Acquired activated protein C resistance is associated with the co-existence of anti-prothrombin antibodies and lupus anticoagulant activity in patients with systemic lupus erythematosus.
Venous thromboembolism (VTE) is one of the common manifestations in the anti-phospholipid (aPL) syndrome. We examined the levels of IgG antibodies (Abs) to beta2-glycoprotein I (beta2-GP I) and prothrombin, lupus anticoagulant (LA) activity, activated protein C resistance (APC-R), and factor V Leiden in 96 patients with systemic lupus erythematosus (SLE); 19 with VTE and 77 without VTE. Acquired APC-R, which was not found in any patient with the factor V Leiden mutation, was present in 33 (34.4%) out of the 96 patients with SLE. The presence of acquired APC-R was a strong risk factor for VTE. The SLE patients were divided into four groups according to the results of enzyme-linked immunosorbent assay (ELISA) and LA activity for each aPL Abs: ELISA+, LA+; ELISA+, LA-; ELISA-, LA+; and ELISA-, LA-. A significant association was observed between APC-R and the co-existence of anti-beta2-GP I Abs and LA activity or of anti-prothrombin Abs and LA activity. There was no association between APC-R and the presence of anti-beta2-GP I Abs, anti-prothrombin Abs, or LA activity alone. However, when multivariate logistical regression analysis was performed, it was clear that only the co-existence of anti-prothrombin and LA activity was a significant risk factor for APC-R. These findings indicate that the co-existence of anti-prothrombin Abs and LA activity may be an important factor in the pathogenesis of acquired APC-R in patients with SLE.
Nojima
Junzo
J
Laboratory for Clinical Investigation, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan. nojima@hp-lab.med.osaka-u.ac.jp
Kuratsune
Hirohiko
H
Suehisa
Etsuji
E
Kawasaki
Tomio
T
Machii
Takashi
T
Kitani
Teruo
T
Iwatani
Yoshinori
Y
Kanakura
Yuzuru
Y
D020016:Activated Protein C Resistance / Q000209:etiology*; D000328:Adult; D000368:Aged; D017152:Antibodies, Antiphospholipid / Q000032:analysis; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D005165:Factor V; D005260:Female; D006023:Glycoproteins / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000378:metabolism; D016682:Lupus Coagulation Inhibitor / Q000502:physiology*; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011516:Prothrombin / Q000276:immunology; D012307:Risk Factors; D013923:Thromboembolism / Q000209:etiology*; D020246:Venous Thrombosis / Q000209:etiology*; D053482:beta 2-Glycoprotein I
D017152:Antibodies, Antiphospholipid; D006023:Glycoproteins; D007074:Immunoglobulin G; D016682:Lupus Coagulation Inhibitor; D053482:beta 2-Glycoprotein I; C095381:factor V Leiden; D005165:Factor V; D011516:Prothrombin