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Foret T, Dufrost V, Lagrange J, Costa P, Mourey G, Lecompte T, Magy-Bertrand N, Regnault V, Zuily S, Wahl D. Thrombin Generation Assay in Antiphospholipid Antibodies Positive Subjects as a Personalized Thrombotic Risk Assessment: State of the Art and Perspectives. Curr Rheumatol Rep 2024; 26:178-187. [PMID: 38372872 DOI: 10.1007/s11926-024-01140-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE OF THE REVIEW Thrombotic risk assessment in antiphospholipid positive (aPL +) subjects is a major challenge, and the study of in vitro thrombin generation (thrombin generation assays (TGA)) could provide useful information. Activated protein C (APC) sensitivity is involved in thrombotic events in antiphospholipid syndrome patients. We summarized methods used to assess APC sensitivity with TGA and evaluated the prognostic role of APC resistance through literature search. RECENT FINDINGS APC resistance induced by aPL is a complex pathway. Several cross-sectional studies assessed APC sensitivity to understand thrombotic event mechanisms in aPL + subjects. Only one prospective cohort had investigated the prognostic impact of APC resistance in aPL + subjects, with a positive and significant correlation between APC sensitivity and the risk of thrombosis during the follow up (hazard ratio, 6.07 [95% CI, 1.69-21.87]). APC resistance assessed with TGA could be associated with thrombotic events in aPL + subjects.
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Affiliation(s)
- Thomas Foret
- Vascular Medicine Unit, Vascular and Endovascular Surgery Department, CHU-Besancon, 3 BD Alexandre Fleming, F-25000, Besancon, France.
- Université de Franche-Comté, SINERGIES, F-25000, Besancon, France.
| | - Virginie Dufrost
- Université de Lorraine, INSERM, DCAC, F-54000, Nancy, France
- Vascular Medicine Division and National Referral Center for Rare Vascular and Systemic Autoimmune Diseases, CHRU-Nancy, F-54000, Nancy, France
| | - Jeremy Lagrange
- Université de Lorraine, INSERM, DCAC, F-54000, Nancy, France
- CHRU-Nancy, F-54000, Nancy, France
| | - Patricia Costa
- Vascular Medicine Unit, Vascular and Endovascular Surgery Department, CHU-Besancon, 3 BD Alexandre Fleming, F-25000, Besancon, France
| | - Guillaume Mourey
- Université de Franche-Comté, SINERGIES, F-25000, Besancon, France
- Medical Biology Laboratory, Biological Haemostasis Department, CHU Besançon, F-25000, Besançon, France
| | - Thomas Lecompte
- Vascular Medicine Division and National Referral Center for Rare Vascular and Systemic Autoimmune Diseases, CHRU-Nancy, F-54000, Nancy, France
- Université de Lorraine, Nancy, France
| | | | - Veronique Regnault
- Université de Lorraine, INSERM, DCAC, F-54000, Nancy, France
- CHRU-Nancy, F-54000, Nancy, France
| | - Stéphane Zuily
- Université de Lorraine, INSERM, DCAC, F-54000, Nancy, France
- Vascular Medicine Division and National Referral Center for Rare Vascular and Systemic Autoimmune Diseases, CHRU-Nancy, F-54000, Nancy, France
| | - Denis Wahl
- Université de Lorraine, INSERM, DCAC, F-54000, Nancy, France
- Vascular Medicine Division and National Referral Center for Rare Vascular and Systemic Autoimmune Diseases, CHRU-Nancy, F-54000, Nancy, France
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Kaneshige R, Shimizu N, Motoki Y, Nojima J. Antibody binding activity specific to monocyte scavenger receptor CD36 is frequently detectable in the plasma of patients with antiphospholipid syndrome. Lupus 2023; 32:1353-1355. [PMID: 37715736 DOI: 10.1177/09612033231203026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Affiliation(s)
- Risa Kaneshige
- Department of Laboratory Science, Faculty of Health Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Naoto Shimizu
- Department of Laboratory Science, Faculty of Health Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yukari Motoki
- Department of Laboratory Science, Faculty of Health Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Junzo Nojima
- Department of Laboratory Science, Faculty of Health Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
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Delarue A, Dragon-Durey MA, Darnige L. [Contribution of antiphosphatidylserine/prothrombin (anti-PS/PT) antibody detection in the diagnosis and management of antiphospholipid syndrome (APS)]. Rev Med Interne 2022; 43:545-551. [PMID: 35752484 DOI: 10.1016/j.revmed.2022.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 10/17/2022]
Abstract
Antiphospholipid syndrome (APS) is an autoimmune disease and one of the most common causes of acquired thrombophilia. It is characterised by the occurrence of thrombotic or obstetric events associated with the presence of persistent antiphospholipid antibodies. The diagnosis can be challenging, particularly because some biological tests can be disturbed by anticoagulant treatment or inflammation. In the recent years, new antiphospholipid antibodies, including anti-phosphatidylserine/prothrombin antibodies (anti-PS/PT), have emerged but their clinical significance and causality remain uncertain. Biologically, several studies have found a strong correlation between the presence of lupus anticoagulant (LA) and anti-PS/PT antibodies. Clinically, the presence of anti-PS/PT antibodies is associated with an increased risk of thrombosis and obstetric complications. There is also an association with thrombocytopenia, suggesting that the presence of anti-PS/PT antibodies may be associated with more severe clinical APS. Among seronegative APS patients, 6-17% of patients are positive for anti-PS/PT antibodies. This might influence the therapeutic management of patients. This article aims to provide an update on contribution of anti-PS/PT antibodies detection for the diagnosis and management of APS.
