Establishment of ELISA-comparable moderate and high thresholds for anticardiolipin and anti-β2 glycoprotein I chemiluminescent immunoassays according to the 2023 ACR/EULAR APS classification criteria and evaluation of their diagnostic performance.

anti-β2GPI anticardiolipin antiphospholipid syndrome classification criteria

Journal

Clinical chemistry and laboratory medicine
ISSN: 1437-4331
Titre abrégé: Clin Chem Lab Med
Pays: Germany
ID NLM: 9806306

Informations de publication

Date de publication:
24 Jul 2024
Historique:
received: 08 05 2024
accepted: 10 07 2024
medline: 24 7 2024
pubmed: 24 7 2024
entrez: 24 7 2024
Statut: aheadofprint

Résumé

Recently published 2023 ACR/EULAR APS classification criteria emphasize the importance of quantifying single-, double-, and triple-antiphospholipid antibody positivity, distinguishing between IgG and IgM isotypes, and delineating moderate/high levels of anticardiolipin (aCL) and anti-β2 glycoprotein I (anti-β2GPI) antibodies. We aimed to establish clinically important moderate/high thresholds for aCL and anti-β2GPI IgG/IgM chemiluminescent immunoassays (CLIA), in particular QUANTA Flash, comparable to our in-house ELISAs used for over two decades, and to evaluate their diagnostic performance. QUANTA Flash CLIA and in-house ELISAs were used to measure aCL and anti-β2GPI IgG/IgM. Moderate thresholds for QUANTA Flash CLIA were determined using a non-parametric approach, calculating a 99th percentile on serum samples from 139 blood donors, and by mirroring the diagnostic performance of in-house ELISA on 159 patient samples. Thresholds for QUANTA Flash CLIA achieving diagnostic performance equivalent to in-house ELISAs were 40 CU for moderate and 80 CU for high levels for aCL and anti-β2GPI IgG and IgM. The assays showed good qualitative agreement, ranging from 76.10 to 91.19 %. When considering in-house ELISA results, 14 out of 80 (17.5 %) patients did not fulfill the new ACR/EULAR laboratory classification criteria, while 27 out of 80 (33.8 %) did not when considering QUANTA Flash CLIA results. We determined moderate and high thresholds for aCL and anti-β2GPI IgG and IgM detected with QUANTA Flash CLIA, aligning with long-established in-house ELISA thresholds. These thresholds are crucial for seamlessly integrating of the new 2023 ACR/EULAR classification criteria into future observational clinical studies and trials.

Identifiants

pubmed: 39044613
pii: cclm-2024-0570
doi: 10.1515/cclm-2024-0570
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024 Walter de Gruyter GmbH, Berlin/Boston.

