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. 2018 Oct 22;9:2413. doi: 10.3389/fimmu.2018.02413

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Copyright © 2018 McDonnell, Willis, Pericleous, Ripoll, Giles, Isenberg, Brasier, Gonzalez, Papalardo, Romay-Penabad, Jamaluddin, Ioannou and Rahman.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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PEGylated DI inhibits the LA effect of APS-IgG samples. In each figure, the y-axis shows the ratio of clotting times obtained in the presence of LS and LR reagents. LS:LR value >1.1 suggests an LA effect. (A) Demonstration of the effect of inhibitors on a modified dRVVT assay, this graph shows combined results from testing 9 samples. The mean LS:LR ratio was significantly lower in the presence of non-PEG-DI, 20 or 40 kDa WT-PEG-DI than in the absence of any of these agents. Significance was seen with all inhibitors compared to no inhibition (*p < 0.05) but there were no significant differences between the results obtained with non-PEG-DI, 20 and 40-kDa-PEG-DI. (B) Each separate line shows results from IgG of an individual patient inhibited with PEGylated and non-PEGylated Domain I in the modified dRVVT assay. The LS:LR ratios obtained with PEG-DI are either similar to or lower than those obtained with non-PEG-DI for all samples. (C) Control experiment showing that addition of non-DI proteins (albumin and octreotide) has no effect on LS:LR ratios in this coagulation assay. Each group of five columns shows the results from blood of a single individual (two with APS, one with SLE but not APS, and one HC) and in each group there are no significant differences between the columns. (D) Comparison of WT-DI and DI(D8S,D9G) in tests on three samples. Here PEG-DI(D8S,D9G) and non-PEG-DI(D8S,D9G) have similar effects to each other but less than WT-PEG-DI.