Anticardiolipin Antibodies In Patients Research Articles

Exploring the role of autoantibodies in Iraqi females with polycystic ovary syndrome

Background: Polycystic ovary syndrome (PCOS) is a prevalent endocrinopathy that affects 5-10% of women during their reproductive years. Clinicians characterize it by the occurrence of ovarian cysts, oligomenorrhea, amenorrhea, and either clinical or biochemical evidence of hyperandrogenism. Recent research suggests a potential link between autoantibodies and PCOS development. Aim of study: This study investigated the relationship between autoantibodies and Polycystic ovary syndrome (PCOS). Materials and methods: The study involved a total of 150 female participants diagnosed with PCOS, aged between 20 to 35, and a control group of 150 individuals. We utilized chemiluminescent immunoassays to measure Anti-thyroid antibodies thyroglobulin (TG) and thyroid peroxidase (TPO). We conducted IgM and IgG for anti-cardiolipin (ACL) and β-2 glycoprotein I (B2GPI) using the enzyme-linked immunosorbent assay (ELISA). To measure lupus (La), we employed coagulation time. To assess the serum levels of total antibodies Ig (M, G, A), Serum amyloid A (SAA), High-Sensitivity C-reactive protein (hs-CRP), and Procalcitonin (PCT), we used nephelometry methods. Results: In our findings, patients showed a significantly higher level of TPO autoantibodies (91.9±14.7) compared to the control group (12.4±5.1). This difference was highly significant (<0.001). Similarly, we observed high levels of anti-TG antibodies in patients (50.4±10.3) compared to the control group (30.6±7.2). This points out the important role of both TPO and TG antibodies in this context. Moreover, the level of IgM for ACL was significantly higher in patients (19.2±4.2 AU/dl) than in controls (3.3±1.0 AU/dl). The level of IgG for ACL was also higher in patients (22.5±2.3 AU/dl) compared to controls (3.3±1.0 AU/dl). These increases in ACL antibodies in patients suggested a risk factor for the disease. Additionally, Serum amyloid A (SAA) and high-sensitivity C-reactive protein (hs-CRP) were significantly higher in patients, with measurements of 66±10.4 (AU/ml) and 55±12.5 (AU/ml) respectively, compared to controls who had measurements of 3.6±1.9 (AU/ml) and 2.3±0.98 (AU/ml) respectively, which was highly significant (<0.001). Procalcitonin (PCT) was also highly significant in patients (40±6.3 AU/ml) compared to the control group (6.4±2.6 AU/ml). Lastly, the concentration of total IgG antibodies was significantly higher in patients (25.3±2.6 AU/dl) than in controls (4.3±1.0 AU/dl), with a significant difference (P=0.006). Conclusion: High concentrations of autoantibodies in patients suggest a risk factor and positive associations with the disease.

Anticardiolipin Antibodies in Patients with Cancer: A Case–Control Study

Antiphospholipid antibodies are highly prevalent in autoimmune diseases and mainly associated with thromboembolic events, which is one of the major reasons for cancer-related mortality. Confirmed adult cancer patients were included (n = 40) with an equal number of age- and sex-matched healthy controls. The presence and concentration of anticardiolipin antibodies were investigated by the enzyme-linked immunosorbent assay using the venous blood samples. aCL antibodies were detected in 60.0% (n = 24) of the cancer patients compared to none in the healthy controls (p < 0.001). The serum concentration of aCL antibodies was significantly higher in cancer patients than controls (p < 0.001) and ranged from 89.0 U/mL to 133.0 U/mL among the aCL-positive patients. All the lung cancer patients (n = 6) were diagnosed with positive aCL, and a borderline significant association of aCL antibody positivity was observed in colon cancer patients (p = 0.051). About 72.7% of the advanced-stage cancer individuals and 81.8% of the cancer patients who underwent surgery were diagnosed with positive aCL antibodies. A significant association of aCL antibody positivity was observed with cancer patients comorbid with heart diseases (p = 0.005). The prevalence and serum levels of aCL antibodies were significantly higher in cancer patients compared to healthy controls. Cancer patients (i.e., lung, liver, and colon), at advanced-stage, comorbid with heart diseases, who underwent surgery, were more likely to be diagnosed with aCL antibodies.

