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Publication Detail
Anti-protein C antibodies and acquired protein C resistance in SLE: novel markers for thromboembolic events and disease activity?
  • Publication Type:
    Journal article
  • Publication Sub Type:
    Article
  • Authors:
    Ramirez GA, Mackie I, Nallamilli S, Pires T, Moll R, Pericleous C, Isenberg DA, Cohen H, Efthymiou M
  • Publisher:
    Oxford University Press (OUP)
  • Publication date:
    01/03/2021
  • Journal:
    Rheumatology
  • Status:
    Published
  • Country:
    England
  • Print ISSN:
    1462-0324
  • PII:
    5910321
  • Language:
    eng
  • Keywords:
    activated protein C resistance, anti-protein C antibodies, antiphospholipid antibodies, systemic lupus erythematosus, thrombosis
Abstract
OBJECTIVES: Risk factors for thromboembolism in SLE are poorly understood. We hypothesized a possible role for protein C, based on its dual activity in inflammation and haemostasis and on the evidence of an association between acquired activated protein C (APC) resistance (APCR) and high-avidity anti-protein C antibodies (anti-PC) with a severe thrombotic phenotype in venous thrombosis APS patients. METHODS: In a cross-sectional study of 156 SLE patients, the presence and avidity of IgG anti-PC was established by in house-ELISA, and APCR to exogenous recombinant human APC (rhAPC) and Protac (which activates endogenous protein C) was assessed by thrombin generation-based assays. Associations with aPL profile, thrombotic history and disease activity (BILAG and SLEDAI-2K) were also established. RESULTS: Anti-PC were detected in 54.5% of patients and APCR in 59%. Anti-PC positivity was associated with APCR to both rhAPC (P <0.0001) and Protac (P =0.0001). High-avidity anti-PC, detected in 26.3% of SLE patients, were associated with APCR in patients with thrombosis only (P <0.05), and with the development of thrombosis over time (range: 0-52 years; P =0.014). High-avidity anti-PC levels correlated with SLEDAI-2K (P =0.033) and total BILAG (P =0.019); SLEDAI-2K correlated inversely with APCR to Protac (P =0.004). CONCLUSION: Anti-PC occur in patients with SLE, independently of aPL profile, and are associated with APCR. High-avidity anti-PC are associated with thrombosis and with active disease and might prove a novel marker to monitor the risk of thrombosis and disease progression in SLE.
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