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Cellular Immunity to ß₂-Glycoprotein-1 in Patients with the Antiphospholipid Syndrome¹

Inflammation Research Unit, School of Pathology, University of New South Wales, Sydney, Australia

Patients with antiphospholipid syndrome (APS) suffer recurrent thromboses, thrombocytopenia, and/or fetal loss in association with Abs that can be detected in phospholipid-dependent assays. Despite the name, the Igs associated with APS are predominantly directed against epitopes on phospholipid-binding plasma proteins, such as ß₂-glycoprotein-1 (ß₂GP1) and prothrombin. The aim of this study was to examine the cellular immune response to ß₂GP1 in patients with APS. Using a serum-free stimulation assay, PBMCs from 8 of 18 patients with APS proliferated to purified ß₂GP1 or to the ß₂GP1 present in serum, whereas no stimulation was observed by PBMCs from healthy individuals, patients with other autoimmune diseases, or anticardiolipin Ab-positive patients without histories of thromboses or fetal loss. The immune response was Ag-specific, requiring class II molecules, CD4⁺ T cells, and APCs, and was associated with a selective expansion of CD4⁺ but not CD8⁺ T cells. The proliferating T cells produced IFN- but not IL-4, indicating a bias toward a type 1 immune response. Chronic low grade stimulation of autoreactive ß₂GP1-specific, IFN--producing Th1 CD4⁺ T cells may contribute to the high risk of thromboses and pregnancy failure in patients with APS.

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