Mitral Valve Replacement for Enlarged Libman-Sacks Endocarditis in a Patient with Persistent Primary Antiphospholipid Syndrome and Recurrent Stroke: A Case Report.

BACKGROUND Anticardiolipin antibodies in patients with Libman-Sacks endocarditis (LS) are indicative of comorbid antiphospholipid syndrome (APS) and can result in cerebral infarctions. We describe a case of LS and primary APS with recurrent cerebral infarctions despite anticoagulation treatment. The patient underwent surgery for enlarged LS vegetation with high titers of antiphospholipid antibodies. CASE REPORT A 41-year-old Japanese man was admitted to hospital for small cerebral infarction recurrence in a left parietal lesion. At age 35, the patient had suffered multiple cerebral infarctions. He was found to have high serum titers of all 3 antiphospholipid antibodies. Transesophageal echocardiography (TEE) findings were normal. Differential diagnosis ruled out other autoimmune diseases and a clinical diagnosis of primary APS was made. Warfarin anticoagulation was started. When cerebral infarction recurred 6 years after the first episode, serum titers of antiphospholipid antibodies remained high, and TEE showed a 7×8 mm area of mitral vegetation. A TEE results from his first admission revealed a 5×6 mm area of mitral vegetation, which was believed to be related to the current vegetation. As anticoagulation produced no improvement, the mitral valve was replaced with a mechanical valve. Examination of the excised vegetation found it to be consistent with LS. The patient made good progress within 3 years after surgery. CONCLUSIONS LS size can increase despite anticoagulation in cases with high titers of all 3 antiphospholipid antibodies and cerebral infarction. Such patients require ongoing TEE follow-up and surgical treatment should be considered.

Prevalence and coagulation correlation of anticardiolipin antibodies in patients with COVID-19.

We aimed to determine prevalence and characteristics of anticardiolipin antibodies (ACLs) and its correlations with laboratory coagulation variables in patients with coronavirus disease 2019 (COVID-19). We retrospectively analyzed the prevalence of serum ACLs and its correlation with coagulative laboratory variables in 87 patients with COVID-19. ACLs were detected in 13/21 (61.91%) critically ill patients, and 21/66 (31.82%) in non-critically ill patients. For ACLs, IgA, and IgG were the most common types. The prevalence of IgG in critical ill patients was much higher than that in non-critical patients with odd ratio = 2.721. And the levels of all isotypes of ACLs in critically ill patients were much higher than those in non-critically ill patients. Correlation analysis showed that activated partial thromboplastin time and thrombin time had weak correlation with ACLs-IgG (R = 0.308, P = .031; R = 0.337, P = .018, respectively). Only the prevalence of ACLs-IgG shows a significant difference when compared critically ill patients with non-critically ill patients. ACLs do not seem to have a clear correlation with thrombosis occurred in COVID-19 patients.

The Interaction of Sickle Cell Trait and Anticardiolipin Antibodies in Venousthromboembolism

