Antibodies to phosphatidylserine/prothrombin (aPS/PT) enhanced the diagnostic performance in Chinese patients with antiphospholipid syndrome.

BACKGROUND: Increasing evidence has highlighted the role of non-criteria antiphospholipid antibodies (aPLs) as important supplements to the current criteria aPLs for the diagnosis of antiphospholipid syndrome (APS). In this retrospective study, we evaluated the clinical relevance of antibodies to phosphatidylserine/prothrombin (aPS/PT) in Chinese patients with APS. METHODS: A total of 441 subjects were tested, including 101 patients with primary APS (PAPS), 140 patients with secondary APS (SAPS), 161 disease controls (DCs) and 39 healthy controls (HCs). Serum IgG/IgM aPS/PT was determined by ELISA. RESULTS: The levels of IgG/IgM aPS/PT were significantly increased in patients with APS compared with DCs and HCs. IgG and IgM aPS/PT were present in 29.7% and 54.5% of PAPS, and 42.1% and 53.6% of SAPS, respectively. For diagnosis of APS, IgG aCL exhibited the highest positive likelihood ratio (LR+) of 21.60, followed by LA (13.84), IgG aß2GP1 (9.19) and IgG aPS/PT (8.49). aPS/PT was detected in 13.3% of seronegative PAPS patients and 31.3% of seronegative SAPS patients. LA exhibited the highest OR of 3.64 in identifying patients with thrombosis, followed by IgG aCL (OR, 2.63), IgG aPS/PT (OR, 2.55) and IgG aß2GP1 (OR, 2.33). LA and IgG aCL were correlated with both arterial and venous thrombosis, whereas IgG aPS/PT and IgG aß2GP1 correlated with venous or arterial thrombosis, respectively. CONCLUSIONS: Our findings suggest that the inclusion of IgG/IgM aPS/PT may enhance the diagnostic performance for APS, especially in those in whom APS is highly suspected, but conventional aPLs are repeatedly negative. In addition, IgG aPS/PT may contribute to identify patients at risk of thrombosis.

Value of anti-phosphatidylserine/prothrombin antibody in diagnosis of seronegative antiphospholipid syndrome / 上海交通大学学报（医学版）

Objective • To investigate diagnostic value of anti-phosphatidylserine/prothrombin antibody (aPS/PT), IgA anti-cardiolipin antibody (aCL), and IgA anti-β2-glycoprotein antibody (aβ2-GPI) in seronegative antiphospholipid (SNAPS). Methods • Serum samples were collected from 86 patients with antiphospholipid (APS) (APS group), 48 patients with SNAPS (SNAPS group), 79 patients with systemic lupus erythematosus (SLE) (SLE group), and 85 healthy donors (healthy control group, HC group) for aPS/PT (IgG and IgM), aCL (IgA) and aβ2-GPI (IgA) detected by ELISA. The sensitivity and specificity of the four antibodies for the diagnosis of SNAPS were calculated, and the ROC curves were analyzed. The correlation between the four antibodies and the clinical manifestations of SNAPS was also analyzed.Results • A total of 25 (52.1%) SNAPS patients were positive in aPS/PT (IgG/IgM), including 29.2% patients positive in aPS/PT (IgG) and 35.4% positive in aPS/PT (IgM). There were 16.7% SNAPS patients positive in aβ2-GPI (IgA), but none was aCL (IgA) positive. The positive rates of aPS/PT (IgG and IgM) and aβ2-GPI (IgA) were statistically higher in SNAPS group than those in HC group (P=0.000). The area under curve (AUC) of aPS/PT (IgG) (AUC=0.753) for SNAPS diagnosis was the biggest among the four antibodies, and the second was aβ2-GPI (IgA) (AUC=0.725). A positive correlation was found in SNAPS group between presence of venous thrombosis and aPS/PT (IgG) (OR=5.54, 95% CI 1.67-17.33, P=0.003) or aβ2-GPI (IgA) (OR=3.43, 95% CI 0.86-11.53, P=0.041), and also found between pregnancy loss and aPS/PT (IgM) (OR=5.11, 95% CI 1.31-21.29, P=0.004). Conclusion • aPS/PT (IgG/IgM) and aβ2-GPI (IgA) can be used as potential complementary indicators for laboratory diagnosis of SNAPS, and aPS/PT (IgG/IgM) is also valuable for clinical evaluation of the risk of thrombosis and pregnancy loss in SNAPS patients.

Autoimmune/inflammatory syndrome induced by adjuvants (Shoenfeld's syndrome) - An update.

Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) has been widely described in many studies conducted thus far. The syndrome incorporates five immune-mediated conditions, all associated with previous exposure to various agents such as vaccines, silicone implants and several others. The emergence of ASIA syndrome is associated with individual genetic predisposition, for instance those carrying HLA-DRB1*01 or HLA-DRB4 and results from exposure to external or endogenous factors triggering autoimmunity. Such factors have been demonstrated as able to induce autoimmunity in both animal models and humans via a variety of proposed mechanisms. In recent years, physicians have become more aware of the existence of ASIA syndrome and the relationship between adjuvants exposure and autoimmunity and more cases are being reported. Accordingly, we have created a registry that includes at present more than 300 ASIA syndrome cases that have been reported by different physicians worldwide, describing various autoimmune conditions induced by diverse adjuvants. In this review, we have summarized the updated literature on ASIA syndrome and the knowledge accumulated since 2013 in order to elucidate the association between the exposure to various adjuvant agents and its possible clinical manifestations. Furthermore, we especially referred to the relationship between ASIA syndrome and systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS).