Thromb Haemost 2020; 120(11): 1557-1568
DOI: 10.1055/s-0040-1714653
New Technologies, Diagnostic Tools and Drugs

Is There an Additional Value in Detecting Anticardiolipin and Anti-β2 glycoprotein I IgA Antibodies in the Antiphospholipid Syndrome?

Walid Chayoua
1  Synapse Research Institute, Maastricht, The Netherlands
2  Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
,
Dong-mei Yin
1  Synapse Research Institute, Maastricht, The Netherlands
2  Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
,
Hilde Kelchtermans
1  Synapse Research Institute, Maastricht, The Netherlands
2  Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
,
Gary W. Moore
3  Department of Haemostasis and Thrombosis, Viapath Analytics, Guy's & St. Thomas' Hospitals, London, United Kingdom
,
Jean-Christophe Gris
4  Centre Hospitalier Universitaire de Nîmes et Université de Montpellier, Nîmes, France
5  Ivan Sechenov First Moscow State Medical University, Moscow, Russia
,
Jacek Musiał
6  Department of Internal Medicine, Allergy and Immunology, Jagiellonian University Medical College, Kraków, Poland
,
Stéphane Zuily
7  Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, Centre Hospitalier Regional Universitaire de Nancy, Université de Lorraine, Inserm, DCAC, Nancy, France
,
Hugo ten Cate
8  Laboratory of Clinical Thrombosis and Haemostasis, Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
,
Bas de Laat
1  Synapse Research Institute, Maastricht, The Netherlands
2  Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
,
Katrien M. J. Devreese
9  Coagulation Laboratory, Department of Diagnostic Sciences, Ghent University Hospital, Gent, Belgium
› Author Affiliations

Abstract

Background Anticardiolipin (aCL) and anti-β2 glycoprotein I (aβ2GPI) immunoglobulin A (IgA) antiphospholipid antibodies (aPL) have shown to associate with thrombosis and pregnancy morbidity. However, inclusion of IgA aPL in the classification criteria of the antiphospholipid syndrome (APS) has been debated. We investigated the value of aCL and aβ2GPI IgA aPL in the detection of thrombosis and pregnancy morbidity in addition to the current aPL panel for APS.

Methods We included 1,068 patients from eight European medical centers: 259 thrombotic APS patients, 122 obstetric APS patients, 204 non-APS thrombosis patients, 33 non-APS obstetric patients, 60 APS patients with unspecified clinical manifestations, 196 patients with autoimmune diseases, and 194 controls. aCL and aβ2GPI IgG/M/A were detected with four commercial assays and lupus anticoagulant was determined by the local center.

Results Positivity for IgA aPL was found in 17 to 26% of the patients with clinical manifestations of APS and in 6 to 13% of the control population. Both aCL and aβ2GPI IgA were significantly associated with thrombosis and pregnancy morbidity. Isolated IgA positivity was rare in patients with clinical manifestations of APS (0.3–5%) and not associated with thrombosis and/or pregnancy morbidity. Addition of IgA to the current criterion panel did not increase odds ratios for thrombosis nor pregnancy morbidity.

Conclusion aCL and aβ2GPI IgA are associated with clinical manifestations of APS. However, isolated IgA positivity was rare and not associated with thrombosis or pregnancy morbidity. These data do not support testing for aCL and aβ2GPI IgA subsequent to conventional aPL assays in identifying patients with thrombosis or pregnancy morbidity.

Supplementary Material



Publication History

Received: 14 April 2020

Accepted: 16 June 2020

Publication Date:
21 July 2020 (online)

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