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Serum protocadherin 18 as a potential biomarker for antiphospholipid syndrome: a case-control study
Yuebing Wang1, Guijuan Guo2, Xiangjun Liu1
1Department of Rheumatology and Immunology, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis, Peking University People's Hospital, Beijing, China.
Abstract:
This study aimed to evaluate the discriminatory capacity of serum Protocadherin 18 (PCDH18) for Antiphospholipid Syndrome (APS), investigate its association with specific clinical and laboratory manifestations. A total of 208 participants were enrolled, including 104 patients with APS, 28 asymptomatic aPL carriers, and 76 healthy donors (HD). Serum PCDH18 levels were quantified using enzyme-linked immunosorbent assay (ELISA). We evaluated the associations of PCDH18 levels with clinical manifestations and laboratory test parameters. The discriminatory capacity was evaluated using Receiver Operating Characteristic (ROC) curve analysis. Serum PCDH18 levels were significantly elevated in APS patients compared to both aPL carriers and HD [97.42 (IQR: 82.48) pg/mL vs. 42.74 (IQR: 52.95) pg/mL, P<0.001; 97.42 (IQR: 52.95) pg/mL vs. 43.92 (IQR: 51.85) pg/mL, P<0.001], with no significant difference between aPL carriers and HD. PCDH18 had moderate value in discriminating APS from aPL carriers (AUC = 0.779, 95% CI: 0.691-0.866). At a cut-off of 98.63 pg/mL, specificity was 100.00% and sensitivity 50.00%, yielding a positive likelihood ratio (LR+) of infinity and a negative likelihood ratio (LR-) of 0.50. For differentiating APS from HD, the AUC was 0.746 (95% CI: 0.674-0.818); at a cut-off of 54.66 pg/mL, sensitivity and specificity were 71.15% and 65.79%, respectively (LR+ = 2.08, LR- = 0.44). When comparing APS with total controls, the AUC was 0.755 (95% CI: 0.690-0.819), with a cut-off of 92.46 pg/mL providing 51.92% sensitivity and 84.62% specificity (LR+ = 3.38, LR- = 0.57). Elevated PCDH18 levels were significantly associated with thrombosis recurrence (OR = 1.02, 95% CI: 1.00-1.05). Serum PCDH18 is elevated in APS patients, demonstrates moderate discriminatory capacity in distinguishing APS from aPL carriers and healthy donors, and correlates with thrombotic recurrence, indicating its potential as an exploratory adjunctive biomarker.