Anti-cardiolipin (aCL) IgM is an autoantibody directed against cardiolipin, a phospholipid component of mitochondrial membranes. It is one of the three major antiphospholipid antibodies—alongside aCL IgG and anti-beta-2 glycoprotein I (anti-β2GPI)—associated with antiphospholipid syndrome (APS), a systemic autoimmune disorder characterized by recurrent thrombosis and pregnancy morbidity. Although aCL IgG is more strongly linked to clinical events, the IgM isotype is included in the APS classification criteria, particularly when persistently elevated and present in conjunction with relevant clinical features.
In clinical settings, aCL IgM is tested as part of the antiphospholipid antibody panel for patients with unexplained blood clots, recurrent miscarriages, or other thrombotic disorders. While its clinical significance is generally considered lower than that of the IgG isotype, aCL IgM may be relevant in certain patients—especially when IgG is absent but clinical suspicion remains high. Persistent medium-to-high titers, confirmed over a 12-week period, support the diagnosis of APS. In research, aCL IgM is studied to better understand the diversity of autoimmune responses in APS and its potential role in early immune activation or secondary autoimmune processes. Investigations also explore its interactions with other autoantibodies and contributions to the prothrombotic state characteristic of APS.
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