IntroductionAmong the risk factors for venous thromboembolism (VTE) are inheritance of the sickle cell gene and antiphospholipid syndrome. Antiphospholipid antibodies are elevated in sickle cell disease but there is little information on its levels in sickle cell trait. The prevalence of anticardiolipin antibodies and association with VTE is equally not known in the Nigerian population.MethodsA case control study involving 50 consecutive patients with Doppler confirmed venous thromboembolism at the University College Hospital Ibadan and 50 apparently healthy individuals. Haemoglobin electrophoresis was carried out using cellulose acetate membrane. IgG and IgM anticardiolipin antibodies were assayed by ELISA.ResultsThe mean age of the patients was 58.7±18.5years, range of 21-89 years, there were 21 males (42%). Majority of the patients (42 (84%)) had deep venous thrombosis while five (10%) patients presented with pulmonary embolism, one had both deep venous thrombosis and pulmonary embolism. A patient had portal vein thrombosis and another, an intracardiac clot. Sedentary lifestyles, hypertension and concomitant malignancy were the most prevalent risk factors (34% each) (figure I). Both sedentary lifestyle and cancer were significantly associated with VTE (p<0.001). Sickle cell trait (Hb AS) occurred in the same number of patients and controls (eleven each). Higher levels of both IgG and IgM anticardiolipin antibodies were found among the VTE patients with sickle cell trait than controls. (Table 1) The mean levels of IgG antibody in Hb AS patients was 31.7 ± 12.8 GPL compared to 25 ± 13.8 GPL in the controls (p= 0.254) and mean IgM anticardiolipin antibodies in Hb AS patients was 18.7 ± 6.2 GPL while that of the controls was 16.8 ± 11.6 GPL (p= 0.633). The global mean levels of IgG and IgM anticardiolipin antibodies in the patients with VTE were 29.7 ± 9.1 GPL and 24.8 ±16.7 GPL respectively versus 28.5 ±13.7 GPL and 25.2 ±16.2 GPL in the controls. A multivariable logistic regression showed age, sedentary lifestyle and anemia as independent risk factors while a positive IgM anticardiolipin antibody appeared protective for VTE. (Table 2)ConclusionThe prevalence of sickle cell trait and anticardiolipin levels did not differ between VTE patients and healthy controls. Age, hypertension, sedentary lifestyle and malignancies were identified risk factors in our cohort of patients. Larger prospective studies may be helpful in determining the influence of sickle cell trait and antiphospholipid antibodies in venous thromboembolism. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

IBCL-309: The Frequency of Anticardiolipin Antibodies in Patients with Non-Hodgkin Lymphoma

Context: The prevalence of antiphospholipid antibodies in the general population ranges from 1–5% and increases when associated with chronic diseases, including oncological ones. Anticardiolipin antibodies are autoantibodies that mistakenly target the body's own cardiolipins on the outside of cell membranes and platelets. Objective: Case detection of anticardiolipin antibodies (aCL) in patients with non-Hodgkin lymphoma (NHL) in order to identify the likelihood of thrombosis. Materials and Methods: The study included 47 primary patients: 31 with aggressive NHL and 16 with indolent NHL patients being complexly investigated, including the study of antibodies to aCL IgG, IgM, anti-β2-glycoprotein I, and lupus anticoagulant according to age, sex, morphology of NHL, focus of the primary tumor, and stage tumor. The definition of Euro-Phospholipid for anti-phospholipid antibody syndrome has been applied. Results: Forty-seven out of 58 NHL patients hospitalized in the Hematology Department of IMSPIO, Republic of Moldova met the criteria of inclusion in the study. At the first visit, 64,1±1,3 (i-v 37–78) was the average age of patients, the duration of the disease was 4,3 (i-v1–12) months, and 42.5% of patients were women, while 57.5% of patients were men. Anticardiolipin antibodies were found in 7 patients (14.9%), in both sexes (men: 4, women: 3), with a predominance in stage IV of the disease of 83.3%. In 71.4%, the primary tumor focus was detected in the lymph nodes, with predominance in the peripheral lymph nodes (61.5%). Conclusions: Anticardiolipin antibodies were estimated in 14.9% of NHL cases, with the same frequency in gender and mean age of 64.1±1.3 years old. The frequency of anticardiolipin antibodies in stage IV was 83.3%, which was the highest.

Sex Hormones and Prolactin Levels and Their Association with Anti Cardiolipin Antibody in Patients with Systemic Lupus Erythematosus.

Pathogenesis of systemic lupus erythematosus (SLE) is complex and multi-factorial. Among various suggested mechanisms for the disease, the hormonal theory has been considered as one of the most important mechanisms. Recently, the association of sex hormones with manifestations of antiphospholipid antibody syndrome (APLS) has been hypothesized. The aim of present study was to assess the serum levels of anticardiolipin antibody (ACA), sex hormones and prolactin in SLE female patients and their association with the disease. This study comprised 40 SLE female patients and 41 healthy age-matched female subjects. For all patients and controls, the serum levels of ACA (IgG and IgM), estradiol, testosterone, progesterone, dehydroepiandrosterone sulfate (DHEA-S) and prolactin were measured by ELISA method. Our study revealed that serum levels of testosterone, DHEA-S and progesterone were significantly lower in SLE patients than control (p<0.001). However, serum levels of estradiol and prolactin were significantly higher in SLE patients compared to controls (p<0.001). There was a significant difference between mild and moderate severity patients group for ACA positivity (95% CI 13.67-41.3; p=0.03). Also, SLE patients with positive ACA showed significantly lower (p<0.001) serum levels of testosterone, DHEA-S and progesterone and significantly higher (p<0.001) estradiol and prolactin serum levels compared to negative ACA patients. The results of our study indicated that expression and metabolism of sex hormones and prolactin are different in female SLE patients compared to healthy subjects. It seems, change in serum levels of these hormones is related to higher SLE disease activity, increased thrombotic risks and increased renal involvement.

