Non-Criteria Antiphospholipid Antibodies in Obstetrical “seronegative Anti-Phospholipid syndrome”

Arsene Mekinian¹, Marie Charlotte Bourrienne², Lionel Carbillon³, Sabine Grootenboer², Luc Dechaisemartin⁴, Sylvie chollet Martin², Olivier Fain⁵ and Pascale Nicaise-Roland⁶, ¹Internal Medicine, DHUi2B Saint Antoine Hospital, paris, France, ²Unité Fonctionnelles d'Immunologie « Autoimmunité et Hypersensibilités », AP-HP, Hôpital Bichat-Claude Bernard, Paris, paris, France, ³Service de gynécologie-obstétrique, Université Paris 13, AP-HP, Hôpital Jean Verdier, 93140, Bondy, France., Bondy, France, ⁴Unité Fonctionnelles d'Immunologie « Autoimmunité et Hypersensibilités », AP-HP, Hôpital Bichat-Claude Bernard, Paris, PARIS, France, ⁵Hôpital Saint Antoine, DHU i2B, Service de Médecine Interne, paris, France, ⁶Unité Fonctionnelles d'Immunologie « Autoimmunité et Hypersensibilités », AP-HP, Hôpital Bichat-Claude Bernard, Paris, Paris, France

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: antiphospholipid syndrome and pregnancy

Session Information

Title: Antiphospholipid Syndrome

Session Type: Abstract Submissions (ACR)

Background/Purpose

The aims of our prospective study were to determine the prevalence of non-criteria aPL and their clinical relevance in a seronegative population with pregnancy morbidity according to Sapporo criteria.

Methods

We included 118 women: 73 with history of pregnancy morbidity according to clinical Sapporo’s criteria (SN-APS), 38 patients with confirmed obstetrical APS (SP-APS) and 45 with pregnancy without any obstetrical complication (Controls). Other than APS thrombophilia screening was negative in all women (protein C, S, ATIII, V and II mutations).

The IgG/ IgM anti-phosphatidylethanolamine antibodies (aPE), IgG/IgM anti-phosphatidylserin/prothrombin antibodies (aPS/PT) and IgG anti-annexin 5 antibodies (aANX) were measured by commercial ELISAs (Theradiag, Instrumentation laboratory).

Results

Among the SN-APS group, 47% women presented ≥ 3 early miscarriages, 43% mid-to-late pregnancy loss and 22% premature birth <34 weeks of gestation related to placental insufficiency.

Non-criteria aPL were detected in 32% of SN-APS and 72% SP-APS and 13% controls (p<0.05). Among the non-criteria aPL antibodies, only the aPE IgG were more frequent in SN-APS patients than controls (18% vs 2%; p<0.05) and the levels of IgG aPE and IgG aANX were higher in SN-APS patients (median titres 6 U/mL and 8 U/mL, respectively), than in controls (2 U/mL and 2 U/mL, respectively; p<0.0001)(figures 2-3). Non-criteria aPL antibodies were present in 74% SP-APS versus 33% of SN-APS (p<0.05). APS/PT antibodies were more frequent in the SP-APS group: 48% vs 4.4% in controls and 2.2% in SN-APS (p<0.001). IgA anti-β2GPI antibodies were negative in SN-APS vs 23% SP-APS. Antibodies to anti-domain I of β2GPI were absent in SN-APS vs 30% of SP-APS. None of the five aPL antibodies was associated with specific obstetrical feature in SN-APS.

Conclusion

Our results suggest that non-criteria antibodies can be detected in 33% of women with obstetrical complications suggestive of APS with negative aPL.

Figure 1. The prevalence of non-criteria APL in SN-APS, SP-APS and controls.

Figure 3. Anti-PE IgG titres in different groups.

Figure 2. The frequency of different non-criteria APS prevalence in SN-APS, SP-APS and controls.

Disclosure:

A. Mekinian,
None;

M. C. Bourrienne,
None;

L. Carbillon,
None;

S. Grootenboer,
None;

L. Dechaisemartin,
None;

S. chollet Martin,
None;

O. Fain,
None;

P. Nicaise-Roland,
None.

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