHODS: Our multicenter study comprised 1008 patients, including APS patients and controls. Anti-CL and aβ2GPI IgG and IgM antibodies were detected with four commercially available solid phase assays. RESULTS: Positivity for aCL and/or aβ2GPI antibodies was significantly correlated with thrombosis and pregnancy morbidity, independent of the isotype and solid phase assay. Higher odds ratios were obtained for IgG compared to IgM positivity. Isolated IgM was rare in thrombotic APS, but more frequent in obstetric APS, ranging from 3.5% to 5.4% and 5.7% to 12.3%, respectively, dependent on the solid phase assay. In a multivariate logistic regression analysis of aPL, IgM positivity was found to be associated with pregnancy morbidity. However, detection of IgM was not independently associated with thrombosis. Combined positivity for LAC, IgG, and IgM was highly associated with thrombosis and pregnancy morbidity. CONCLUSIONS: Our data support testing for aCL and aβ2GPI IgM in women suspected of obstetric APS. However, no added value was found for testing IgM in patients suspected of thrombotic APS. Still, IgM aPL might be useful as a second-line test to improve thrombotic risk stratification.
Authors: Medha Barbhaiya; Stephane Zuily; Yasaman Ahmadzadeh; Mary-Carmen Amigo; Tadej Avcin; Maria Laura Bertolaccini; D Ware Branch; Guilherme de Jesus; Katrien M J Devreese; Camille Frances; David Garcia; Francis Guillemin; Steven R Levine; Roger A Levy; Michael D Lockshin; Thomas L Ortel; Surya V Seshan; Maria Tektonidou; Denis Wahl; Rohan Willis; Ray Naden; Karen Costenbader; Doruk Erkan Journal: Arthritis Care Res (Hoboken) Date: 2021-09-02 Impact factor: 5.178
Authors: Pavla Bradacova; Ludek Slavik; Jana Ulehlova; Adela Skoumalova; Jana Ullrychova; Jana Prochazkova; Antonin Hlusi; Gayane Manukyan; Eva Kriegova Journal: Biomedicines Date: 2021-02-08
Authors: Eva K Kempers; Virgil A S H Dalm; Marie Josee E van Rijn; Annemarie G M G J Mulders; Frank W G Leebeek; Moniek P M de Maat; A J Gerard Jansen Journal: Rheumatol Adv Pract Date: 2021-11-27