Presence of Anticardiolipin Antibodies in Patients with Dementia: A Systematic Review and Meta-Analysis.

Growing evidences are supporting towards the involvement of antiphospholipid antibodies [aPLs e.g., lupus anticoagulant (LA), anticardiolipin (aCL) and anti-β2-glycoprotein I (anti-β2-GPI) antibodies] in various neurological manifestations including migraine, epilepsy and dementia in the presence or absence of autoimmune diseases such as antiphospholipid syndrome or systemic lupus erythematosus. The aim of this systematic review and meta-analysis was to assess the presence of aPLs in dementia patients without a diagnosis of any autoimmune disease. Electronic databases (e.g., PubMed, Web of Science, Scopus, ScienceDirect and Google Scholar) were searched without any year or language restrictions and based on the inclusion criteria, nine prospective case-control studies assessing only aCL were included involving 372 dementia patients and 337 healthy controls. No studies were found to assess the presence of both LA or anti-β2-GPI. The study-specific odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random-effects model. We observed the prevalence of aCL in dementia was higher (32.80%) than that of controls (9.50%) e.g., 3.45 times higher risk of presenting with dementia than the controls, and significant presence of aCL antibodies was detected in dementia patients compared to controls (OR: 4.94, 95% CI: 2.66 – 9.16, p < 0.00001; I2 = 32%, p = 0.16). Publication bias was not observed from Egger’s (p = 0.081) and Begg’s tests (p = 0.180). Based on the study quality assessment using modified Newcastle–Ottawa Scale for case-control studies, seven of nine studies were of high methodological quality scoring ≥ 7 (median value). In summary, aCL antibodies were significantly present in dementia patients suggesting that aCL antibodies are generated due to the autoimmune-derived effects of dementia or there might be a potential causative role of this autoantibody in dementia pathogenesis.

The Clinical Significance of Both IgM and IgG Anticardiolipin Antibodies in Non-Hodgkin’s Lymphoma

Background: Anticardiolipin (ACL) antibodies are associated with a wide variety of disorders including malignancies. The aim of this study was to investigate the prevalence and prognostic implication of ACL antibodies in patients with Non-Hodgkin’s lymphoma (NHL). Methods: Sixty-four patients with NHL were included in this study. Enzyme-linked immunosorbent assay kits were used to measure the concentrations of all IgM and IgG antibodies. Results: Antibodies (IgM, IgG) were found in 35.9% and 84.3% of patients respectively. The presence of elevated aCl IgM was correlated with relapse in NHL (P<0.001). Pretreatment serum levels of aCL IgG were significantly higher in patients with NHL (P<0.001), and significantly normalized in complete remission. Positive ACL IgG was also found in patients with relapse. A negative correlation was found between aCL antibodies (IgM, IgG) positivity and CD23 (P=0.037, P=0.003) respectively. Conclusion: Anticardiolipin antibodies are associated with lymphomas. Their determination is useful to predict treatment outcome or disease prognosis.

