Review : Anti-endothelial cell antibodies in systemic autoimmune diseases: prevalence and clinical significance

Abstract

Objective: To investigate the prevalence and characteristics of anti-endothelial cell antibodies (AECA) in a large cohort of patients with several well defined systemic autoimmune diseases, in order to determine their relationship with the clinical and laboratory features of these diseases.

Methods: Clinical and laboratory features of 216 consecutive Caucasian patients were prospectively studied. One hundred and seven patients had been diagnosed as having a primary systemic vasculitis-specifically, 39 had temporal arteritis (TA), 25 polyarteritis nodosa (PAN), 9 Wegener's granulomatosis (WG), and 34 Behçet's disease (BD)-, 90 patients had systemic lupus erythematosus (SLE), and 19 had a primary Sjögren's syndrome (SS). The AECA were determined by ELISA.

Results: One hundred and four (48%) patients with systemic autoimmune diseases were found to have a positive titre of AECA. Specifically, AECA were detected in 41 (38%) patients with a primary systemic vasculitis (13 (33%) with TA, 14 (56%) with PAN, 5 (56%) with WG and 9 (26%) with BD), in 58 (63%) patients with SLE, and in 5 (26%) patients with a primary SS. In patients with a primary systemic vasculitis, those with AECA were found to have an increased prevalence of disease activity (P < 0.05). In SLE patients, those with AECA were found to have an increased prevalence of vascular lesions (P < 0.05), lupus nephropathy (P < 0.05), and antic ardiolipin antibodies (aCL) (P < 0.001).

Conclusions: Patients with systemic autoimmune diseases have a high prevalence of AECA and they are associated with the presence of vascular lesions, nephropathy, and aCL in SLE, as well as with disease activity in several primary systemic vasculitis (TA, PAN, WG and BD).

Keywords

anti-endothelial cell antibodies systemic vasculitis systemic lupus erythematosus antiphospholipid antibodies

Get full access to this article

View all access options for this article.

References

Lindqvist KJ , Osterland CK Human antibodies to vascular endothelium. Clin Exp Immunol 1971; 9: 753-760.

Tan EM , Pearson CM Rheumatic disease sera reactive with capillaries in the mouse kidney. Arthritis Rheum 1972; 15: 23-28.

Cervera R , Khamashta MA , Hughes GRV (eds). Antibodies to Endothelial Cells and Vascular Damage. CRC Press: Boca Ratón, 1994.

Adler Y. et al. Anti-endothelial cell antibodies: a need for standardization . Lupus 1994; 3: 77-84.

Meroni PL , Khamashta MA , Youinou P. , Shoenfeld Y. Mosaic of antiendothelial antibodies: Review of the first international workshop on anti-endothelial antibodies: clinical and pathological significance. Milan, 9 November 1994. Lupus 1995; 4: 95-99.

D'Cruz DP et al. Antibodies to endothelial cells in systemic lupus erythematosus: a potential marker for nephritis and vasculitis. Clin Exp Immunol 1991; 85: 254-261.

Frampton G. et al. Autoantibodies to endothelial cells and neutrophil cytoplasmic antigens in systemic vasculitis.Clin Exp Immunol 1990; 82: 227-232.

Del Papa N. et al. Anti-endothelial cell IgG antibodies from patients with Wegener's granulomatosis bind to human endothelial cells in vitro and induce adhesion molecule expression and cytokine secretion. Arthritis Rheum 1996; 39: 758-766.

Cervera R. et al. Antibodies to endothelial cells in dermatomyositis: Association with interstital lung disease. Br Med J 1991 ; 302: 880-881.

10.

Navarro M. et al. Antibodies to endothelial cells and to β2-glycoprotein I in the antiphospholipid syndrome: prevalence and isotype distribution. Br J Rheumatol 1996; 35; 523-528.

11.

Tan EM et al. The 1982 revised criteria for classification of SLE. Arthritis Rheum 1982; 25: 1271-1272.

12.

Vitali C. et al. Preliminary criteria for the classification of Sjögren's syndrome . Arthritis Rheum 1993; 36: 340-347.

13.

Hunder GG et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum 1990 ; 33: 1122-1128.

14.

