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Semin Thromb Hemost 2022; 48(02): 132-144
DOI: 10.1055/s-0041-1730357
Review Article

Laboratory Approaches to Test the Function of Antiphospholipid Antibodies

Gábor Szabó
1   Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
2   Thrombosis, Haemostasis and Vascular Biology Programme, Kálmán Laki Doctoral School, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
,
Péter Antal-Szalmás
1   Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
,
Adrienne Kerényi
1   Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
3   Faculty of Pharmacy, University of Debrecen, Debrecen, Hungary
,
Krisztina Pénzes
4   Division of Medical Laboratory Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
,
Bálint Bécsi
5   Department of Medical Chemistry, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
,
János Kappelmayer
1   Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
› Author Affiliations Funding This work was supported by Hungarian Scientific Research Fund (OTKA_K_16 120725), and Economic Development and Innovation Operational Programme (GINOP-2.3.3–15-2016–00020).
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Abstract

Antiphospholipid syndrome (APS) is a systemic autoimmune disorder caused by the presence of aPLs (antiphospholipid antibodies, i.e., anti-β2-glycoprotein I and anti-cardiolipin). Everyday practice in terms of laboratory diagnostics of APS includes determination of aPLs and well-known functional assays assessing for lupus anticoagulant (LA), in turn using various tests. According to recent guidelines, the recommended method for LA identification or exclusion is based on the Russell Viper Venom test and a sensitive activated partial thromboplastin time assay. Despite the fact that LA can be quantified in laboratory practice in this way, LA is still used as a binary parameter that is just one of the risk factors of thrombosis in APS. As of today, there are no other functional assays to routinely assess the risk of thrombosis in APS. It is well-known that APS patients display a wide range of clinical outcomes although they may express very similar laboratory findings. One way to solve this dilemma, could be if antibodies could be further delineated using more advanced functional tests. Therefore, we review the diagnostic approaches to test the function of aPLs. We further discuss how thrombin generation assays, and rotational thromboelastometry tests can be influenced by LA, and how experimental methods, such as flow cytometric platelet activation, surface plasmon resonance, or nano differential scanning fluorimetry can bring us closer to the puzzling interaction of aPLs with platelets as well as with their soluble protein ligand. These novel approaches may eventually enable better characterization of aPL, and also provide a better linkage to APS pathophysiology.

Keywords

antiphospholipid syndrome - anti-β2GPI - functional assay


Publication History

Article published online:
14 July 2021

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