STUDY ON RELATIONSHIP BETWEEN SERUM ANTI-CARDIOLIPIN ANTIBODIES AND BRAIN LESION VOLUMES, SEVERITY IN PATIENTS WITH ACUTE CEREBRAL INFARCTION

Objective: (1) To determine positive percentage and levels of serum anticardiolipin antibodies in patients with acute cerebral infarction. (2) To determine survey on relationship between serum anticardiolipin antibodies and brain lesion volumes, severity in these patients. Subjects and Methods: cross-sectional descriptive study, 68 patients with acute cerebral infarction at Hue Medical University Hospital. The quantitative analysis of serum IgM, IgG anticardiolipin (aCL) antibodies was performed by indirect ELISA technique. Data processing method according to usual medical statistics and SPSS 16.0. Results: The positive percentage of IgG aCL antibody was 20,6% and IgM aCL antibody was 7,4% in acute cerebral infarction patients. The average levels of the aCL-IgG (+) in acute cerebral infarction patients was 33,98 ± 29,42 GPL/mL and aCL-IgM (+) was 26,58 ±10,30 MPL/mL. There was a close correlation between aCL-IgG levels and brain lesion volumes (r = 0,709; p &lt;0,01) and close inverse correlation between aCL-IgG levels and Glasgow coma scale (r = -0,643; p &lt;0,01). There was an average correlation between aCL-IgM levels and brain lesion volumes (r = 0,407; p &lt;0,01); and average inverse correlation between aCL-IgM levels and Glasgow coma scale (r = -0,393; p &lt;0,01). Conclusion: levels of the aCL-IgG (+) was 33,98 ± 29,42 GPL/mL and aCL-IgM (+) was 26,58 ±10,30 MPL/mL in acute cerebral infarction patients. Serum aCL levels correlated to brain lesion volumes and severity of acute cerebral infarction patients. Key words: anti-cardiolipin, aCL, acute cerebral infarction

Association between HLA-DQ alleles and anticardiolipin antibody in patients with recurrent miscarriage

Association between HLA-DQ alleles and anticardiolipin antibody in patients with recurrent miscarriage

Serum anticardiolipin antibodies in patients with neuromyelitis optica spectrum disorder

The presence of anticardiolipin antibodies (ACLA) in multiple sclerosis (MS) patients has been reported, but there are some debates on the relationship between ACLA and MS. We assessed the clinical features of neuromyelitis optica spectrum disorders (NMOSD) patients with ACLA. A consecutive cohort of 480 subjects with NMOSD (n = 70), MS (n = 90) and control (n = 220) were analysed retrospectively. Patients' serum was tested by a dot-immunogold filtration assay for the presence of ACLA-IgG, IgM and IgA antibodies. In MS patients, 5 (5.6 %) of the 90 patients showed ACLA-IgG reactivity in the serum. In NMOSD patients, 32 (45.7 %) of the 70 patients showed ACLA reactivity in the serum, among which ACLA-IgG seropositivity was 45.7 % (32/70), ACLA-IgG + IgM seropositivity was 8.6 % (6/70), and ACLA-IgG + IgA seropositivity was 4.3 % (3/70). NMOSD patients were higher in ACLA-IgG (p < 0.0001) and ACLA-IgG + IgM (p = 0.006) than the MS patients. NMOSD patients had higher ACLA-IgG than the control patients (p < 0.0001). In comparison with the controls, the MS patients were lower in ACLA for IgG (p = 0.014) and IgM (p = 0.004). Seropositive ACLA patients increased in age (p = 0.013) and had higher D-dimer levels (DD) (p = 0.002) than the seronegative NMOSD patients. Furthermore, positive ACLA-IgG + IgM patients were increased in age (p = 0.001), had higher baseline EDSS (p = 0.001), antithrombin III activity (p = 0.04), and DD levels (p = 0.005) than the pure positive ACLA-IgG NMOSD patients. Patients with NMOSD had more occurrences of ACLA than patients with MS. NMOSD patients with positive ACLA-IgG + IgM had a worse outcome that may be associated with elder age and abnormal coagulation parameters in blood.

