Non-criteria antiphospholipid antibodies and pediatric rheumatic disease: a case series

Pediatric antiphospholipid syndrome: is it the same as an adult?

IMPORTANCE

Antiphospholipid syndrome in neonates and children is a rare, but in some cases life-threatening condition with arterial and/or venous thrombosis and/or non-thrombotic neurological, skin, ophthalmological and other manifestations.

OBSERVATIONS

This review highlights the available information about the features of pediatric APS, including the rare catastrophic form, the differences between pediatric and adult APS, and the role of genetic thrombophilia in APS manifestation.

CONCLUSIONS AND RELEVANCE

The clinical manifestations and treatment options for APS in children may differ from those in adults, and prescribing therapy can be challenging due to the unique clinical and morphological characteristics of the pediatric patient. Pediatric APS may be a predictor of the development of certain autoimmune diseases and classic manifestations of APS in adulthood, therefore, a revision of the existing criteria for the diagnosis and treatment of APS in children is necessary.

Non-criteria antiphospholipid antibodies and calprotectin as potential biomarkers in pediatric antiphospholipid syndrome

Our study aimed to evaluate the presence, clinical associations, and potential mechanistic roles of non-criteria antiphospholipid antibodies (aPL) and circulating calprotectin, a highly stable marker of neutrophil extracellular trap release (NETosis), in pediatric APS patients. We found that 79% of pediatric APS patients had at least one non-criteria aPL at moderate-to-high titer. Univariate logistic regression demonstrated that positive anti-beta-2 glycoprotein I domain 1 (anti-D1) IgG (p = 0.008), anti-phosphatidylserine/prothrombin (aPS/PT) IgG (p < 0.001), and aPS/PT IgM (p < 0.001) were significantly associated with venous thrombosis. Positive anti-D1 IgG (p < 0.001), aPS/PT IgG (p < 0.001), and aPS/PT IgM (p = 0.001) were also associated with non-thrombotic manifestations of APS, such as thrombocytopenia. Increased levels of calprotectin were detected in children with APS. Calprotectin correlated positively with absolute neutrophil count (r = 0.63, p = 0.008) and negatively with platelet count (r = -0.59, p = 0.015). Mechanistically, plasma from pediatric APS patients with high calprotectin levels impaired platelet viability in a dose-dependent manner.

Lupus Anticoagulant Detection under the Magnifying Glass

Diagnosis of antiphospholipid syndrome (APS) requires the presence of a clinical criterion (thrombosis and/or pregnancy morbidity), combined with persistently circulating antiphospholipid antibodies (aPL). Lupus anticoagulant (LA) is one of the three laboratory parameters (the others being antibodies to either cardiolipin or β2-glycoprotein I) that defines this rare but potentially devastating condition. For the search for aCL and aβ2-GP-I, traditionally measured with immunological solid-phase assays (ELISA), several different assays and detection techniques are currently available, thus making these tests relatively reliable and widespread. On the other hand, LA detection is based on functional coagulation procedures that are characterized by poor standardization, difficulties in interpreting the results, and interference by several drugs commonly used in the clinical settings in which LA search is appropriate. This article aims to review the current state of the art and the challenges that clinicians and laboratories incur in the detection of LA.

Anti-β2-glycoprotein I antibody maybe a novel biomarker of spontaneous preterm birth

BACKGROUND

Spontaneous preterm birth is challenging to prevent. Only few predictors of spontaneous preterm birth risk have been reported, and further studies on spontaneous preterm birth should be conducted to reduce the number of cases.

PURPOSE

The aim of the present study was to explore if anti-β₂-glycoprotein I antibody can be used to predict the risk of spontaneous preterm birth, and its clinical value in assessing the risk of spontaneous preterm birth.

METHODS

A total of 302 pregnant women who had delivered between January 2019 and December 2021 were enrolled into the study. The subjects were assigned to the case group (28-33⁺⁶ weeks, n = 41; 34-36⁺⁶ weeks, n = 96) and control group (37-42 weeks, n = 165) according to the gestational period. The age, body mass index, and gestational days of the two groups were recorded. Blood samples were collected and the levels of anti-β₂-glycoprotein I antibody, white blood cell, red blood cell, hemoglobin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, urea, creatinine, glucose, triglyceride, and total cholesterol were evaluated. Pregnant women diagnosed with sPTB that met the standards after evaluation by the clinician were included in the study.

RESULTS

The level of anti-β₂-glycoprotein I antibody was higher in case group than in the control group [(23.93 ± 8.11)Ru/mL vs (11.50 ± 5.33)Ru/mL]. The results showed that anti-β₂-glycoprotein I antibody was an independent risk factor for spontaneous preterm birth. The area under ROC curve of anti-β₂-glycoprotein I antibody to predict spontaneous preterm birth was 0.8875 (95%CI 0.8443-0.9307). The highest predicted value of anti-β₂-glycoprotein I antibody was 16.49Ru/ml.

CONCLUSION

Anti-β₂-glycoprotein I antibody has a high clinical significance and can be used by clinicians to evaluate the probability of spontaneous preterm birth.