Références

Wilson, WA, Gharavi, AE, Koike, T, Lockshin, MD, Branch, DW, Piette, JC, et al.. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: report of an international workshop. Arthritis Rheum 1999;42:1309–11. https://doi.org/10.1002/1529-0131(199907)42:7<1309::aid-anr1>3.0.co;2-f .
doi: 10.1002/1529-0131(199907)42:7<1309::AID-ANR1>3.0.CO;2-F
Miyakis, S, Lockshin, MD, Atsumi, T, Branch, DW, Brey, RL, Cervera, R, et al.. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006;4:295–306. https://doi.org/10.1111/j.1538-7836.2006.01753.x .
doi: 10.1111/j.1538-7836.2006.01753.x
Pengo, V, Ruffatti, A, Legnani, C, Gresele, P, Barcellona, D, Erba, N, et al.. Clinical course of high-risk patients diagnosed with antiphospholipid syndrome. J Thromb Haemost 2010;8:237–42. https://doi.org/10.1111/j.1538-7836.2009.03674.x .
doi: 10.1111/j.1538-7836.2009.03674.x
Meroni, PL, Borghi, MO, Raschi, E, Tedesco, F. Pathogenesis of antiphospholipid syndrome: understanding the antibodies. Nat Rev Rheumatol 2011;7:330–9. https://doi.org/10.1038/nrrheum.2011.52 .
doi: 10.1038/nrrheum.2011.52
Lee, E, Wu, Y, Dave, E, Chock, E, Sureshanand, S. Low-titer antiphospholipid antibodies is associated with increased risk of late preterm stillbirth. Am J Obstet Gynecol 2023;228:S298–9. https://doi.org/10.1016/j.ajog.2022.11.529 .
doi: 10.1016/j.ajog.2022.11.529
Pregnolato, F, Gerosa, M, Raimondo, MG, Comerio, C, Bartoli, F, Lonati, PA, et al.. EUREKA algorithm predicts obstetric risk and response to treatment in women with different subsets of anti-phospholipid antibodies. Rheumatology 2021;60:1114–24. https://doi.org/10.1093/rheumatology/keaa203 .
doi: 10.1093/rheumatology/keaa203
Barbhaiya, M, Zuily, S, Naden, R, Hendry, A, Manneville, F, Amigo, M-C, et al.. The 2023 ACR/EULAR antiphospholipid syndrome classification criteria. Arthritis Rheumatol 2023;75:1687–702. https://doi.org/10.1002/art.42624 .
doi: 10.1002/art.42624
Favaloro, EJ, Pasalic, L, Lippi, G. Classification criteria for the antiphospholipid syndrome: not the same as diagnostic criteria for antiphospholipid syndrome. Semin Thromb Hemost 2023. https://doi.org/10.1055/s-0043-1776318 (EFirst).
doi: 10.1055/s-0043-1776318
Pierangeli, SS, de Groot, PG, Dlott, J, Favaloro, E, Harris, EN, Lakos, G, et al.. ‘Criteria’ aPL tests: report of a task force and preconference workshop at the 13th international congress on antiphospholipid antibodies, Galveston, Texas, April 2010. Lupus 2011;20:182–90. https://doi.org/10.1177/0961203310395055 .
doi: 10.1177/0961203310395055
Iwaniec, T, Kaczor, MP, Celińska-Löwenhoff, M, Polański, S, Musiał, J. Clinical utility of automated chemiluminescent antiphospholipid antibody assay. Thromb Res 2015;136:1033–9. https://doi.org/10.1016/j.thromres.2015.08.021 .
doi: 10.1016/j.thromres.2015.08.021
Lakos, G, Bentow, C, Mahler, M. A clinical approach for defining the threshold between low and medium anti-cardiolipin antibody levels for QUANTA Flash assays. Antibodies 2016;5. https://doi.org/10.3390/antib5020014 .
doi: 10.3390/antib5020014
Jacobs, JFM, Bossuyt, X. Standardization and harmonization of autoimmune diagnostics. Clin Chem Lab Med 2018;56:1563–7. https://doi.org/10.1515/cclm-2018-0807 .
doi: 10.1515/cclm-2018-0807
Harris, EN. Special report. The second international anti-cardiolipin standardization workshop/the Kingston anti-phospholipid antibody study (KAPS) group. Am J Clin Pathol 1990;94:476–84. https://doi.org/10.1093/ajcp/94.4.476 .
