Anti-phosphatidylserine/prothrombin antibodies and thrombosis associate positively with HLA-DRB113 and negatively with HLA-DRB103 in SLE

• Published in: Rheumatology (Oxford, England) Vol. 62; no. 2; pp. 924 - 933
• Main Authors: Elbagir, Sahwa, Diaz-Gallo, Lina-Marcela, Grosso, Giorgia, Zickert, Agneta, Gunnarsson, Iva, Mahler, Michael, Svenungsson, Elisabet, Rönnelid, Johan
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-02-2023
• Subjects: Antibodies, Antiphospholipid; antiphosphatidylserine; Antiphospholipid Syndrome; aPL; Basic Science; beta 2-Glycoprotein I; HLA; HLA-DRB1 Chains - genetics; Humans; Lupus Erythematosus, Systemic - genetics; Medicin och hälsovetenskap; Phosphatidylserines; Prothrombin; SLE; thrombosis; Thrombosis - genetics; thrombosis; HLA; aPL; SLE; antiphosphatidylserine/prothrombin
• ISSN: 1462-0324; 1462-0332; 1462-0332
• DOI: 10.1093/rheumatology/keac327

Emerging evidence demonstrates that aPS-PT associate with thrombotic events. Genetic predisposition, including HLA-DRB1 alleles, is known to contribute to the occurrence of conventional aPL [anti-β2glycoprotein-I (anti-β2GPI) and aCL]. We investigated associations between aPS-PT and HLA-DRB1* alleles and thrombosis in SLE. Conventional aPL were included for comparison.
We included 341 consecutive SLE patients, with information on general cardiovascular risk factors, including blood lipids, LA and thrombotic events. aPS/PT, anti-β2GPI and aCL of IgA/G/M isotypes and LA were quantified.
aPS/PT antibodies associated positively with HLA-DRB1*13 [odds ratio (OR) 2.7, P = 0.002], whereas anti-β2GPI and aCL antibodies associated primarily with HLA-DRB1*04 (OR 2.5, P = 0.0005). These associations remained after adjustment for age, gender and other HLA-DRB1* alleles. HLA-DRB1*13, but not DRB1*04, remained as an independent risk factor for thrombosis and APS after adjustment for aPL and cardiovascular risk factors. The association between DRB1*13 and thrombosis was mediated by aPS-PT positivity. HLA-DRB1*03, on the other hand, associated negatively with thrombotic events as well as all aPL using both uni- and multivariate analyses. HLA-DRB1*03 had a thrombo-protective effect in aPL-positive patients. Additionally, HLA-DRB1*03 was associated with a favourable lipid profile regarding high-density lipoprotein and triglycerides.
HLA-DRB1*13 confers risk for both aPS-PT and thrombotic events in lupus. The association between HLA-DRB1*13 and thrombosis is largely, but not totally, mediated through aPS-PT. HLA-DRB1*03 was negatively associated with aPL and positively with favourable lipid levels. Thus, HLA-DRB1*03 seems to identify a subgroup of SLE patients with reduced vascular risk.