Antiphospholipid antibody profile, immunochemical properties, and diagnostic value in women with early recurrent spontaneous miscarriage
Antiphospholipid antibodies (aPL), a heterogeneous group of autoantibodies, have a pathogenetic and diagnostic value for obstetric APS.Menzhinskaya I.V., Van'ko L.V., Krechetova L.V., Tetruashvili N.K., Sukhikh G.T.
Aim.0h RSM were 3.4–8.5 times more likely to be positive for antibodies against β2-glycoprotein-I (β2-GP-I), cardiolipin (CL), annexin A5 (An A5), phosphatidylserine/prothrombin complex (PS/PT), and phosphatidylethanolamine (PE) than healthy women. Serum level of IgG antibodies to β2-GP-I >17.6 U/ml was associated with a high probability of the presence of antibodies to domain I. IgG2 subclass of aPL with moderate and high levels of avidity were predominant. The panel of antibodies to β2-GP-I, An A5, PS/PT, and PE showed a high diagnostic value for RSM.
Conclusion. In patients with early RSM, the aPL profile testing including antibodies to CL, β2-GP-I, domain I, antibodies to An A5, PE, and PS/PT improves the accuracy of diagnosis in APS.
Keywords
early recurrent spontaneous miscarriage
antiphospholipid antibody profile
diagnostic value
avidity
IgG subclasses
References
- Бицадзе В.О., Хизроева Д.Х., Макацария Н.А., Егорова Е.С., Баймурадова С.М., Машкова Т.Я. Антифосфолипидные антитела, их патогенетическое и диагностическое значение при акушерской патологии. Акушерство, гинекология и репродукция. 2014; 8(2): 39-60. [Bitsadze V.O., Khizroeva D.Ch., Makatsaria N.A., Egorova E.S., Baymuradova S.M., Mashkova T.Ya. Antiphospholipid antibodies, their pathogenetic and diagnostic value in obstetric pathology. Obstetrics, gynecology, and Reproductology. 2014; 8 (2): 39-60. (in Russian)].
- Cervera R. Antiphospholipid syndrome. Thromb. Res. 2017; 151(Suppl. 1): S43-7. https://dx.doi.org/10.1016/S0049-3848(17)30066-X.
- Galarza-Maldonado C., Kourilovitch M.R., Perez-Fernandez O.M., Gaybor M., Cordero C., Cabrera S., Soroka N.F. Obstetric antiphospholipid syndrome. Autoimmun. Rev. 2012; 11(4): 288-95. https://dx.doi.org/10.1016/j.autrev.2011.10.006.
- D'Ippolito S., Meroni P.L., Koike T., Veglia M., Scambia G., Di Simone N. Obstetric antiphospholipid syndrome: a recent classification for an old defined disorder. Autoimmun. Rev. 2014; 13(9): 901-8. https://dx.doi.org/10.1016/j.autrev.2014.05.004.
- Менжинская И.В., Ванько Л.В. Патофизиологические механизмы развития акушерского антифосфолипидного синдрома. Акушерство и гинекология. 2018; 1: 5-12. [Menzhinskaya I.V., Van’ko L.V. Pathophysiological mechanisms of development of obstetric antiphospholipid syndrome. Obstetrics and Gynecology. 2018; 1: 5-12. (in Russian)]. https://dx.doi.org/10.18565/aig.2018.1.5-12.
- Менжинская И.В., Ванько Л.В. Антифосфолипидные антитела как диагностические маркеры акушерского антифосфолипидного cиндрома. Акушерство и гинекология. 2019; 2: 5-12. [Menzhinskaya I.V., Vanko L.V. Antiphospholipid antibodies as diagnostic markers of obstetric antiphospholipid syndrome. Obstetrics and gynecology. 2019; 2: 5-12. (in Russian)]. https://dx.doi.org/10.18565/aig.2019.2.5-12.
- Fialova L., Petráčková M., Kuchař O. Comparison of different enzyme-linked Immunosorbent assay methods for avidity determination of antiphospholipid antibodies. J. Clin. Lab. Anal. 2017; 31(6): e22121. https://dx.doi.org/10.1002/jcla.22121.
- McDonnell T., Artim-Esen B., Wincup C., Ripoll V.M., Isenberg D., Giles I.P. et al. Antiphospholipid antibodies to domain I of beta-2-glycoprotein I show different subclass predominance in comparison to antibodies to whole beta-2-glycoprotein I. Front. Immunol. 2018; 9: 2244. https://dx.doi.org/10.3389/fimmu.2018.02244.
- Cervera R., Conti F., Doria A., Iaccarino L., Valesini G. Does seronegative antiphospholipid syndrome really exist? Autoimmun. Rev. 2012; 11(8): 581-4. https://dx.doi.org/10.1016/j.autrev.2011.10.017.