Autoantibody profiling in systemic lupus erythematosus

Autoantibody profiling in systemic lupus erythematosus Song-Chou Hsieh,1 Chia-Li Yu1,2 1Department of Internal Medicine, 2Institute of Molecular Medicine, National Taiwan University College of Medicine, Taipei, Taiwan Abstract: Systemic lupus erythematosus (SLE) is an archetype of systemic autoimmune disease characterized by the production of a broad spectrum of autoantibodies. More than 100 autoantibodies have been found in the sera of patients with SLE, including antibodies against nuclear, cytoplasmic, surface-membrane, and extracellular antigens. There has been considerable debate as to whether these antinuclear autoantibodies (ANAs) are merely biomarkers for disease or are responsible for organ/tissue damage in SLE. In recent years, sufficient evidence has supported the hypothesis that many ANAs, such as anti-double-stranded DNA (anti-dsDNA), antiribosomal P, anti-Sm, antiribonucleoprotein (anti-RNP), and even anti-Sj&ouml;gren&#39;s syndrome (SS)-B/La antibodies not only act against specific nuclear antigens but also cross-react with different surface-expressed cognate molecules. The binding of autoantibodies to the cell surface leads to their penetration into the cell&#39;s interior to elicit cellular damage. There are at least four conceivable routes for ANAs to penetrate the cytoplasm: (1) nonspecific Fc&gamma; receptor-mediated uptake, (2) cell-surface caveolae-mediated endocytosis, (3) electrostatic interactions between positively charged amino acids of the complementarity-determining regions of the antibody molecule and the negatively charged surface membrane, and (4) the binding of the autoantibody with its cross-reactive cell surface-expressed cognate molecule, and its subsequent endocytosis into the cytoplasm. In this review, we discuss in detail the immunopathogenic mechanisms of the commonly encountered ANAs, such as anti-dsDNA, antiribosomal P, and anti-SSB/La, that are associated with lupus pathogenesis. Additionally, the detrimental thromboembolism-inducing anticardiolipin antibodies in patients with SLE were found to not only damage vascular endothelial cells, red blood cells, and platelets but also suppress lymphocyte proliferation, neutrophil phagocytosis, glomerular mesangial cell growth, and brain damage through their nonspecific membranotropic effects. For future clinical applications, useful biomarkers in SLE sera should be identified to determine disease susceptibility, diagnosis, activity evaluation, and specific organ damage. Keywords: systemic lupus erythematosus, pathogenic autoantibody, cross-reactivity, autoantibody penetration, lupus pathogenesis, neuropsychiatric SLE

352 Anticardiolipin Antibodies in Patients with Acute Myeloid Leukemia

BackgroundLeukemia in general is known to be associated with coagulopathies. The presence of antiphospholipid antibodies was associated with several medical problems, including recurrent spontaneous abortion, arterial and venous thromboses, and thrombocytopenia. A number of studies report the prevalence of anticardiolipin (ACL) antibodies in acute myeloid leukemia (AML). This study was designed to explore the prevalence and the clinical and prognostic significance of ACL antibodies in patients with acute myeloid leukemia (AML).Material and MethodsThe study includes 28 AML patients >15 years old and with no evidence of infection at the time of enrollment. The previous history of thromboembolism, recurrent abortion, and autoimmune disease was given from patients. Serum level of ACL antibodies was determined by indirect enzyme immunoassay.ResultsACL antibodies were found in 9 patients (32.14%). None of the patients had high positive titers (>40 GPL). Two patients had moderately positive (20–40 GPL), while 7 patients had low positive (10–20 GPL) ACL antibody titers.ConclusionsACL antibody positivity was not correlated with the risk of thromboembolism, fetal loss, and autoimmune disease. These preliminary results demonstrate a prevalence of ACL antibodies in AML patients and suggest that serum ACL antibodies may have a role in some haematological malignancies. The correlation of ACL antibodies with predicting, relapse, and documenting disease activity is will be continue until 4 to 19 months of follow up.

