Anti-phospholipid antibodies against phosphatidylinositol, and phosphatidylserine are more significant in reproductive failure than antibodies against cardiolipin only.

PROBLEM: The humoral immune response to phospholipids was investigated in women with reproductive failure [1073 women after one in vitro fertilization (IVF), 853 women after two and more IVF, 627 women after three and more repeated spontaneous miscarriages or missed abortions, 412 women after diagnostic laparoscopy] and compared with that of 391 healthy fertile women. METHOD OF STUDY: Sera from all women in the study were tested by enzyme-linked immunosorbent assay (ELISA) for the detection of IgG, IgA, and IgM isotypes of antibodies against seven phospholipids (aPLs), i.e. cardiolipin, L-phosphatidylserine, phosphatidylglycerol, phosphatidylinositol, phosphatidylethanolamine, phosphatidylacid as well as against beta2-glycoprotein I. RESULTS: Patients after two and more IVF (48 and 50%, respectively), patients with three and more repeated spontaneous miscarriages (50 and 46.5%, respectively) are associated with significantly higher serum levels of aPLs against inositol, and L-serine (P < 0.01). A quarter of them were positive for three and more aPLs. CONCLUSION: It seems that determination of aPLs only against cardiolipin in reproductive failure is not sufficient for obstetric-gynecology diagnosis as the primary anti-phospholipid syndrome. Our long-ranging study (from 1998 to 2003) shows the necessity to test for a complete aPLs profile. Sera from patients after two and more IVF procedures, and sera from women after three and more repeated abortions are immunologically more active than sera from women after one unsuccessful IVF and sera from women after diagnostic laparoscopy. This important result is very significant for future treatment.

Seven antiphospholipid antibodies in HIV-positive patients: correlation with clinical course and laboratory findings.

OBJECTIVE: To compare the clinical course of HIV-1-infected patients, their CD4+, CD8+ T lymphocytes, and viral loads (VL) with the levels of seven antiphospholipid antibodies (aPLs) before, during, and after the highly active antiretroviral therapy (HAART). PATIENTS AND METHODS: aPLs were examined in patients (20 men, 10 women, aged 12-64 years, median 33 years) from the AIDS center of Western Bohemia before the initiation of HAART, and two (23 patients), and five (20 patients) years later. Flow-cytometry was used for CD4+ and CD8+ T lymphocytes analysis, commercial kits were used for VL-measurements, and commercial enzyme-linked immunosorbent assay (ELISA) was used to determine serum levels of anti-beta2-glycoprotein I (GPI) of immunoglobulin G (IgG) and IgA isotypes, and anticardiolipin levels (ACA) of IgG and IgM isotypes. APLs screening also included L-alpha-phosphatidic (ph) acid, L-alpha-phosphatidylethanolamine, L-alpha-phosphatidyl-DL-glycerol, L-alpha-phosphatidylinositol, and L-alpha-phosphatidylserine of IgG and IgM autoantibodies. Statistical analysis was performed using cut-off levels for immunoglobulin-isotypes of aPLs using 3 S.D. or 95th percentile calculated using Statgraphics-software. RESULTS: In 14 of 21 patients treated by HAART an increased number of CD4+ T lymphocytes was detected, and in 14 of 21 patients VL decreased below detection threshold during the 5 years of observation. We did not observe correlations of aPLs with age, the initial low CD4+ and high number of CD8+ T lymphocytes, and the viremic levels over the entire observation period. We did not find the elevation of aPLs in 2 of 5 patients in stage C (AIDS). Ten of 11 HIV-positive homosexuals had positive aPLs, and the same result was seen in 7 of 10 patients infected through heterosexual intercourse. aPLs levels were significantly increased in 18 of 30 patients at the beginning of HAART. ACA IgG was elevated in 14 of 30 cases, IgG antibodies against L-alpha-ph-acid in 5 of 30, ph-ethanolamine in 10 of 30, ph-inositol in 9 of 30, and L-serine in 14 of 30, combined positivity of six aPLs together was detected in 10 HIV positive patients. Significantly decreased levels of aPLs because of HAART were found in eight patients. APLs were still present in only four patients after 5 years of the treatment. Abnormalities in blood clotting were not present in any of our patients. CONCLUSION: Results of screening for seven aPLs in HIV-positive patients suggest that HAART also positively influences the autoimmune response represented by aPLs levels, but individual differences in aPLs levels were observed.