- Mekinian A., Bourrienne M.C., Carbillon L., Benbara A., Noémie A., Chollet-Martin S. et al. Non-conventional antiphospholipid antibodies in patients with clinical obstetrical APS: Prevalence and treatment efficacy in pregnancies. Semin. Arthritis Rheum. 2016; 46(2): 232-7. https://dx.doi.org/10.1016/j.semarthrit.2016.05.006.
- Rodríguez-García V., Ioannou Y., Fernández-Nebro A., Isenberg D.A., Giles I.P. Examining the prevalence of non-criteria anti-phospholipid antibodies in patients ith anti-phospholipid syndrome: a systematic review. Rheumatology (Oxford). 2015; 54(11): 2042-50. https://dx.doi.org/10.1093/rheumatology/kev226.
- Bertolaccini M.L., Amengual O., Atsumi T., Binder W.L., de Laat B., Forastiero R. et al. Non-criteria’ aPL tests: report of a task force and preconference workshop at the 13th International congress on antiphospholipid antibodies, Galveston, TX, USA, April 2010. Lupus. 2011; 20(2): 191-205. https://dx.doi.org/10.1177/0961203310397082.
- Менжинская И.В., Кашенцева М.М., Ионанидзе Т.Б., Ванько Л.В., Сухих Г.Т. Спектр антифосфолипидных антител у женщин с привычным невынашиванием беременности и их диагностическое значение. Иммунология. 2016; 37(1): 4-9. [Menzhinskaya I.V., Kashentseva M.M., Ionanidze T.B., Vanko L.V., Sukhykh G.T. Spectrum of antiphospholipid antibodies in women with recurrent pregnancy loss and their diagnostic value. Immunology. 2016; 37 (1): 4-9. (in Russian)].
- Čučnik S., Kveder T., Artenjak A., Ulcova Gallova Z., Swadzba J., Musial J. et al. Avidity of anti-beta2-glycoprotein I antibodies in patients with antiphospholipid syndrome. Lupus. 2012; 21(7): 764-5. https://dx.doi.org/10.1177/0961203312440057.
- Alijotas-Reig J., Ferrer-Oliveras R., Ruffatti A., Tincani A., Lefkou E., Bertero M.T. et al. The European Registry on Obstetric Antiphospholipid Syndrome (EUROAPS): A survey of 247 consecutive cases. Autoimmun. Rev. 2015; 14(5): 387-95. https://dx.doi.org/10.1016/j.autrev.2014.12.010.
- Clark C.A., Davidovits J., Spitzer K.A., Laskin C.A. The lupus anticoagulant: results from 2257 patients attending a high-risk pregnancy clinic. Blood. 2013; 122(3): 341-7; quiz 466. https://dx.doi.org/10.1182/blood-2013-02-485839.
- Gardiner C., Hills J., Machin S.J., Cohen H. Diagnosis of antiphospholipid syndrome in routine clinical practice. Lupus. 2013; 22(1): 18-25. https://dx.doi.org/10.1177/0961203312460722.
- Mekinian A., Loire-Berson P., Nicaise-Roland P., Lachassinne E., Stirnemann J., Boffa M.C. et al. Outcomes and treatment of obstetrical antiphospholipid syndrome in women with low antiphospholipid antibody levels. J. Reprod. Immunol. 2012; 94(2): 222-6. https://dx.doi.org/10.1016/j.jri.2012.02.004.
- Meroni P.L., Chighizola C. Pathophysiology of the antiphospholipid syndrome (APS). Rev. Med. Interne. 2012; 33(Suppl. 2): A2-4. https://dx.doi.org/10.1016/j.revmed.2012.09.010.
- Radin M., Cecchi I., Rubini E., Schreiber K., Roccatello D., Mahler M., Sciascia S. Prevalence and significance of anti-phosphatidylserine antibodies: a pooled analysis in 5992. Thromb. Res. 2018; 170: 28-31. https://dx.doi.org/10.1016/j.thromres.2018.07.031.
- Agmon-Levin N., Seguro L., Rosario C., Mahler M., Gatto M., Tomer N. et al. Anti-β2GPI-DI antibodies are a marker of APS severity. Arthritis Rheum. 2013; 65(Suppl. 10, Special Issue): S1.
- Yin D., Chayoua W., Kelchtermans H., de Groot P.G., Moore G.W., Gris J.-C. et al. Detection of anti-domain I antibodies by chemiluminescence enables the identification of high-risk antiphospholipid syndrome patients: A multicenter multiplatform study. J. Thromb. Haemost. 2020; 18(2): 463-78. https://dx.doi.org/10.1111/jth.14682.
- Vidarsson G., Gillian Dekkers G., Rispens T. IgG subclasses and allotypes: from structure to effector functions. Front. Immunol. 2014; 5: 520. https://dx.doi.org/10.3389/fimmu.2014.00520.