Bloody mess

Women with positive antiphospholipid antibodies may present with severe preeclampsia, fetal growth restriction (FGR), fetal demise, and recurrent miscarriage.1Ziakas P.D. Pavlou M. Voulgarelis M. Heparin treatment in antiphospholipid syndrome with recurrent pregnancy loss A systematic review and meta-analysis.Obstet Gynecol. 2010; 115: 1256-1262Crossref PubMed Scopus (137) Google Scholar, 2Branch D.W. Silver R.M. Porter T.F. Obstetric antiphospholipid syndrome: current uncertainties should guide our way.Lupus. 2010; 19: 446-452Crossref PubMed Scopus (28) Google Scholar In addition, these women are at increased risk of arterial and venous thrombosis.3American College of Obstetricians and GynecologistsACOG practice bulletin no. 118.Antiphospholipid syndrome. January 2011; Google Scholar As a result, testing for these antibodies is increasing in women with such complications and those with positive tests for lupus anticoagulant, anticardiolipin, or anti-B2 glycoprotein I are considered to have the antiphospholipid antibody syndrome (APS). Once APS is diagnosed, the essential question is whether any treatment, beyond counseling and close observation in subsequent pregnancy, is necessary. During the past 2 decades, several authors suggested using heparin with or without aspirin to improve pregnancy outcome in women with APS.2Branch D.W. Silver R.M. Porter T.F. Obstetric antiphospholipid syndrome: current uncertainties should guide our way.Lupus. 2010; 19: 446-452Crossref PubMed Scopus (28) Google Scholar, 3American College of Obstetricians and GynecologistsACOG practice bulletin no. 118.Antiphospholipid syndrome. January 2011; Google Scholar There are no randomized trials evaluating the benefits of such therapy in women with prior severe preeclampsia, FGR, or fetal demise. There are 9 randomized or pseudorandomized trials evaluating heparin with aspirin, aspirin alone, or a placebo in patients with recurrent miscarriage and APS. The results of these trials are inconsistent.4Miyakis S. Lockshin M.D. Atsumi T. et al.International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome.J Thromb Haemost. 2006; 4: 295-306Crossref PubMed Scopus (4921) Google Scholar Of interest, the rate of live birth in the placebo subjects (n = 28) ranged from 85% to 100%; in the aspirin-only subjects (n = 207), the rate was 42-90%; in the unfractionated heparin-plus-aspirin subjects (n = 113), the rate was 31-85%; and in the low-molecular-weight heparin-plus-aspirin subjects (n = 111), it was 69-84%. In 2006, the laboratory criteria for APS have been revised,5Laskin C.A. Spitzer K.A. Clark C.C. et al.Low molecular weight heparin and aspirin for recurrent pregnancy loss: results from the randomized, controlled Hep ASA trial.J Rheumatol. 2009; 36: 279-287Crossref PubMed Scopus (271) Google Scholar and thus, there are currently no randomized trials evaluating the benefits of heparin and aspirin in women with recurrent miscarriage and true APS. A recent American College of Obstetricians and Gynecologists practice bulletin on APS does not support screening for anticardiolipin antibodies in patients with severe preterm preeclampsia or FGR but recommends screening those patients with 1 fetal loss or 3 or more recurrent embryonic losses. It also recommends the prophylactic use of heparin and aspirin in subsequent pregnancies in such women. However, such recommendation is not evidence based. Because the potential benefits of treatment are uncertain, screening such women is very costly and is associated with anxiety, and treatment is associated with side effects that can be severe. At present, data from relevant literature suggest that the association of anticardiolipin antibodies with recurrent miscarriage and placental insufficiency is weak at best. There are no evidence-based studies to indicate that treatment with prophylactic doses of heparin plus aspirin are beneficial. Thus, there is an urgent need for a multicenter trial with adequate sample size. Such trials will hopefully provide conclusive evidence-based treatment to replace recommendations based on personal bias.

Anticardiolipin antibodies in patients with Behcet's disease

The aims of this study are to determine anticardiolipin antibodies in patients with Sy Behcet and to determine correlation between the levels of anticardiolipin antibodies in serum in patients with clinic systemic and ocular manifestations. The study was conducted on 11 patients with Behcet disease (group I), and on 11 healthy subjects (group II). Anticardiolipin antibodies -aCL were determined by the standard ELISA method, where 1GPL= 1 microgram/ml IgG aCL and 1 MPL= 1 microgram/ ml IgM, and were considered negative < 10 GPL or MPL, low positive (10-40 GPL and MPL), or high positive (>40 GPL and MPL). In the group of 11 patients with the diagnosis Sy Behcet, 6 of them were (54.5%) with values of anticardiolipin antibodies over 10 positive. In the control group of the healthy examinees aCl were positive in 2 cases (18.2%). There are no statistically significant differences in the presence of systemic clinic characteristics between aCl positive and negative patients. All the patients with SY Behcet in whom anticardiolipn antibodies were found have extremely severe visual damage which is not present in the group of those patients where the values of aCl were low. The difference is statistically significant. The level of anticardiolipin antibodies is increased in the patients with Behcet. There are no statistically significant differences in the presence of systemic clinical characteristics between aCL positive and negative patients. Visual acuity in patients with SY Behcet is statistically significantly much lower in patients who had increased values of aCL.

