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Antibodies against the Activated Coagulation Factor X (FXa) in the Antiphospholipid Syndrome That Interfere with the FXa Inactivation by Antithrombin¹

Yao-Hsu Yang^*,, Kwan-Ki Hwang^2,*, John FitzGerald^*, Jennifer M. Grossman^*, Mihaela Taylor^*, Bevra H. Hahn^* and Pojen P. Chen^*

^* Division of Rheumatology, Department of Medicine, University of California, Los Angeles, CA 90095; and Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan

Antiphospholipid Ab have been shown to promote thrombosis and fetal loss in the antiphospholipid syndrome (APS). Previously, we found IgG anti-thrombin Ab in some APS patients that could interfere with inactivation of thrombin by antithrombin (AT). Considering that activated coagulation factor X (FXa) is homologous to thrombin in the catalytic domains and is also regulated primarily by AT, we hypothesized that some thrombin-reactive Ab may bind to FXa and interfere with AT inactivation of FXa. To test these hypotheses, we studied reactivity of eight patient-derived monoclonal IgG antiphospholipid Ab with FXa and the presence of IgG anti-FXa Ab in APS patients and investigated the effects of FXa-reactive mAb on AT inactivation of FXa. The results revealed that six of six thrombin-reactive IgG mAb bound to FXa and that the levels of plasma IgG anti-FXa Ab in 38 APS patients were significantly higher than those in 30 normal controls (p < 0.001). When the mean plus 3 SDs of the 30 normal controls was used as the cutoff, 5 of 38 APS patients (13.2%) had IgG anti-FXa Ab. Importantly, three of six FXa-reactive mAb significantly inhibited AT inactivation of FXa. Combined, these results indicate that anti-FXa Ab may contribute to thrombosis by interfering with the anticoagulant function of AT on FXa in some APS patients.

The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

¹ This work was supported by in part by Grant AR042506 from the National Institutes of Health. Y.-H.Y. was supported by a Faculty Development Award from National Taiwan University Hospital (Taipei, Taiwan).

² Address correspondence and reprint requests to Dr. Kwan-Ki Hwang, Department of Medicine/Rheumatology, University of California, Los Angeles, 1000 Veteran Avenue, Los Angeles, CA 90095-1670. E-mail address: hwangkk{at}ucla.edu

³ Abbreviations used in this paper: APS, antiphospholipid syndrome; aPL, anti-phospholipid Ab; PL, phospholipid; ₂GPI, 2-glycoprotein I; PT, prothrombin; tPA, tissue plasminogen activator; TF, tissue factor; FX, factor X; FXa, factor Xa; EC, endothelial cell; aCL, anti-cardiolipin Ab; aPT, anti-PT Ab; RU, reference unit; RCL, reactive center loop; SLE, systemic lupus erythematosus.