Pathogenesis of antiphospholipid syndrome: understanding the antibodies
Abstract
Antiphospholipid antibodies (aPL) are both diagnostic markers for, and pathogenic drivers of, antiphospholipid syndrome (APS). Although the presence of aPL is a necessary pre-condition, APS-associated clotting is seemingly triggered by an additional 'second hit', frequently related to innate inflammatory immune responses. β(2) glycoprotein I (β(2)GPI)-dependent aPL, the most important subset of these antibodies, mediate several--not necessarily alternative--thrombogenic mechanisms, mainly on the basis of their reactivity with β(2)GPI expressed on the membrane of cells that participate in the coagulation cascade. Recurrent pregnancy complications associated with aPL cannot be explained solely by thrombosis, and alternative pathogenic mechanisms have been reported. Although one in vivo model of fetal loss suggests a mechanism of aPL-mediated acute placental inflammation, other models and the histopathological examination of APS placentae do not support a widespread inflammatory signature. β(2)GPI-dependent aPL are thought to recognize their antigen on placental tissues, inhibit the growth and differentiation of trophoblasts, and eventually cause defective placentation. Why antibodies with similar antigen specificity produce different clinical manifestations is not clear. Characterization of the molecular basis of the pathogenic mechanisms involved, including the putative second hits and the role of complement activation, might offer an answer to this question.
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LA is identified in patients with antiphospholipid syndrome and also other diseases such as coronavirus disease 2019.
“LA is identified in patients with antiphospholipid syndrome [14,24] and also other diseases such as coronavirus disease 2019 [25], in which anti-PS/PT is detected [26].”
From Performance characteristics of 5 numerical indexes in mixing test interpretation under coexistence of lupus anticoagulant and coagulation factor deficiency (2023) · cites this paper as [24]
There is no single test to detect all LA, and guidelines recommend performance of two different tests (dRVVT and LA-sensitive APTT).
“There is no single test to detect all LA1, 6, 7, 8 and guidelines recommend performance of two different tests that represent different assay principles, the diluted Russell's viper venom time (dRVVT) and a LA‐sensitive activated partial thromboplastin time (APTT).6, 7, 8”
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Self-citationHydroxychloroquine as an Immunomodulatory and Antithrombotic Treatment in Antiphospholipid Syndrome
Arachchillage, D. J., Laffan, M., & Pericleous, C. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24021331 · Cited by 53 · see citing works
Prinz, N., Clemens, N., Canisius, A., & Lackner, K. J. (2013) · Thrombosis and Haemostasis · doi:10.1160/th12-06-0421 · Cited by 53 · see citing works
Current insights in obstetric antiphospholipid syndrome
Schreiber, K. I., Radin, M., & Sciascia, S. (2017) · Current Opinion in Obstetrics & Gynecology · doi:10.1097/gco.0000000000000406 · Cited by 53 · see citing works
Pathophysiology of thrombosis and pregnancy morbidity in the antiphospholipid syndrome
Oku, K., Amengual, O., & Atsumi, T. (2012) · European Journal of Clinical Investigation · doi:10.1111/j.1365-2362.2012.02697.x · Cited by 50 · see citing works
Obstetric and vascular APS: Same autoantibodies but different diseases?
Meroni, P. L., Raschi, E., Grossi, C., Pregnolato, F., Trespìdi, L., Acaia, B., & Borghi, M. O. (2012) · Lupus · doi:10.1177/0961203312438116 · Cited by 50 · see citing works
Self-citationTalotta, R., & Robertson, E. S. (2021) · Cytokine & Growth Factor Reviews · doi:10.1016/j.cytogfr.2021.05.001 · Cited by 50 · see citing works
- Authors
- Meroni, P. L., Borghi, M. O., Raschi, E., & Tedesco, F.
- Affiliations
- University of Milan (IT)
- IRCCS Istituto Auxologico Italiano (IT)
- University of Trieste (IT)
- Corresponding author
- Meroni, Pier Luigi
- Venue
- Nature Reviews Rheumatology
- Published
- 2011-05-10
- Volume
- 7
- Issue
- 6
- Pages
- 330-339
- ISSN
- 1759-4790 (ISSN-L)
- 1759-4804
- OpenAlex
- W1999555834
- Cited by
- 620
- References
- 89
- Citations by year
- 2026: 38 · 2025: 34 · 2024: 35 · 2023: 34 · 2022: 39 · 2021: 47 · 2020: 34 · 2019: 41 · 2018: 43 · 2017: 43 · 2016: 54 · 2015: 33 · 2014: 63 · 2013: 37 · 2012: 36
- FWCI
- 6.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Nature Reviews Rheumatology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Keywords
- antiphospholipid syndrome, antiphospholipid antibodies, beta2-glycoprotein I, thrombosis, recurrent pregnancy loss, placental inflammation, trophoblast differentiation, complement activation, innate immune response, autoantibody pathogenesis
- MeSH terms
- Female, Humans, Pregnancy, Pregnancy Complications, Antiphospholipid Syndrome, Antibodies, Antiphospholipid
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