Some anticardiolipin antibodies recognize a combination of phospholipids with thrombin-modified antithrombin, complement C4b-binding protein, and lipopolysaccharide binding protein
J. Arvieux et al., Some anticardiolipin antibodies recognize a combination of phospholipids with thrombin-modified antithrombin, complement C4b-binding protein, and lipopolysaccharide binding protein, BLOOD, 93(12), 1999, pp. 4248-4255
The standard enzyme-linked immunosorbent assay (ELISA) for anticardiolipin
antibodies (ACA) detects a heterogenous group of antibodies against cardiol
ipin on its own, beta(2)-glycoprotein I (beta(2)GPI), and, potentially, oth
er phospholipid-binding plasma proteins from bovine or human origin. In an
attempt to identify new proteic targets of ACA, we selected 6 patients who
possessed cofactor-dependent ACA but no antibody to human or bovine beta(2)
GPI detectable in the beta(2)GPI-ELISA. Three of these samples proved to re
cognize beta(2)GPI in combination with cardiolipin, but not beta(2)GPI dire
ctly immobilized on gamma-irradiated polystyrene or agarose beads. In the o
ther cases, the component required for ACA binding was purified from adult
bovine serum or plasma by means of ammonium sulfate precipitation and chrom
atography on Phenyl-Sepharose, diethyl aminoethyl (DEAE)-cellulose, heparin
-Ultrogel, and Sephacryl S-300 columns. Sodium dodecyl sulfate-polyacrylami
de gel electrophoresis (SDS-PAGE) analysis coupled to N-terminal amino acid
microsequencing identified the cofactors of patients no. 4, 5, and 6 ACA a
s lipopolysaccharide binding protein (LBP), complement C4b-binding protein
(C4BP), and the thrombin-antithrombin (AT) complex, respectively. Adsorptio
n of each of these cofactor preparations with cardiolipin liposomes led to
suppression of ACA reactivity, concomitant with the loss of bands from SDS
gels corresponding to sequenced material. Bacterial lipopolysaccharide (whi
ch forms high-affinity complexes with LBP) specifically neutralized the cof
actor activity of the LBP preparation in a concentration-dependent manner.
Bovine serum and plasma, as well as the C4BP preparation, optimally support
ed the binding of a rabbit anti-C4BP antiserum to immobilized cardiolipin.
The binding of a rabbit anti-AT antiserum to solid-phase cardiolipin was su
stained by the thrombin-AT preparation and bovine serum, but neither by bov
ine plasma nor by native AT,thus reproducing the behavior of patient no. 6
ACA. Taking advantage of the restricted recognition by the latter ACA of a
cofactor from bovine origin appearing upon clotting, we studied the generat
ion of such activity in human plasma supplemented with bovine AT or bovine
prothrombin before clotting. In these conditions, patient no. 6 antibody bi
nding to cardiolipin required the addition of bovine AT,whereas addition of
bovine prothrombin alone was ineffective. We therefore concluded that thos
e ACA targeted bovine AT once it has been modified/cleaved by thrombin. The
se findings underline the wide heterogeneity of ACA and the links that may
exist between various coagulation pathways, inflammation and the complement
system. (C) 1999 by The American Society of Hematology.