title: Clinical and neuroimaging correlates of antiphospholipid antibodies in multiple sclerosis: a preliminary study.
abstract: BACKGROUND
  The presence of antiphospholipid antibodies (APLA) in multiple sclerosis (MS) patients has been reported frequently but no clear relationship between APLA and the clinical and neuroimaging features of MS have heretofore been shown. We assessed the clinical and neuroimaging features of MS patients with plasma APLA.
  
  
  METHODS
  A consecutive cohort of 24 subjects with relapsing-remitting (RR) MS were studied of whom 7 were in remission (Rem) and 17 in exacerbation (Exc). All subjects were examined and underwent MRI of brain. Patients' plasma was tested by standard ELISA for the presence of both IgM and IgG antibodies using a panel of 6 targets: cardiolipin (CL), beta2 glycoprotein I (beta2GPI), Factor VII/VIIa (FVIIa), phosphatidylcholine (PC), phosphatidylserine (PS) and phosphatidylethanolamine (PE).
  
  
  RESULTS
  In exacerbation up to 80% of MS subjects had elevated titers of IgM antibodies directed against the above antigens. However, in remission, less than half of MS patients had elevated titers of IgM antibodies against one or more of the above antigens. This difference was significant, p < 0.01, for all 6 target antigens. Interestingly, none of the MS patients had elevated plasma titers of IgG against any of the target antigens tested. Correlation analysis between MRI enhancing lesions and plasma levels of APLA revealed high correlation for aPC, aPS and aFVIIa (p </= 0.0065), a trend for aPE and aCL (p = 0.056), and no correlation for abeta2GP1. The strongest correlation was for aFVIIa, p = 0.0002.
  
  
  CONCLUSIONS
  The findings of this preliminary study show that increased APLA IgM is associated with exacerbations of MS. Currently, the significance of this association in pathogenesis of MS remains unknown. However, systematic longitudinal studies to measure APLA in larger cohorts of patients with relapsing-remitting MS, particularly before and after treatment with immunomodulatory agents, are needed to confirm these preliminary findings.
authors.affiliation: Wallace H. Coulter Platelet Laboratory, University of Miami Dept. of Medicine, Miller School Of Medicine, Miami, FL, USA. cbidot@med.miami.edu
authors.forename: Carlos J
authors.initials: CJ
authors.lastname: Bidot
authors.forename: Lawrence L
authors.initials: LL
authors.lastname: Horstman
authors.forename: Wenche
authors.initials: W
authors.lastname: Jy
authors.forename: Joaquin J
authors.initials: JJ
authors.lastname: Jimenez
authors.forename: Carlos
authors.initials: C
authors.lastname: Bidot
authors.forename: Yeon S
authors.initials: YS
authors.lastname: Ahn
authors.forename: J Steven
authors.initials: JS
authors.lastname: Alexander
authors.forename: Eduardo
authors.initials: E
authors.lastname: Gonzalez-Toledo
authors.forename: Roger E
authors.initials: RE
authors.lastname: Kelley
authors.forename: Alireza
authors.initials: A
authors.lastname: Minagar
mesh_terms: D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009103:Multiple Sclerosis / Q000097:blood* / Q000175:diagnosis / Q000473:pathology*
chemical_list: D017152:Antibodies, Antiphospholipid; D007075:Immunoglobulin M