- Чепанов С.В., Шляхтенко Т.Н., Зайнулина М.С., Мирашвили М.И., Соколов Д.И., Сельков С.А. Антитела к аннексину V у женщин с привычным невынашиванием беременности. Акушерство и гинекология. 2014; 7: 29-32. [Chepanov S.V., Shlyakhtenko T.N., Zainulina M.S., Mirashvili M.I., Sokolov D.I., Selkov S.A. Antibodies to annexin V in women with recurrent pregnancy loss. Obstetrics and gynecology. 2014; 7: 29-32. (in Russian)].
- Bećarević M. The IgG and IgM isotypes of anti-annexin A5 antibodies: relevance for primary antiphospholipid syndrome. J. Thromb. Thrombolysis. 2016; 42(4): 552-7. https://dx.doi.org/10.1007/s11239-016-1389-5.
- Rand J.H., Wu X.X., Quinn A.S., Taatjes D.J. The annexin A5-mediated pathogenic mechanism in the antiphospholipid syndrome: role in pregnancy losses and thrombosis. Lupus. 2010; 19(4): 460-9. https://dx.doi.org/10.1177/0961203310361485.
- Conti F., Alessandri C., Sorice M., Capozzi A., Longo A., Garofalo T. et al. Thin-layer chromatography immunostaining in detecting anti-phospholipid antibodies in seronegative anti-phospholipid syndrome. Clin. Exp. Immunol. 2012; 167(3): 429-37. https://dx.doi.org/10.1111/j.1365-2249.2011.04532.x.
- Sugi T. Kininogen-dependent antiphosphatidylethanolamine antibodies and autoantibodies to factor XII in patients with recurrent pregnancy loss. J. Obstet. Gynaecol. Res. 2013; 39(7): 1223-9. https://dx.doi.org/10.1111/jog.12110.
- Amengual O., Forastiero R., Sugiura-Ogasawara M., Otomo K., Oku K., Favas C. et al. Evaluation of phosphatidylserine-dependent antiprothrombin antibody testing for the diagnosis of antiphospholipid syndrome: results of an international multicentre study. Lupus. 2017; 26(3): 266-76. https://dx.doi.org/10.1177/0961203316660203.
- Kitaori T., Sugiura-Ogasawara M., Oku K, Papisch W., Ebara T., Ozaki Y. et al. Determination of clinically significant tests for antiphospholipid antibodies and cutoff levels for obstetric antiphospholipid syndrome. Lupus. 2015; 24(14): 1505-19. https://dx.doi.org/10.1177/0961203315595128.
Received 14.04.2020
Accepted 12.05.2020
About the Authors
Irina V. Menzhinskaya, Dr.Med.Sci., Leading Researcher at the Laboratory of Clinical Immunology, V.I. Kulakov NMRC for OG&P of Minzdrav of Russia.Tel.: +7(495)438-11-83. E-mail: i_menzinskaya@oparina4.ru. 4, Oparina str., Moscow, 117997, Russian Federation.
Ludmila V. Van’ko, Dr.Med.Sci., Professor, Leading Researcher at the Laboratory of Clinical Immunology, V.I. Kulakov NMRC for OG&P of Minzdrav of Russia.
Tel.: +7(495)438-11-83. E-mail: LVanko@oparina4.ru. 4, Oparina str., Moscow, 117997, Russian Federation.
Lubov V. Krechetova, Dr.Med.Sci., Head of the Laboratory of Clinical Immunology, V.I. Kulakov NMRC for OG&P of Minzdrav of Russia.
Tel.: +7(495)438-11-83. E-mail: l_krechetova@oparina4.ru. 4, Oparina str., Moscow, 117997, Russian Federation.
Nana K. Tetruashvili, Dr.Med.Sci., Head of the 2nd Obstetrics Department of Pathology of Pregnancy, V.I. Kulakov NMRC for OG&P of Minzdrav of Russia.
Tel.: +7(495)438-14-88. E-mail: n_tetruashvili@oparina4.ru. 4, Oparina str., Moscow, 117997, Russian Federation.
Gennady T. Sukhikh, Dr.Med.Sci., Professor, Academician of the RAS, Director of the V.I. Kulakov NMRC for OG&P of Minzdrav of Russia.
Tel.: +7(495)438-18-00. E-mail: g_sukhikh@oparina4.ru. 4, Oparina str., Moscow, 117997, Russian Federation.
For citation: Menzhinskaya I.V., Van'ko L.V., Krechetova L.V., Tetruashvili N.K., Sukhikh G.T. Antiphospholipid antibody profile, immunochemical properties, and diagnostic value in women with early recurrent spontaneous miscarriage.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2020; 8: 39-46 (in Russian)
https://dx.doi.org/10.18565/aig.2020.8.39-46