Anti-cardiolipin, anti-endothelial-cell and anti-malondialdehyde-LDL antibodies in uremic patients undergoing hemodialysis: Relationship with vascular access thrombosis and thromboembolic events

Article type: Research Article

Authors: George, J.^a | Aron, A.^a | Levy, Y.^a | Gilburd, B.^a | Ben-David, A.^b | Renaudineau, Y.^c | Zonana-Nachach, A.^a | Youinou, P.^b | Harats, D.^c | Shoenfeld, Y.^{a; *}

Affiliations: [a] Department of Internal Medicine `B', The Research Unit of Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel | [b] The Nephrology Unit, Sheba Medical Center, Tel Hashomer, and The Sackler Faculty of Medicine, Tel Aviv University, Israel | [c] Laboratory of Immunology, Brest, France | [d] The Lipid and Atherosclerosis Research Institute, Israel

Correspondence: [*] Corresponding author: Yehuda Shoenfeld MD, Department of Medicine B, Sheba Medical Center, Tel Hashomer 52621, Israel. Tel.: +972 3 530 2652; Fax: +972 3 535 2855; E-mail: shoenfeld@post.tau.ac.il.

Abstract: Patients with chronic renal failure requiring regular hemodialysis are known to be prone to thromboembolic events due to a hypercoagulable state. Vascular access thrombosis (VAT; including thrombosis of the vascular shunt or graft) represents a serious complication and jeopardizes life in these patients. In the current study, conducted on 81 consecutive patients from the Hemodialysis Unit, we have employed ELISA for the estimation of various autoantibody levels (anti-endothelial cell antibodies, anti-cardiolipin, anti-β2GPI and anti-modified LDL antibodies) and correlated them with the occurrence of thromboembolic events in general, and VAT in particular. We have found that the levels of antibodies reactive with human umbilical vein endothelial cells (HUVEC) but not with other EC lines (microvascular or EaHy 929) were significantly higher in hemodialysed patients with VAT in comparison with patients with no VAT (p=0.001). A weaker but yet positive correlation was observed between the levels of anti-HUVEC and anti-cardiolipin antibodies and the occurrence of thromboembolic events including deep vein thrombosis, pulmonary infarction, cerbrovascular events and VAT (both p-values equal 0.02). Anticardiolipin antibodies (aCL) were not cross reactive with β2GPI or with HUVEC. Antibodies to modified LDL, although higher in hemodialyzed patients, did not correlate with thromboembolic events. The results of this study suggest that antibodies to HUVEC may prove as a fairly good marker of VAT in hemodialysis. High levels of aCL are weakly associated with thromboembolic events and antibodies to modified LDL do not correlate with a prothrombotic state.

Keywords: Anti endothelial cell antibodies, hemodialysis, thromboembolic events

DOI: 10.3233/HAB-1999-9206

Journal: Human Antibodies, vol. 9, no. 2, pp. 125-131, 1999