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News and meta-analysis regarding anti-Beta 2 glycoprotein I antibodies and their determination. Clin Immunol 2019; 205:106-115. [DOI: 10.1016/j.clim.2019.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/03/2019] [Accepted: 06/03/2019] [Indexed: 11/18/2022]
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Savelli SL, Roubey RAS, Kitzmiller KJ, Zhou D, Nagaraja HN, Mulvihill E, Barbar-Smiley F, Ardoin SP, Wu YL, Yu CY. Opposite Profiles of Complement in Antiphospholipid Syndrome (APS) and Systemic Lupus Erythematosus (SLE) Among Patients With Antiphospholipid Antibodies (aPL). Front Immunol 2019; 10:885. [PMID: 31134052 PMCID: PMC6514053 DOI: 10.3389/fimmu.2019.00885] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/05/2019] [Indexed: 12/18/2022] Open
Abstract
APS is the association of antiphospholipid antibodies (aPL) with thromboses and/or recurrent pregnancy loss (RPL). Among patients with SLE, one-third have aPL and 10–15% have a manifestation of secondary APS. Animal studies suggested that complement activation plays an important role in the pathogenesis of thrombosis and pregnancy loss in APS. We performed a cross-sectional study on complement proteins and genes in 525 patients with aPL. Among them, 237 experienced thromboses and 293 had SLE; 111 had both SLE and thromboses, and 106 had neither SLE nor thrombosis. Complement protein levels were determined by radial immunodiffusion for C4, C3 and factor H; and by functional ELISA for mannan binding lectin (MBL). Total C4, C4A and C4B gene copy numbers (GCN) were measured by TaqMan-based realtime PCR. Two to six copies of C4 genes are frequently present in a diploid genome, and each copy may code for an acidic C4A or a basic C4B protein. We observed significantly (a) higher protein levels of total C4, C4A, C4B, C3, and anticardiolipin (ACLA) IgG, (b) increased frequencies of lupus anticoagulant and males, and (c) decreased levels of complement factor H, MBL and ACLA-IgM among patients with thrombosis than those without thrombosis (N = 288). We also observed significantly lower GCNs of total C4 and C4A among aPL-positive patients with both SLE and thrombosis than others. By contrast, aPL-positive subjects with SLE had significantly reduced protein levels of C3, total C4, C4A, C4B and ACLA-IgG, and higher frequency of females than those without SLE. Patients with thrombosis but without SLE (N = 126), and patients with SLE but without thrombosis (N = 182) had the greatest differences in mean protein levels of C3 (p = 2.6 × 10−6), C4 (p = 2.2 × 10−9) and ACLA-IgG (p = 1.2 × 10−5). RPL occurred in 23.7% of female patients and thrombotic SLE patients had the highest frequency of RPL (41.0%; p = 3.8 × 10−10). Compared with non-RPL females, RPL had significantly higher frequency of thrombosis and elevated C4 protein levels. Female patients with homozygous C4A deficiency all experienced RPL (p = 0.0001) but the opposite was true for patients with homozygous C4B deficiency (p = 0.017). These results provide new insights and biomarkers for diagnosis and management of APS and SLE.
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Affiliation(s)
- Stephanie L Savelli
- The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States.,Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, OH, United States.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Robert A S Roubey
- Division of Rheumatology, Allergy and Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kathryn J Kitzmiller
- The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Danlei Zhou
- The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, United States.,Division of Rheumatology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Haikady N Nagaraja
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Evan Mulvihill
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, United States.,Division of Rheumatology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Fatima Barbar-Smiley
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, United States.,Division of Rheumatology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Stacy P Ardoin
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, United States.,Division of Rheumatology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Yee Ling Wu
- The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Microbiology and Immunology, Loyola University Chicago, Maywood, IL, United States
| | - Chack-Yung Yu
- The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, United States.,Division of Rheumatology, Nationwide Children's Hospital, Columbus, OH, United States
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Lonati PA, Scavone M, Gerosa M, Borghi MO, Pregnolato F, Curreli D, Podda G, Femia EA, Barcellini W, Cattaneo M, Tedesco F, Meroni PL. Blood Cell-Bound C4d as a Marker of Complement Activation in Patients With the Antiphospholipid Syndrome. Front Immunol 2019; 10:773. [PMID: 31031764 PMCID: PMC6474283 DOI: 10.3389/fimmu.2019.00773] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/25/2019] [Indexed: 01/22/2023] Open
Abstract
