General Description
The presence of anti-cardiolipin antibodies in systemic lupus erythematosus (SLE) can be related to the development of thrombosis and thrombocytopenia. In gynaecology they are supposed to cause intrauterine death or recurrent abortion. Furthermore, anti-cardiolipin antibodies have been detected in neurological disorders like cerebrovascular insufficiency, cerebral ischemia, epilepsy or chorea. Anti-cardiolipin autoantibodies occur in the immunoglobulin classes IgG, IgM or IgA. The determination of IgM antibodies is a valuable indicator in the diagnosis of beginning autoimmune diseases, whereas IgG antibodies are present in progressive stages of manifested autoimmune disorders. The determination of IgA antibodies seems to have a greater importance in the African-Caribbean population.
Quantitative measurement of anti-cardiolipin antibodies, especially IgG, shows high specificity in therapy-monitoring of secondary APS related to SLE. Clinical indications for determination of anticardiolipin antibodies are: SLE, thrombosis, thrombocytopenia, cerebral ischemia, chorea, epilepsy, recurrent abortion, intrauterine death. The discovery that anti-phospholipid antibodies recognize plasma proteins that are associated with phospholipids rather than binding to the phospholipids themselves has been a major advance in APS research. Several reports indicate that beta-2-glycoprotein I antibodies are clinically relevant. Recent studies suggest the presence of a dominant epitope on the first domain of beta-2-glycoprotein I. In contrast to antibodies recognizing other domains of beta-2- glycoprotein I, anti-domain I antibodies are found to be highly associated with clinical symptoms. Anti-cardiolipin and anti-beta-2-glycoprotein I antibodies are independent risk factors for the occurrence of vascular thrombosis and pregnancy loss. However, patients testing positive for multiple antibody specificities generally have a more severe disease and higher recurrence rates despite treatment.