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Aktuelle Rheumatologie 2014; 39(01): 58-63
DOI: 10.1055/s-0033-1353149
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Neue Wege in der Diagnostik des Antiphospholipid Syndroms

New Approach in the Diagnostics of Antiphospholipid Syndrome
D. Roggenbuck
1   Faculty of Natural Sciences, Brandenburg Technical University Cottbus-Senftenberg, Senftenberg
4   GA Generic Assays GmbH, Dahlewitz/Berlin
,
K. Egerer
2   Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin
,
P. von Landenberg
3   Institute of Laboratory Medicine, Bürgerspital Solothurn, Schweiz
,
T. Dörner
2   Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin
› Author Affiliations
Further Information

Publication History

Publication Date:
09 August 2013 (online)

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Zusammenfassung

Die Diagnose des Antiphospholipid Syndroms (APS) stellt unverändert eine klinische Herausforderung insbesondere bezüglich der Bestimmung der sogenannten Antiphospholipid Antikörper (aPLAk) und deren Einfluss auf die Diag­nosestellung dieser klinischen Entität dar. Die vor Kurzem revidierten Klassifikationskriterien für APS empfehlen bei klinischem Verdacht die Verwendung von enzyme-linked immunosorbent assays (ELISAs) für die Bestimmung von anti-beta 2 Glykoprotein I (β2GPI) und Cardiolipin-abhängigen anti-β2GPI IgG und IgM. Zusätzlich können aPLAk als Lupusantikoagulanz mittels eines funktionellen Gerinnungstestes als Laborkriterium zur Diagnosestellung ermittelt werden. Entsprechend den Klassifikationskriterien ist ohne positives Laborkriterium keine Diagnose des APS möglich. Andere aPLAk mit Reaktivitäten gegen unterschiedliche Phospholipide und deren Kofaktoren wurden beschrieben und deren potentieller Nutzen für die APS Serologie hervorgehoben. Antikörperprofiling verschiedener aPLAk wird als ein neuer Ansatz für die Risikoabschätzung der Entwicklung von thrombotischen Ereignissen für Patienten mit APS diskutiert. Je mehr aPLAk Spezifitäten gegen unterschiedliche Phospholipid- bzw. Kofaktorepitope vorkommen, desto höher ist das Risiko für das Auftreten von klinischen Komplikationen des APS wie zum Beispiel thrombotische Ereignisse. Daher können neue Wege für die gleichzeitige Bestimmung von mehreren aPLAk in einer Patientenprobe sinnvoll sein, um zusätzliche Information für die Diagnose und letztendlich Risikoabschätzung von APS zu liefern. Multiplextechnologien zur Bestimmung von aPLAk können eine Alternative dafür sein. Insbesondere Line-Immunoassays (LIAs) mit Membranen als Festphase für die Immobilisierung von Phospholipiden und deren Kofaktoren sind als Alternative zu ELISA für die Bestimmung von aPLAk kürzlich beschrieben worden. Diese Übersichtsarbeit diskutiert die neuen Entwicklungen auf dem Gebiet des aPLAk Profilings und die entsprechende Verwendung von LIAs in der APS Serologie.

Abstract

The diagnosis of antiphospholipid syndrome (APS) remains a clinical challenge in particular with regard to the assessment of so called antiphospholipid (aPL) antibodies and their impact on the diagnosis of this autoimmune clinical entity. The recently revised classification criteria for APS recommend, when there is a clinical suspicion, the use of an enzyme-linked immunosorbent assay (ELISA) for the detection of anti-beta 2 glycoprotein I (β2GPI) and cardiolipin-dependent anti-β2GPI IgG and IgM. In addition, aPL antibodies can be determined as lupus anticoagulant by a functional coagulation assay as laboratory criterion. According to the classification criteria, a diagnosis of APS requires at least one positive laboratory criterion. However, other aPL antibodies are reactive with differing phospholipids and corresponding cofactors have been reported to be useful for the serological diagnosis of APS while the jury is still out concerning the possibility to reliably identify the full range of true APS cases. Antibody profiling of several aPL antibodies appears to pave the way for a new understanding of the risk assessment of thrombotic events in APS patients. The more different aPL antibodies occur in a patient the higher is the risk for the development of clinical APS manifestations such as thrombotic events. Thus, new approaches to multiparametric aPL antibody detection are required to provide the necessary information regarding diagnosis and eventually outcome in APS patients. Multiplex analysis of aPL antibodies candidates as an alternative thereof. In particular, line immunoassays (LIAs) employing membranous solid phases for the immobilisation of phospholipids and their respective cofactors are reported to detect the corresponding antibodies efficiently and represent an alternative to ELISA. Novel developments in the field of aPL antibody profiling and the currently available data on LIAs for APS serology are summarised in this review.

Schlüsselwörter

Antiphospholipid Syndrom - Antiphospholipid Antikörper - Line-Immunoassay

Key words

antiphospholipid syndrome - antiphospholipid antibodies - line immunoassay
 

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