title: Optimising testing for phospholipid antibodies.
abstract: OBJECTIVE
  To compare anticardiolipin (ACL) and anti-beta2 glycoprotein 1 (beta2gp1) enzyme linked immunosorbent assays (ELISAs) in the diagnosis of antiphospholipid syndrome (APS) and to incorporate these results into a meta-analysis of published data.
  
  
  METHODS
  Three representative commercial ACL ELISAs and an in house beta2gp1 assay were optimised and then assessed on 124 sera from normal donors, patients with infection, or patients with APS. A Medline search was screened for papers meeting defined criteria to conduct a meta-analysis. The performance of the assays used in this study was included.
  
  
  RESULTS
  A non-quantitative ACL assay performed at least as well as the anti-beta2gp1 assay in the diagnosis of APS. Meta-analysis confirmed that neither assay is perfect, although the anti-beta2gp1 assay had a higher specificity and lower sensitivity than the ACL assay.
  
  
  CONCLUSIONS
  The pooled data suggest that the ACL assay is used to investigate thrombosis without overt underlying pathology and that the improved specificity of the anti-beta2gp1 assay is exploited where infection, connective tissue disease, or atheroma are present.
authors.affiliation: Department of Immunopathology, St Bartholomews and the London NHS Trust, London EC1A 7BE, UK. mrhelbert@mds.qmw.ac.uk
authors.forename: M
authors.initials: M
authors.lastname: Helbert
authors.forename: S
authors.initials: S
authors.lastname: Bodger
authors.forename: J
authors.initials: J
authors.lastname: Cavenagh
authors.forename: D
authors.initials: D
authors.lastname: D'Cruz
authors.forename: J M
authors.initials: JM
authors.lastname: Thomas
authors.forename: P
authors.initials: P
authors.lastname: MacCallum
mesh_terms: D017153:Antibodies, Anticardiolipin / Q000097:blood*; D016736:Antiphospholipid Syndrome / Q000175:diagnosis*; D001323:Autoantibodies / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D006023:Glycoproteins / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D012372:ROC Curve; D012680:Sensitivity and Specificity; D053482:beta 2-Glycoprotein I
chemical_list: D017153:Antibodies, Anticardiolipin; D001323:Autoantibodies; D006023:Glycoproteins; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D053482:beta 2-Glycoprotein I