doi: 10.1093/ajcp/94.4.476
Tincani, A, Allegri, F, Balestrieri, G, Reber, G, Sanmarco, M, Meroni, P, et al.. Minimal requirements for antiphospholipid antibodies ELISAs proposed by the European Forum on antiphospholipid antibodies. Thromb Res 2004;114:553–8. https://doi.org/10.1016/j.thromres.2004.06.035 .
doi: 10.1016/j.thromres.2004.06.035
Bozic, B, Kveder, T, Stegnar, M, Morosini-Berus, E, Kos-Golja, M, Peternel, P, et al.. Influence of degraded phosphatidylserine on binding of antiphospholipid antibodies. Int Arch Allergy Immunol 1997;112:19–26. https://doi.org/10.1159/000237426 .
doi: 10.1159/000237426
Avcin, T, Markelj, G, Niksic, V, Rener-Primec, Z, Cucnik, S, Zupancic, M, et al.. Estimation of antiphospholipid antibodies in a prospective longitudinal study of children with migraine. Int J Headache 2004;24:831–7. https://doi.org/10.1111/j.1468-2982.2004.00752.x .
doi: 10.1111/j.1468-2982.2004.00752.x
Zigon, P, Perdan Pirkmajer, K, Tomsic, M, Kveder, T, Bozic, B, Sodin, SS, et al.. Anti-Phosphatidylserine/prothrombin antibodies are associated with adverse pregnancy outcomes. J Immunol Res 2015;2015:975704. https://doi.org/10.1155/2015/975704 .
doi: 10.1155/2015/975704
Čučnik, S, Ambrožič, A, Božič, B, Skitek, M, Kveder, T. Anti-beta2-glycoprotein I ELISA: methodology, determination of cut-off values in 434 healthy Caucasians and evaluation of monoclonal antibodies as possible international standards. Clin Chem Lab Med 2000;38:777–83. https://doi.org/10.1515/cclm.2000.111 .
doi: 10.1515/cclm.2000.111
Reber, G, Schousboe, I, Tincani, A, Sanmarco, M, Kveder, T, De, MP, et al.. Inter-laboratory variability of anti-beta2-glycoprotein I measurement. A collaborative study in the frame of the European Forum on Antiphospholipid Antibodies Standardization Group. Thromb Haemost 2002;88:66–73. https://doi.org/10.1055/s-0037-1613156 .
doi: 10.1055/s-0037-1613156
Artenjak, A, Leonardi, A, Križaj, I, Ambrožič, A, Sodin-Semrl, S, Božič, B, et al.. Optimization of unnickedβ2-glycoprotein I and high avidity anti-β2-glycoprotein I antibodies isolation. J. Immunol. Res 2014;2014:1–8. https://doi.org/10.1155/2014/195687 .
doi: 10.1155/2014/195687
Pengo, V, Tripodi, A, Reber, G, Rand, JH, Ortel, TL, Galli, M, et al.. Update of the guidelines for lupus anticoagulant detection. Subcommittee on lupus anticoagulant/antiphospholipid antibody of the Scientific and Standardisation committee of the international society on thrombosis and Haemostasis. J Thromb Haemostasis 2009;7:1737–40. https://doi.org/10.1111/j.1538-7836.2009.03555.x .
doi: 10.1111/j.1538-7836.2009.03555.x
Devreese, KM, Pierangeli, SS, de Laat, B, Tripodi, A, Atsumi, T, Ortel, TL. Testing for antiphospholipid antibodies with solid phase assays: guidance from the SSC of the ISTH. J Thromb Haemostasis 2014;12:792–5. https://doi.org/10.1111/jth.12537 .
doi: 10.1111/jth.12537
Meneghel, L, Ruffatti, A, Gavasso, S, Tonello, M, Mattia, E, Spiezia, L, et al.. The clinical performance of a chemiluminescent immunoassay in detecting anti-cardiolipin and anti-β2 glycoprotein I antibodies. A comparison with a homemade ELISA method. Clin Chem Lab Med 2015;53:1083–9. https://doi.org/10.1515/cclm-2014-0925 .
doi: 10.1515/cclm-2014-0925
Gardiner, C, Hills, J, Machin, SJ, Cohen, H. Diagnosis of antiphospholipid syndrome in routine clinical practice. Lupus 2013;22:18–25. https://doi.org/10.1177/0961203312460722 .
doi: 10.1177/0961203312460722
