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Anti-beta-2-glycoprotein I domain 1 identifies antiphospholipid antibodies-related injuries in patients with concomitant lupus nephritis

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Abstract

Background

In this study we aimed to evaluate the usefulness of domain profiling of Beta-2-glycoprotein I(β2GPI)-Domain-1 (D1) antibodies in relation to antiphospholipid antibodies (aPL)-related nephropathy (aPL-N) in patients with biopsy-proven lupus nephritis (LN).

Methods

Of 124 consecutive patients (96 women, mean age 45.5 ± 12.3 years, mean disease duration 14.7 ± 9.6 years) fulfilling the 1982 criteria for systemic lupus erythematosus (SLE), we identified 39 patients (mean age 39.84 ± 8.6 years, mean disease duration 11.3 ± 7.7 years) with the following characteristics: (a) biopsy-proven LN; (b) no previous diagnosis of antiphospholipid syndrome (APS) according to the current classification criteria.

Results

Patients with both LN and aPL-N had higher median aβ2GPI-D1 antibody titres (220.1 CU, 25–75th IQ 29.1–334.2) as compared those with LN alone (46.5 CU, 25–75th IQ 12.5–75.1) (p = 0.0087). Median aβ2GPI-D1 antibody titres were higher in patients with acute thrombotic microangiopathy (aTMA) (N = 7) (250.1 CU, 25–75th IQ 61.2–334.2) vs. with LN alone (46.5 CU, 25–75th IQ 12.5–75.1 CU) (p = 0.0009). Having a Global Antiphospholipid Syndrome Score > 10 confers an increased probability of having acute features of aTMA (OR 6.25, 95%CI 1.2–31.8). As compared to other aPL, aβ2GPI-D1 antibodies have the best diagnostic accuracy for aTMA as evaluated by performances in Area Under the Curves in a ROC analysis.

Conclusions

aβ2GPI-D1 antibodies detection might provide a second-line assay to be performed in aβ2GPI positive patients with LN, allowing more accurate stratification of the renal vascular involvement risk, thus potentially leading to a more tailored management.

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Author information

Authors and Affiliations

  1. Department of Clinical and Biological Sciences, Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Piazza del Donatore di Sangue 3, 10154, Turin, Italy

    Savino Sciascia, Massimo Radin, Irene Cecchi, Roberta Fenoglio, Simone Baldovino, Daniela Rossi, Paolo Miraglia, Elena Rubini & Dario Roccatello

  2. Department of Clinical and Biological Sciences, School of Specialization of Clinical Pathology, University of Turin, Turin, Italy

    Massimo Radin, Irene Cecchi & Elena Rubini

  3. Pathology Division, Giovanni Bosco Hospital, Turin, Italy

    Andrea De Marchi

  4. Nephrology and Dialysis, Santa Croce Hospital, Cuneo, Italy

    Luca Besso

Authors
  1. Savino Sciascia
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Contributions

SS, MR, DRoc: research idea and study design; DRoc, LB, DRos, RF, ADM: data acquisition; SS, MR, IC, ER, DRoc: data analysis/interpretation; MR, SS, PM, SB: statistical analysis; DRoc, SS supervision or mentorship. SS: takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. Each author contributed important intellectual content during manuscript drafting or revision, accepts personal accountability for the author’s own contributions, and agrees to ensure that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved.

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Correspondence to Savino Sciascia.

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Research involving human participants and/or animals and informed consent

The study was conducted according to the declaration of Helsinki and informed consent was given to all patients that participated in the study.

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Sciascia, S., Radin, M., Cecchi, I. et al. Anti-beta-2-glycoprotein I domain 1 identifies antiphospholipid antibodies-related injuries in patients with concomitant lupus nephritis. J Nephrol 33, 757–762 (2020). https://doi.org/10.1007/s40620-019-00698-9

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