The Prevalence of Anticardiolipin Antibody in Patients with Systemic Lupus Erythematosus and Its Association with Clinical Manifestations
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Abstract
The central immunological disturbance in systemic lupus erythematosus (SLE) is autoantibody production. Some of these antibodies affecting components of the cell nucleus are the major characteristics of SLE. The present study was aimed to assess importance of anticardiolipin (ACL) antibody and its association with clinical state in SLE patients. A cross sectional study was performed on 100 patients with SLE referred to rheumatology outpatient clinic in Ekbatan hospital in Hamadan (Iran) between 2007 and 2008. Serum samples were extracted and screened for IgG and IgM using an ACL enzyme-linked immunosorbent assay. Up to 36% of patients were positive for ACL antibody that was more frequent in women than men (39.8% versus 8.3%). No association was revealed between ACL antibody and age. Clinical manifestations of antiphospholipid antibody syndrome were observed in 23.0% of patients that was more prevalent in ACL positive group compared with ACL negative group (41.7% versus 125%). The prevalence of other manifestations including pregnancy-related disorders (recurrent abortion), central nervous system defects, and deep vein thrombosis was 33.3%, 25.0%, and 30.6% in ACL positive group and was 9.4%, 7.8%, and 7.8% in ACL negative group that all were more frequent in the former group. The prevalence of thrombocytopenia was also higher in ACL positive group than another group (22.2% versus 15.6%). Among ACL positive patients with clinical manifestations of antiphospholipid antibody syndrome, 86.6% had medium to high titer of ACL. Our study emphasized value of (ACL) antibody to assess clinical status in SLE patients.
Gharavi AE, Pierangeli SS, Harris EN. New developments in viral peptides and APL induction. J Autoimmun2000;15(2):227-30.
Haralampos M, Moutsopoulos Panayotis G.Antiphospholipid Antibody Syndrom . Harrison Principles of Medicine. 18 th edition. New York: McGraw-Hill Professional; 2012.
Amoroso A, Mitterhofer AP, Del Porto F, Garzia P, FerriGM, Galluzzo S, Vadacca M, Caccavo D, Afeltra A.Antibodies to anionic phospholipids and anti-β2GPI: association with thrombosis and thrombocytopenia in systemic lupus erythematosus. Hum Immunol 2003;64(2):265–73.
Alarcón-Segovia D, Delezé M, Oria CV, Sánchez- Guerrero J, Gómez-Pacheco LCabiedes J, Fernández LPonce de León S. Antiphospholipid antibodies and the antiphospholipid syndrome in systemic lupus erythematosus. A prospective analysis of 500 consecutivepatients. Medicine 1989;68(6):353-65.
Tincani A, Allegri F, Sanmarco M, Cinquini M, Taglietti M, Balestrieri G, Koike T, Ichikawa K, Meroni P, Boffa MC. Anticardiolipin antibody assay: a methodological analysis for a better consensus in routine determinations: a cooperative project of the European Antiphospholipid Forum. Thromb Haemost 2001;86(2):575-83.
Brandt JT, Barna LK, Triplett DA. Laboratory identification of lupus anticoagulants: results of the Second International Workshop for Identification of Lupus Anticoagulants. Thromb Haemost 1995; 74(6):1597-603.
Harris EN, Pierangeli SS. Revisiting the anticardiolipin test and its standardization. Lupus 2002; 11(5):269-75.
Harris EN. Special report: the Second International Anticardiolipin Standardization Workshop/the Kingston Anti- Phospholipid Antibody Study (KAPS) group. Am J Clin Pathol 1990; 94(4):476-84.
Petrovas C, Vlachoyiannopoulos PG, Kordossis T, Moutsopoulos HM. Antiphospholipid antibodies in HIV infection and SLE with or without antiphospholipid syndrome: comparisons of phospholipid specificity, avidity and reactivity with β2GPI. J Autoimmun 1999;13(3):347–55.
Merrill JT, Zhang HW, Shen C, Butman BT, Jeffries EP, Lahita RG, Myones BL. Enhancement of protein S anticoagulant function by β2GPI, a major target antigen of antiphospholipid antibodies: β2GPI interferes with binding of protein S to its plasma inhibitor, C4b-binding protein. Thromb Haemost 1999;81(5):748–57.
Wiener MH, Burke M, Fried M, Yust I. Thromboagglutination by anticardiolipin antibody complex in the antiphospholipid syndrome: a possible mechanism of immune-mediated thrombosis. Thromb Res 2001; 103(3):193–9.
Galli M, Ruggeri L, Barbui T. Differential effects of anti- _2GPI and antiprothrombin antibodies on the anticoagulant activity of activated protein C. Blood 1998;91(6):1999-2004.
Pierangeli SS, Colden-Stanfield M, Liu X, Barker JH, Anderson GL, Harris EN. Antiphospholipid antibodiesfrom antiphospholipid syndrome patients activate endothelial cells in vitro and in vivo. Circulation 1999; 99(15):1997–2002.
Danowski A, de Azevedo MN, de Souza Papi JA, Petri M. Determinants of risk for venous and arterial thrombosis in primary antiphospholipid syndrome and in antiphospholipid syndrome with systemic lupus erythematosus. Rheumatol Int. 2012; 32(12):3881-6.
Hahn BH. Systemic Lupus Erythematosus. Harrisons Principles of Internal Medicine. 17th edition. New York: MC Graw-Hill; 2008;p.2075-83.