Ichikawa, K, Tsutsumi, A, Atsumi, T, Matsuura, E, Kobayashi, S, Hughes, GR, et al.. A chimeric antibody with the human gamma1 constant region as a putative standard for assays to detect IgG beta2-glycoprotein I-dependent anticardiolipin and anti-beta2-glycoprotein I antibodies. Arthritis Rheum 1999;42:2461–70. https://doi.org/10.1002/1529-0131(199911)42:11<2461::aid-anr25>3.0.co;2-o .
doi: 10.1002/1529-0131(199911)42:11<2461::AID-ANR25>3.0.CO;2-O
Vandevelde, A, Chayoua, W, de Laat, B, Gris, J-C, Moore, GW, Musiał, J, et al.. Semiquantitative interpretation of anticardiolipin and antiβ2glycoprotein I antibodies measured with various analytical platforms: communication from the ISTH SSC Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibodies. J Thromb Haemostasis 2022;20:508–24. https://doi.org/10.1111/jth.15585 .
doi: 10.1111/jth.15585
Miro-Mur, FA, Alijotas-Reig, J, Anunciacion-Llunell, A, Marques-Soares, J, Esteve-Valverde, E, Pardos-Gea, J. Correspondence on ‘2023 ACR/EULAR antiphospholipid syndrome classification criteria’ by Barbhaiya et al. Ann Rheum Dis 2023. https://doi.org/10.1136/ard-2023-225042 .
doi: 10.1136/ard-2023-225042
Huisman, A, Urbanus, RT, Meijer, P. Antiphospholipid antibody solid phase-based assays: problems and proposed solutions for the 2023 ACR/EULAR classification criteria for antiphospholipid syndrome. J Thromb Haemostasis 2023. https://doi.org/10.1016/j.jtha.2023.12.019 .
doi: 10.1016/j.jtha.2023.12.019
Harris, EN, Pierangeli, SS. Revisiting the anticardiolipin test and its standardization. Lupus 2002;11:269–75. https://doi.org/10.1191/0961203302lu202cr .
doi: 10.1191/0961203302lu202cr
Avcin, T, Ambrozic, A, Bozic, B, Accetto, M, Kveder, T, Rozman, B. Estimation of anticardiolipin antibodies, anti-beta2 glycoprotein I antibodies and lupus anticoagulant in a prospective longitudinal study of children with juvenile idiopathic arthritis. Clin Exp Rheumatol 2002;20:101–8.
Tektonidou, MG, Andreoli, L, Limper, M, Amoura, Z, Cervera, R, Costedoat-Chalumeau, N, et al.. EULAR recommendations for the management of antiphospholipid syndrome in adults. Ann Rheum Dis 2019;78:1296–304. https://doi.org/10.1177/0961203310361356 .
doi: 10.1177/0961203310361356
Aggarwal, R, Ringold, S, Khanna, D, Neogi, T, Johnson, SR, Miller, A, et al.. Distinctions between diagnostic and classification criteria? Arthritis Care Res 2015;67:891–7. https://doi.org/10.1002/acr.22583 .
doi: 10.1002/acr.22583

Auteurs

Polona Žigon (P)

Department of Rheumatology, 364687 University Medical Centre Ljubljana , Ljubljana, Slovenia.
FAMNIT, University of Primorska, Koper, Slovenia.

Nika Boštic (N)

Department of Rheumatology, 364687 University Medical Centre Ljubljana , Ljubljana, Slovenia.
Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia.

Aleš Ambrožič (A)

Department of Rheumatology, 364687 University Medical Centre Ljubljana , Ljubljana, Slovenia.

Žiga Rotar (Ž)

Department of Rheumatology, 364687 University Medical Centre Ljubljana , Ljubljana, Slovenia.
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.

Elizabeta Blokar (E)

Department of Rheumatology, 364687 University Medical Centre Ljubljana , Ljubljana, Slovenia.

Manca Ogrič (M)

Department of Rheumatology, 364687 University Medical Centre Ljubljana , Ljubljana, Slovenia.

Saša Čučnik (S)

Department of Rheumatology, 364687 University Medical Centre Ljubljana , Ljubljana, Slovenia.
Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia.

Classifications MeSH