beta 2 Glycoprotein-I (beta 2GPI), a plasma component with in vitro anticoagulant properties, has been identified as a cofactor for the binding of some antiphospholipid antibodies (aPAs). In order to determine whether beta 2GPI changes were associated with the thromboembolic complications of aPAs, we measured beta 2GPI antigen (beta 2GPI:Ag), beta 2GPI aPA cofactor activity (beta 2GPI:Cof) and antibodies to beta 2GPI (alpha beta 2GPI) in 44 systemic lupus erythematosus (SLE) patients, of whom 19 had evidence of aPAs (SLE-aPA+) and 17 patients with primary antiphospholipid syndrome (PaPS). beta 2GPI:Ag levels were significantly increased in SLE-aPA+ patients and PaPS patients compared with SLE-aPA- patients and normal healthy controls. The ratio of beta 2GPI:Cof/Ag was significantly reduced in SLE-aPA+ patients compared with SLE-aPA- patients, indicating functional modification of beta 2GPI in SLE-aPA+ patients. Eighty per cent of patients with anticardiolipin (aCL) IgG also had alpha beta 2GPI, and 13% patients with no detectable aCL IgG had alpha beta 2GPI. Increased beta 2GPI:Ag and alpha beta 2GPI were associated with a clinical history of thrombosis or recurrent fetal loss. The results of these investigations suggest that beta 2GPI may play a role in the pathogenic mechanism of thrombosis associated with aPAs.