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Affiliation(s)
- A Delarue
- Service de médecine vasculaire, Assistance Publique-hôpitaux de Paris-Centre (AP-HP.CUP), 75015 Paris, France
| | - M-A Dragon-Durey
- Service d'immunologie biologique, Assistance Publique-hôpitaux de Paris-Centre (AP-HP.CUP), 75015 Paris, France
| | - L Darnige
- Service d'hématologie biologique, Assistance Publique-hôpitaux de Paris-Centre (AP-HP.CUP), 75015 Paris, France; Université de Paris, Inserm, Innovative Therapies in Haemostasis, 75006 Paris, France.
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Kaneshige R, Motoki Y, Yoshida M, Oku K, Morishita E, Ieko M, Ichihara K, Nojima J. Determination of diagnostic threshold in harmonization and comparison of clinical utility for five major antiphospholipid antibody assays used in Japan. J Clin Lab Anal 2022; 36:e24340. [DOI: 10.1002/jcla.24340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/20/2022] [Accepted: 02/26/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Risa Kaneshige
- Japanese Workshop for Standardization of Antiphospholipid Antibodies Ishikari‐Tobetsu Japan
- Department of Laboratory Science Faculty of Health Science Yamaguchi University Graduate School of Medicine Ube Japan
| | - Yukari Motoki
- Japanese Workshop for Standardization of Antiphospholipid Antibodies Ishikari‐Tobetsu Japan
- Department of Laboratory Science Faculty of Health Science Yamaguchi University Graduate School of Medicine Ube Japan
| | - Mika Yoshida
- Japanese Workshop for Standardization of Antiphospholipid Antibodies Ishikari‐Tobetsu Japan
- Health Sciences University of Hokkaido Dental Clinic Ishikari‐Tobetsu Japan
| | - Kenji Oku
- Japanese Workshop for Standardization of Antiphospholipid Antibodies Ishikari‐Tobetsu Japan
- Department of Rheumatology and Infectious Diseases Kitasato University Sagamihara Japan
| | - Eriko Morishita
- Japanese Workshop for Standardization of Antiphospholipid Antibodies Ishikari‐Tobetsu Japan
- Department of Clinical Laboratory Science Division of Health SciencesKanazawa University Graduate School of Medicine Kanazawa Japan
| | - Masahiro Ieko
- Japanese Workshop for Standardization of Antiphospholipid Antibodies Ishikari‐Tobetsu Japan
- Department of Hematology/Clinical Laboratory Iwate Prefectural Chubu Hospital Kitakami Japan
| | - Kiyoshi Ichihara
- Department of Laboratory Science Faculty of Health Science Yamaguchi University Graduate School of Medicine Ube Japan
| | - Junzo Nojima
- Japanese Workshop for Standardization of Antiphospholipid Antibodies Ishikari‐Tobetsu Japan
- Department of Laboratory Science Faculty of Health Science Yamaguchi University Graduate School of Medicine Ube Japan
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Pengo V. Interaction between Antiphospholipid Antibodies and Protein C Anticoagulant Pathway: A Narrative Review. Semin Thromb Hemost 2022; 48:971-977. [PMID: 35021251 DOI: 10.1055/s-0041-1742083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Thrombotic antiphospholipid syndrome (APS) is a condition in which thrombosis in venous, arterial, and/or small vessels is ascribed to the presence of antiphospholipid antibodies (aPL). Among the various proposed pathogenic theories to explain thrombotic APS, those involving the interaction between aPL and the protein C system have gained much consensus. Indeed, robust data show an acquired activated protein C resistance (APC-R) in these patients. The role of aPL in this impairment is clear, but the mechanism of action is uncertain, as the type of aPL and to what extent aPL are involved remains a gray area. Lupus anticoagulant (LA) is often associated with APC-R, but antibodies generating LA comprise those directed to β2-glycoprotein I and antiphosphatidylserine/prothrombin. Moreover, the induction of APC-R by aPL requires the presence of phospholipids and is suppressed by the presence of an excess of phospholipids. How phospholipids exposed on the cell membranes work in the system in vivo is unknown. Interestingly, acquired APC-R due to aPL might explain the clinical phenotypes of thrombotic APS. Indeed, the literature reports cases of both venous and arterial thromboembolism as well as skin necrosis, the latter observed in the severe form of protein C deficiency and in catastrophic APS.
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Affiliation(s)
- Vittorio Pengo
- Thrombosis Research Laboratory, University of Padova, Padova, Italy.,Arianna Foundation on Anticoagulation, Bologna, Italy
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