Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by
thrombosis and/or
pregnancy complications. β2-glycoprotein I (β2GPI) complexed with
phospholipid is recognized as a major target for
autoantibodies in APS; however, less than half the patients with clinical manifestations of APS possess
autoantibodies against the complexes. Therefore, the range of
autoantigens involved in APS remains unclear. Recently, we found that
human leukocyte antigen (HLA) class II molecules transport misfolded cellular
proteins to the cell surface via association with their
peptide-binding grooves. Furthermore,
immunoglobulin G heavy chain/HLA class II complexes were specific targets for
autoantibodies in
rheumatoid arthritis. Here, we demonstrate that intact β2GPI, not
peptide, forms a complex with HLA class II molecules. Strikingly, 100 (83.3%) of the 120 APS patients analyzed, including those whose
antiphospholipid antibody titers were within normal range, possessed
autoantibodies that recognize β2GPI/HLA class II complexes in the absence of
phospholipids. In situ association between β2GPI and HLA class II was observed in placental tissues of APS patients but not in healthy controls. Furthermore,
autoantibodies against β2GPI/HLA class II complexes mediated
complement-dependent cytotoxicity against cells expressing the complexes. These data suggest that β2GPI/HLA class II complexes are a target in APS that might be involved in the pathogenesis.