Title: Anti-β2-Glycoprotein I Autoantibody Expression as a Potential Biomarker for Strokes in Patients with Anti-Phospholipid Syndrome

Husham Bayazed

College of Medicine / University of Zakho, Iraq


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Anti-phospholipid syndrome (APS) is an autoimmune disease. Cerebral ischemia associated with APS occurs at a younger age than typical atherothrombotic cerebrovascular disease, is often recurrent, and is associated with high positive IgG anti-phospholipid (GPL) unit levels. This study sought to determine the frequency rates of anti-cardiolipin (aCL) dependent on the presence of β2-GPI, anti-β2-glycoprotein I (aβ2-GPI), and anti-phosphatidyl serine (aPS) IgG autoantibodies among stroke patients, and thus demonstrate the importance of testing for aβ2-GPI autoantibodies. For these study, stroke patients and control subjects recruited from Mosul, Erbil, and Dohuk provinces in Northeren Iraq were evaluated. All cases were under 50 years-of-age and had no recognizable risk factors. Using ELISA to evaluate the presence of IgG isotype of aCL, aβ2-GPI, and aPS autoantibodies in their blood, the results indicated that the frequency of aβ2-GPI was 14/50 (28%), aCL was 11/50 (22%), and aPS was 9/50 (18%) among stroke patients. In contrast, aCL was detected in 2/30 (6.7%) of control subjects; each of the other anti-phospholipid antibodies (APLA) was never observed. Of all the aβ2-GPI+ cases, the incidence of stroke patients having the combined profile of aβ2-GPI + aCL was 11/14 (78.6%) and of aβ2-GPI + aPS was 9/14 (64.3%). Only 2/14 (14.3%) of these aβ2-GPI+ patients also expressed aCL in the absence of aPS. The frequency of patients expressing all three markers was only 9/14 (64.3 %). In none of the APS/stroke patients were aCL or aPS expressed in the absence of the aβ2-GPI. Conversely, aβ2-GPI as a sole marker was seen in 3/14 (21.4%) of these patients (i.e., in absence of either other marker). It can be concluded from these studies that the among the three major forms of APLA examined, the presence of aβ2-GPI IgG autoantibodies appeared to correlate best with stroke in patients who were concurrently suffering APS.