Ginsberg JS, Wells PS, Brill-Edwards P. Donovan D, Moffatt K, Johnston M, Stevens P, Hirsh J. Antiphospholipid antibodies and venous thromboembolism. Blood 1995;86(10):3685-91.
Mateo J, Oliver A, Borrell M, Sala N, Fontcuberta J. Laboratory evaluation and clinical characteristics of 2,132 consecutive unselected patients with venous thromboembolism: results of the Spanish Multicentric Study on Thrombophilia (EMET-Study). Thromb Haemost1997; 77(3):444-51.
Alarcon-Segovia D, Deleze M, Oria CV, Sanchez- Guerrero J, Gomez-Pacheco L, Cabiedes J, Fernández L, Ponce de León S. Antiphospholipid antibodies and the antiphospholipid syndrome in systemic lupus erythematosus: a prospective analysis of 500 consecutive patients. Medicine (Baltimore) 1989;68(6):353–65.
Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, Camps MT, Jacobsen S, Lakos G, Tincani A, Kontopoulou-Griva I, Galeazzi M, Meroni PL, Derksen RH, de Groot PG, Gromnica-Ihle E, Baleva M, Mosca M, Bombardieri S, Houssiau F, Gris JC, Quéré I, Hachulla E, Vasconcelos C, Roch B, Fernández-Nebro A, Boffa MC, Hughes GR, Ingelmo M; Euro-Phospholipid Project Group. Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum 2002;46(4):1019-27.
Love PE, Santoro SA. Antiphospholipid antibodies: anticardiolipin and the lupus anticoagulant in systemic lupus erythematosus (SLE) and in non-SLE disorders. Prevalence and clinical significance. Ann Intern Med 1990; 112(9): 682-98.
McMahon MA, Keogan M, O'Connell P, Kearns G. The prevalence of antiphospholipid antibody syndrome among systemic lupus erythematosus patients. Ir Med J 2006;99(10):296-8.
Arnout J, Vermylen J. Current status and implications of autoimmune antiphospholipid antibodies in relation to thrombotic disease, J Thromb Haemost 2003;1(5):931-42.
Pisetsky DS, Gilkeson G, St Clair EW. Systemic lupus erythematosus. Diagnosis and treatment. Med Clin North Am 1997;81(1):113-28.
Lockwood CJ, Romero R, Feinberg RF, Clyne LP, Coster B, Hobbins JC. The prevalence and biologic significance of lupus anticoagulant and anticardiolipin antibodies in a general obstetric population. Am J Obstet Gynecol 1989;161(2):369-73.
Tsapanos V, Kanellopoulos N, Cardamakis E. Fotopoulos A, Schinas V, Kondakis X, Tzingounis V. Anticardiolipin antibodies levels in healthy pregnant and non-pregnant woman. Arch Gynecol Obstet 2000;263(3):111-15.
26. Alarcon-Segovia D, Deleze M, Oria CV, Sanchez- Guerrero J, Gomez-Pacheco L,Cabiedes J, Fernández L,Ponce de León S. Antiphospholipid antibodies and the antiphospholipid syndrome in systemic lupus erythematosus:a prospective analysis of 500 consecutive patients. Medicine (Baltimore) 1989;68(6):353–65.
Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, Camps MT, Jacobsen S, Lakos G, Tincani A, Kontopoulou-Griva I, Galeazzi M, Meroni PL, Derksen RH, de Groot PG, Gromnica-Ihle E, Baleva M, Mosca M, Bombardieri S, Houssiau F, Gris JC, Quéré I, Hachulla E, Vasconcelos C, Roch B, Fernández-Nebro A, Boffa MC, Hughes GR, Ingelmo M; Euro-Phospholipid Project Group. Arthritis Rheum 2002;46(4):1019-27.
Kutteh WH. Antiphospholipid antibodies and reproduction. J Reprod Immunol 1997;35(2):151–71.
Komatireddy GR, Wang GS, Sharp GC, Hoffman RW. Antiphospholipid antibodies among anti-U1-70 kDa autoantibody positive patients with mixed connective tissue disease. J Rheumatol 1997;24(2):319–22.
Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1997; 40(9):1725.
Arnout J, Vermylen J. Current status and implications of autoimmune antiphospholipid antibodies in relation to thrombotic disease. J Thromb Haemost 2003;1(5):931-42.
Krause I, Blank M, Fraser A, Lorber M, Stojanovich L, Rovensky J, Shoenfeld Y. The association ofthrombocytopenia with systemic manifestations the antiphospholipid syndrome. Immunobiology 2005;210(10):749-54.
Klippel JH, Dieppe PA. Antiphospholipid syndrome and SLE. Klippel Textbook of Rheumatology. 2nd Edition. New York: Mosby; 1997.
Galli M, Finazzi G, Norbis F, Marziali S, Marchioli R, Barbui T. The risk of thrombosis in patients with lupus anticoagulant is predicted by their specific coagulation profile. Thromb Haemost1999;81(5):695-700.
Klippel J H, Crofford L J, Stone J H, Weyand C M. Antiphospholipid syndrome. Primer on the rheumatic diseases. Atlanta: Arthritis Foundation; 2001. p. 423–6.
Egner W. The use of laboratory tests in the diagnosis of SLE. J Clin Pathol 2000;53(6): 424-32.
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| Issue | Vol 51, No 1 (2013) | |
| Section | Articles | |
| Keywords | ||
| Anticardiolipin antibody Antiphospholipid syndrome Systemic lupus erythematosus | ||
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