Lightfood RW et al. The American College of Rheumatology 1990 criteria for the classification of polyarteritis nodosa. Arthritis Rheum 1990; 33: 1088-1093.

15.

Leavitt RY et al The American College of Rheumatology 1990 criteria for the classification of Wegener's granulomatosis. Arthritis Rheum 1990; 99: 1101-1107.

16.

International Study Group for Behçet's disease. Criteria for diagnosis of Behçet's disease. Lancet 1990 ; 335: 1078-1080.

17.

Jaffe EA , Nachman RL Becker CG , Minick CR The culture of human endothelial cells derived from umbilical veins. Identification by morphologic and immunologic criteria. J Clin Inst 1973; 52: 2745-2756.

18.

American Rheumatism Association Glossary Committee : Signs and symptoms. Dictionnary Rheum Dis 1982; 1: 1-80.

19.

Urowitz MB , Gladman DD , Tozman Ecs , Goldsmith CH The lupus activity criteria count (LACC). J Rheumatol 1984; 11: 783-787.

20.

Bosch X. et al. Anti-myeloperoxidase autoantibodies in patients with necrotizing glomerular and alveolar capillaritis. Am J Kidney Dis 1992; 20: 231-239.

21.

Gharavi AE , Harris EN , Asherson RA , Hughes Grv. Anticardiolipin antibodies: isotype distribution and phospholipid specificity . Ann Rheum Dis 1987; 46: 231-239.

22.

Cervera R. et al. Isotype distribution of anticardiolipin antibodies in systemic lupus erythematosus. Prospective analysis of a series of 100 patients. Ann Rheum Dis 1990; 49: 109-113.

23.

Brandt JT , Triplett DA , Alving B. , Scharrer I. Criteria for the diagnosis of lupus anticoagulants: an update. Thromb Haemostas 1995; 74: 1185-1190.

24.

Vismara et al. Relationship between anti-cardiolipin and antiendothelial cell antibodies in systemic lupus erythematosus. Clin Exp Immunol 1988; 74: 247-253.

25.

Rosenbaum J. et al. Measurement and characterisation of circulating anti-endothelil cell IgG in connective tissue diseases. Clin Exp Immunol 1988; 72: 450-456.

26.

Baguley E. et al. Antiendothelial cell antibodies in connective tissue diseases (abstract). Br J Rheumatol 1988; 95 (suppl): S164.

27.

Heurkens Ahm et al. Anti-endothelial cell antibodies in patients with rheumatoid arthritis complicated by vasculitis. Clin Exp Immunol 1989; 78: 7-12.

28.

Ferraro G. et al. Anti-endothelial cell antibodies in patients with Wegener's granulomatosis and micropolyarteritis. Clin Exp Immunol 1990; 79: 47-53.

29.

Petty RG , Pearson JD

Endothelium—the axis of vascular health and disease. J

Coll Phys London 1989; 23; 92-102.

30.

Cines DB et al. Presence of complement fixing antiendothelial cell anti-bodies in systemic lupus erythematosus. J Clin Invest 1984; 73: 611-625.

31.

Leung Dym et al. Lytic anti-endothelial cell antibodies in haemolytic uraemic syndrome. Lancet 1988; ii:183-186.

32.

Meroni PL et al. Anti-endothelial cell antibodies: only for scientists or for clinicians too? Clin Exp Immunol 1996; 104: 199-202.

33.

Perry GJ et al.Anti-endothelial cell antibodies in lupus: Correlations with renal injury and circulating markers of endothelial damage. Q J Med 1993; 86: 727-734.

34.

Chan TM , Chenk Ikp. A prospective study of anti-endothelial cell antibodies in patients with systemic lupus erythematosus.Clin Immunol Immunpathol 1996; 78: 41-46.

35.

Chan TM et al. Clinical significance of anti-endothelial cell antibodies in systemic vasculitis: a longitudinal study comparing anti-endothelial cell antibodies and anti-neutrophil cytoplasm antibodies. Am J Kidney Dis 1993; 22: 387-392.

36.

Carreras LO et al. Arterial thrombosis, intrauterine death and 'lupus' anticoagulant: detection of immunoglobulin interfering with postacyclin formation. Lancet 1981; i: 244-246.