Ab1804

Antiphospholipid antibodies in leprotic patients: A correlation with disease manifestations

A. Elbeialy¹, K. Strassburger-Lorna, T. Atsumi, M.L. Bertolaccini, O. Amengual, M. Hanafi¹, M.A. Khamashta, G.R.V. Hughes

Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, London, UK; ¹Al-Azhar Faculty of Medicine, Cairo, Egypt.

ABSTRACT
Objectives
Previous studies showed that antiphospholipid antibodies (aPL) are frequent in the sera of leprosy patients and are most probably directed against body tissue cardiolipins. Some groups have demonstrated differences between the binding specificity of “autoimmune-aPL” and “non-autoimmune-aPL”. It is widely accepted that a plasma protein, b₂-Glycoprotein I (b₂-GPI), is required for the binding of autoimmune anticardiolipin antibodies (aCL) to cardiolipin. However, some reports suggested heterogeneity of leprosy aCL with respect to their b₂-Glycoprotein I (b₂GPI) dependency, although no thromboembolic complications have been reported. This study was designed to assess the specificity of aPL by investigating the prevalence of aCL, anti-phosphatidylserine (aPS), anti-phosphatidylinositol (aPI), anti-b₂GPI and antiprothrombin (aPT) antibodies, and evaluate their clinical significance in a group of patients with lepromatous leprosy.

Patients and methods
35 lepromatous leprosy patients were selected randomly from an Egyptian leprosarium as a study group. 35 normal household contact controls were selected matching the study group for both sex and age. aCL, aPS, aPI, aPT, anti-b₂GPI and b2-dependent aCL antibodies were investigated by ELISA in all patients and controls.

Results
aCL antibodies were more frequent in leprosy patients than in controls [13/35 (37%) vs. 3/35 (9%), respectively, p = 0.02] and significantly correlated with Raynaud's phenomenon, skin nodules, chronic skin ulcers and urticarial skin rash. No association was found with hypopigmentation, hyperpigmentation and saddle nose. None of the patients presented aPS nor aPI. Only 1 subject from the control group presented aPI along with aCL. aPT were present in 2/35 (5.7%) and anti-b₂GPI in 1/35 (2.9%) leprotic patients. None of the individuals from the control group presented aPT nor anti-b₂GPI.

Conclusions
An association was found between the presence of aCL and certain dermatological manifestations of leprosy, such as Raynaud's phenomenon, skin nodules, chronic skin ulcers and urticarial skin rash. As in other infectious diseases, there was a lack of b₂GPI-dependency and an absence of thrombotic complications.

Key words: aPL, leprosy, aCL, b₂-GPI, antiprothrombin.

This work was supported in part by Lupus UK.

Please address correspondence and reprint requests to: Dr M.A. Khamashta, Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, London SE1 7EH, UK.