Journal
LUPUS
Volume 26, Issue 6, Pages 606-615Publisher
SAGE PUBLICATIONS LTD
DOI: 10.1177/0961203316671812
Keywords
Anticardiolipin antibodies; antiphospholipid syndrome; classification; pregnancy morbidity; thrombosis
Categories
Funding
- NIH-NIAMS from the National Institute on Minority Health and Health Disparities [AR43727]
- National Institute on Minority Health and Health Disparities [2U54MD007587]
- NIH [R01 AR056745-01A1]
- Mallinckrodt-Questcor Fellowship Grant
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Background While essential for the classification of antiphospholipid syndrome (APS), anticardiolipin (aCL) assays lack specificity and anti-2glycoproteinI (anti-2GPI) assays lack sensitivity in this regard. Our aim was to perform a comparative analysis of the APhL ELISA assay (IgG/IgM) and criteria antiphospholipid (aPL) immunoassays in identifying APS-related clinical manifestations in a large group of patients with systemic lupus erythematosus (SLE). Methods Serum samples from 1178 patients from the Hopkins (n=543), LUMINA (n=588) and Jamaican SLE cohorts (n=47) were examined for IgG/IgM positivity in aCL (in-house), anti-2GPI (two commercial kits) and APhL (Louisville APL) ELISA assays. Correlation of assay positivity with clinical manifestations and sensitivity, specificity, positive and negative predictive values and likelihood ratios were evaluated. A case series analysis was also performed in patients for whom there was isolated positivity in the specific aPL assays. Results The prevalence of aCL positivity was 34.9%, anti-2GPI kit A was 22.6%, APhL was 11.5% and anti-2GPI kit B was 7.6% in the study population. Anti-2GPI kit B, aCL and APhL assays were correlated with venous thrombosis, while only APhL was significantly correlated with arterial thrombosis and consistently correlated with pregnancy-related morbidity. No significant correlations were noted for anti-2GPI kit A. Sensitivity was greatest for aCL assays followed by anti-2GPI kit A, APhL and anti-2GPI kit B, while specificity was greatest and equal for anti-2GPI kit B and APhL assays. Conclusions Overall, APhL antibodies, especially IgG, represent a promising biomarker for the classification of APS patients in the context of autoimmunity and in risk assessment with regards to pregnancy morbidity and thrombotic manifestations.
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