Clinical Significance of Anticardiolipin Antibody in Patients with Collagen Diseases

Clinical Significance of Anticardiolipin Antibody in Patients with Collagen Diseases

Prevalence of antiphospholipid antibodies among women experiencing unexplained infertility and recurrent implantation failure

The prevalences of antiphospholipid antibodies (APAs) among 1,325 women with a history of unexplained infertility and 676 women experiencing recurrent implantation failure were compared with 789 women experiencing recurrent pregnancy loss and 205 fertile control women. Eight percent and 9% of women with a history of unexplained infertility and recurrent implantation failure had more than one positive APA compared with 1.5% of fertile negative control women and 11% of positive control women experiencing recurrent pregnancy loss.

Contagem de plaquetas e caracterização clínica de úlceras de perna anticardiolipinas positivas

To study the prevalence of anticardiolipin antibodies in patients with venous, diabetic and arterial leg ulcers and to verify if platelet count, previous history of venous thrombosis, obstetrical history and the finding of livedo reticularis are markers of this autoantibody positivity. 151 patients with leg ulcer (81 with venous, 50 with diabetic and 20 with arterial ulcers) and 150 controls were included. In both groups search for the presence of IgG and IgM anticardiolipin and platelet count was done. In the leg ulcer group demographic data, obstetrical history, previous history of venous thrombosis as well as presence of livedo reticularis by physical examination were pointed out. Data was grouped in contingency and frequency tables and the tests of Fisher and chi-squared were used for nominal variables and Mann Whitney and Kruskall Wallis for numerical variables. The adopted significance was of 5%. It was found an anticardiolipin prevalence of 7.2% (n=12) in the leg ulcer group and of 1.3% (n=2) in the control group (p=0.01). Leg ulcer patients with anticardiolipin did not differ from those without it in gender (p=0.98), previous history of venous thrombosis (p=0.69), previous history of abortions (p=0.67) and platelet count (p=0.67). Only two patients had livedo reticularis which precluded any conclusion on this data. There is an increased prevalence of anticardiolipin antibodies in the general population with leg ulcers. Clinical characteristics of ulcers as well as platelet count do not help in the identification of these patients.

Prevalence of Anticardiolipin Antibodies in Patient Cohorts with Distinct Clinical Manifestations of the Antiphospholipid Syndrome

Clinical manifestations of antiphospholipid syndrome (APS) vary from venous and arterial thrombosis to pregnancy loss and pre-eclampsia (PEC). Our aims were to establish the prevalence of anticardiolipin antibodies (aCLA) in patients with clinical features of APS and to compare the reference ELISA method with the novel automated EliA aCLA assay. Serum samples from 1278 patients with either deep venous thrombosis (DVT), young stroke (YS), PEC, or multiple sclerosis (MS) were included. The latter cohort was included because initial presentation of APS might resemble MS. Using the internationally accepted cutoff level of 40 MPL/GPL [IgM antiphospholipid units/mL (MPL)/IgG antiphospholipid units/mL (GPL)], 0.7% and 0.5% of the samples were positive for IgM and IgG aCLA by ELISA, respectively. Using the cutoff level recommended by the manufacturer (15 MPL/GPL), the prevalence was 2.7% and 2.8%, respectively. The prevalence by EliA was 2.0% and 0.5% for IgM and IgG aCLA, respectively (40 MPL/GPL cutoff). However, with a low cutoff level, the prevalence of IgM aCLA, but not IgG aCLA, was higher in the DVT (14.3%), YS (14.6%), and PEC (17.7%) cohorts but not the MS cohort. The prevalence of aCLA was too low for reliable determination of concordance between assays. In patients with DVT, CVA, PEC, and MS, the prevalence of aCLA is low, in particular when internationally accepted cutoff values are applied. Our finding questions the efficacy of aCLA testing. Therefore, there might be either a need for defining specific clinical criteria to obtain a better rational for aCLA testing or aCLA testing should be excluded from the classification criteria.