From the Departments of Hematology and Blood Transfusion and Neurology
(D.Z.), San Carlo Borromeo Hospital, Milan, Italy.
Correspondence to Vincenzo Toschi, MD, Dipartimento di Ematologia e Trasfusionale, Ospedale San Carlo Borromeo, Via Pio II, 3, 20153 Milano, Italy. E-mail vitoschi{at}tin.it
Background and
Purpose—Anticardiolipin antibodies (aCL) are associated with
thrombotic phenomena including cerebral ischemia in young
adults. Although aCL are directed to a neoepitope formed by
phospholipid and ß2-glycoprotein I (ß2-GPI),
immunoassays based on cardiolipin as target antigen are widely used. We
previously demonstrated that 47% of aCL-negative systemic lupus
erythematosus (SLE) patients had antiphospholipid
antibodies (aPL) to epitopes other than cardiolipin, and we found an
association between aPL to noncardiolipin antigens and thrombosis. We
now assess the prevalence and clinical significance of noncardiolipin
aPL in young adults with cerebrovascular disease of undetermined
etiology.
Methods—Seventy-seven non-SLE patients, aged <51 years, with
cerebral ischemia were studied. Specificity of aPL were
characterized by ELISAs using 7 different phospholipids: cardiolipin
(CL), phosphatidylserine (PS), phosphatidylinositol
(PI), phosphatidylglycerol (PG), phosphatidic acid (PA),
phosphatidylcholine, and phosphatidylethanolamine.
Results—Thirty-four patients (44.1%), had aPL to 1 or more of
the following antigens: 23.4% to CL, 18.2% to PS, 15.6% to PG,
14.3% to PA, and 28.6% to PI. Fifty-nine patients (76.6%) were aCL
negative. Of these subjects 23.4% showed aPL to noncardiolipin
epitopes. PI was the specificity with highest prevalence in all
subgroups, and in 6 patients anti-PI antibodies were the only
detectable aPL. The binding of aPL to the different antigens was
ß2-GPI dependent.
Conclusions—Our data demonstrate a high prevalence of aPL in
young adults with cerebral ischemia of undetermined cause. PI
was the specificity with highest prevalence, suggesting that anti-PI
antibodies may be an immunological marker in young patients with
cerebrovascular disease.
© 1998 American Heart Association, Inc.
Original Contributions
High Prevalence of Antiphosphatidylinositol Antibodies in Young Patients With Cerebral Ischemia of Undetermined Cause
Key Words: antibodies, anticardiolipin • antibodies, antiphospholipid • cerebral ischemia • hemostasis • young adults
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