Tetra Positive Thrombotic Antiphospholipid Syndrome: Major Contribution of Anti-phosphatidyl-serine/Prothrombin Antibodies to Lupus Anticoagulant Activity
Open accessAbstract
Background The concurrent presence of lupus anticoagulant, anticardiolipin, and anti β2-glycoprotein I antibodies (triple positive profile) identifies patients at high risk of thromboembolic events. These patients are also positive for anti-phosphatidyl-serine/prothrombin antibodies (tetra-positive profile). Objective Understand which antibody among anti-β2-glycoprotein I and anti-phosphatidyl-serine/prothrombin is responsible for lupus anticoagulant activity. Patients/methods Affinity purified anti-β2-glycoprotein I antibodies from plasma of 14 tetra-positive patients spiked into normal pooled plasma were tested. Results and conclusions Anti-β2-glycoprotein I antibodies did not prolong the diluted Russell viper venom time and silica clotting time (median ratio 0.98, interquartile ratio [IQR] 0.9-1.06; and 1.0, IQR 0.91-1.03, respectively). Anticoagulant activity remained in the flow-through that was deprived of anti-β2 glycoprotein I antibodies (median ratio 1.88, IQR 1.58-2.77; and 1.75, IQR 1.17-2.9, respectively). This material was loaded on size-exclusion chromatography Sephacryl S-300 column and showed that anticoagulant activity and anti-phosphatidyl-serine/prothrombin antibodies coeluted in the same fractions. Besides, the flow through was poured into a prothrombin affinity column. Protein yield in three patients ranged from 54 to 91 μg/mL and showed strong positivity in phosphatidyl-serine/prothrombin ELISA. The affinity purified material prolonged the coagulation ti…
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aPS/PT can be considered a surrogate of LA as these antibodies generally present in triple-positive patients and are responsible for the majority of LA activity.
“Test for anti-phosphatydilserine/prothrombin antibodies (aPS/PT), which can be considered a surrogate of LA as these antibodies generally present in triple-positive patients (determining the so-called “tetra-positivity”) and are responsible for the majority of LA activity [88,89].”
From Lupus Anticoagulant Detection under the Magnifying Glass (2023) · cites this paper as [89]
Cites
Update of the guidelines for lupus anticoagulant detection
PENGO, V., TRIPODI, A., REBER, G., RAND, J. H., ORTEL, T. L., GALLI, M., & DE GROOT, P. G. (2009) · Journal of Thrombosis and Haemostasis · doi:10.1111/j.1538-7836.2009.03555.x · Cited by 1,197 · see citing works
Self-citationClinical course of high‐risk patients diagnosed with antiphospholipid syndrome
PENGO, V., RUFFATTI, A., LEGNANI, C., GRESELE, P., BARCELLONA, D., ERBA, N., TESTA, S., MARONGIU, F., BISON, E., DENAS, G., et al. (2010) · Journal of Thrombosis and Haemostasis · doi:10.1111/j.1538-7836.2009.03674.x · Cited by 633 · see citing works
Self-citationBiasiolo, A., Rampazzo, P., Brocco, T., & Pengo, V. (1999) · Thrombosis and Haemostasis · doi:10.1055/s-0037-1614453 · Cited by 76 · see citing works
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Moore, G. W., Jones, P. O., Platton, S., Hussain, N., White, D., Thomas, W., Rigano, J., Pouplard, C., Gray, E., & Devreese, K. M. J. (2021) · Journal of Thrombosis and Haemostasis · doi:10.1111/jth.15438 · Cited by 47 · see citing works
Diagnostic Challenges on the Laboratory Detection of Lupus Anticoagulant
Tripodi, A. (2021) · Biomedicines · doi:10.3390/biomedicines9070844 · Cited by 14 · see citing works
Lupus Anticoagulant Detection under the Magnifying Glass
Molinari, A. C., Martini, T., Banov, L., Ierardi, A., Leotta, M., Strangio, A., & Santoro, R. C. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12206654 · Cited by 9 · see citing works
“Test for anti-phosphatydilserine/prothrombin antibodies (aPS/PT), which can be considered a surrogate of LA as these antibodies generally present in triple-positive patients (determining the so-called “tetra-positivity”) and are responsible for the majority of LA activity [88,89].”
Background
- Authors
- Cattini, M. G., Bison, E., Pontara, E., Cheng, C., Denas, G., & Pengo, V.
- Affiliations
- University of Padua (IT)
- Corresponding author
- Pengo, Vittorio
- Venue
- Journal of Thrombosis and Haemostasis
- Publisher
- Elsevier BV
- Published
- 2020-05
- Volume
- 18
- Issue
- 5
- Pages
- 1124-1132
- ISSN
- 1538-7836 (ISSN-L)
- OpenAlex
- W3006613364
- Cited by
- 68
- References
- 3
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 10 · 2023: 10 · 2022: 15 · 2021: 11 · 2020: 10
- FWCI
- 8.66
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thrombosis and Haemostasis (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Health Sciences › Medicine › Surgery › Heparin-Induced Thrombocytopenia and Thrombosis
- Keywords
- lupus anticoagulant, anti-beta2-glycoprotein I antibodies, anticardiolipin antibodies, anticoagulant activity, thrombosis risk
- MeSH terms
- Humans, Phosphatidylserines, Prothrombin, Serine, Lupus Coagulation Inhibitor, Antiphospholipid Syndrome, Antibodies, Anticardiolipin
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