title: Influenza vaccination can induce new-onset anticardiolipins but not β2-glycoprotein-I antibodies among patients with systemic lupus erythematosus.
abstract: BACKGROUND
  Antiphospholipid syndrome is characterized by autoantibodies against cardiolipins (aCL), lupus anticoagulant, and independent β2-glycoprotein (β2GPI). Controversy exists as to whether vaccination triggers the development of antiphospholipid antibodies (aPL) in patients with systemic lupus erythematosus (SLE).
  
  
  METHODS
  Patients with SLE (101) and matched controls (101) were enrolled from 2005-2009 and received seasonal influenza vaccinations. Sera were tested by ELISA for aCL at baseline, 2, 6, and 12 weeks after vaccination. Vaccine responses were ranked according to an overall anti-influenza antibody response index. Individuals with positive aCL were further tested for β2GPI antibodies.
  
  
  RESULTS
  Patients with SLE and healthy controls can develop new-onset aCL post vaccination, although at rates which do not differ between patients and controls (12/101 cases and 7/101 controls, OR 1.81, p = 0.34). New-onset moderate aCL are slightly enriched in African American SLE patients (5/36 cases; p = 0.094). The optical density measurements for aCL reactivity in patients were significantly higher than baseline at 2 weeks (p < 0.05), 6 weeks (p < 0.05), and 12 weeks (p < 0.05) post vaccination. No new β2GPI antibodies were detected among patients with new aCL reactivity. Vaccine response was not different between patients with and without new-onset aCL reactivity (p = 0.43).
  
  
  CONCLUSIONS
  This study shows transient increases in aCL, but not anti-β2GPI responses, after influenza vaccination.
authors.affiliation: Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA.
authors.forename: E S
authors.initials: ES
authors.lastname: Vista
authors.forename: S R
authors.initials: SR
authors.lastname: Crowe
authors.forename: L F
authors.initials: LF
authors.lastname: Thompson
authors.forename: G M
authors.initials: GM
authors.lastname: Air
authors.forename: J M
authors.initials: JM
authors.lastname: Robertson
authors.forename: J M
authors.initials: JM
authors.lastname: Guthridge
authors.forename: J A
authors.initials: JA
authors.lastname: James
mesh_terms: D017153:Antibodies, Anticardiolipin / Q000097:blood / Q000276:immunology*; D001323:Autoantibodies / Q000276:immunology*; D002308:Cardiolipins / Q000276:immunology; D005260:Female; D006023:Glycoproteins / Q000276:immunology; D006801:Humans; D007252:Influenza Vaccines / Q000009:adverse effects* / Q000276:immunology*; D016682:Lupus Coagulation Inhibitor / Q000097:blood / Q000276:immunology; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000276:immunology* / Q000503:physiopathology; D014611:Vaccination / Q000009:adverse effects*; D053482:beta 2-Glycoprotein I / Q000276:immunology*
chemical_list: D017153:Antibodies, Anticardiolipin; D001323:Autoantibodies; D002308:Cardiolipins; D006023:Glycoproteins; D007252:Influenza Vaccines; D016682:Lupus Coagulation Inhibitor; D053482:beta 2-Glycoprotein I