Antiphospholipid syndrome (APS) is a chronic and disabling condition characterized by recurrent thrombosis and miscarriages mediated by antibodies against phospholipid-binding proteins (aPL), such as beta2glycoprotein I (β2GPI). Complement is involved in APS animal models and complement deposits have been documented in placenta and thrombotic vessels despite normal serum levels. Analysis of circulating blood cells coated with C4d displays higher sensitivity than the conventional assays that measure soluble native complement components and their unstable activation products in systemic lupus erythematosus (SLE). As C4d-coated blood cell count has been reported to be more sensitive than serum levels of complement components and their activation products in systemic lupus erythematosus (SLE) patients, we decided to evaluate the percentage of C4d positive B lymphocytes (BC4d), erythrocytes (EC4d), and platelets (PC4d) in primary APS patients and asymptomatic aPL positive carriers as marker of complement activation in APS. We assessed by flow cytometry the percentages of BC4d, EC4d, and PC4d in primary APS (PAPS; n. 23), 8 asymptomatic aPL positive carriers, 11 APS-associated SLE (SAPS), 17 aPL positive SLE, 16 aPL negative SLE, 8 aPL negative patients with previous thrombosis, 11 immune thrombocytopenia (ITP) patients, and 26 healthy subjects. In addition, we used an in vitro model to evaluate the ability of a monoclonal anti-β2GPI antibody (MBB2) to bind to normal resting or activated platelets and fix complement. EC4d and PC4d percentages were significantly higher in PAPS and aPL carriers as well as aPL positive SLE and SAPS than in aPL negative controls. The highest values were found in PAPS and in SAPS. The EC4d and PC4d percentages were significantly correlated with serum C3/C4 and anti-β2GPI/anti-cardiolipin IgG. In vitro studies showed that MBB2 bound to activated platelets only and induced C4d deposition. The detection of the activation product C4d on circulating erythrocytes and platelets supports the role of complement activation in APS. Complement may represent a new therapeutic target for better treatment and prevention of disability of APS patients.
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Affiliation(s)
- Paola Adele Lonati
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Mariangela Scavone
- Unità di Medicina II, ASST Santi Paolo e Carlo, Milan, Italy.,Dipartimento di Scienze Della Salute, University of Milan, Milan, Italy
| | - Maria Gerosa
- Dipartimento di Scienze Cliniche e di Comunità, University of Milan, Milan, Italy
| | - Maria Orietta Borghi
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Dipartimento di Scienze Cliniche e di Comunità, University of Milan, Milan, Italy
| | - Francesca Pregnolato
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Daniele Curreli
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Gianmarco Podda
- Unità di Medicina II, ASST Santi Paolo e Carlo, Milan, Italy.,Dipartimento di Scienze Della Salute, University of Milan, Milan, Italy
| | - Eti Alessandra Femia
- Unità di Medicina II, ASST Santi Paolo e Carlo, Milan, Italy.,Dipartimento di Scienze Della Salute, University of Milan, Milan, Italy
| | - Wilma Barcellini
- UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Cattaneo
- Unità di Medicina II, ASST Santi Paolo e Carlo, Milan, Italy.,Dipartimento di Scienze Della Salute, University of Milan, Milan, Italy
| | - Francesco Tedesco
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Pier Luigi Meroni
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy
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54
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Thurman JM, Yapa R. Complement Therapeutics in Autoimmune Disease. Front Immunol 2019; 10:672. [PMID: 31001274 PMCID: PMC6456694 DOI: 10.3389/fimmu.2019.00672] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/12/2019] [Indexed: 12/17/2022] Open
Abstract
Many autoimmune diseases are characterized by generation of autoantibodies that bind to host proteins or deposit within tissues as a component of immune complexes. The autoantibodies can activate the complement system, which can mediate tissue damage and trigger systemic inflammation. Complement inhibitory drugs may, therefore, be beneficial across a large number of different autoimmune diseases. Many new anti-complement drugs that target specific activation mechanisms or downstream activation fragments are in development. Based on the shared pathophysiology of autoimmune diseases, some of these complement inhibitory drugs may provide benefit across multiple different diseases. In some antibody-mediated autoimmune diseases, however, unique features of the autoantibodies, the target antigens, or the affected tissues may make it advantageous to block individual components or pathways of the complement system. This paper reviews the evidence that complement is involved in various autoimmune diseases, as well as the studies that have examined whether or not complement inhibitors are effective for treating these diseases.
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Affiliation(s)
- Joshua M Thurman
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Roshini Yapa
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
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55
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Chaturvedi S, Brodsky RA, McCrae KR. Complement in the Pathophysiology of the Antiphospholipid Syndrome. Front Immunol 2019; 10:449. [PMID: 30923524 PMCID: PMC6426753 DOI: 10.3389/fimmu.2019.00449] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/19/2019] [Indexed: 12/16/2022] Open
Abstract
The antiphospholipid syndrome (APS) is characterized by thrombosis and pregnancy morbidity in the presence of antiphospholipid antibodies (aPL). Complement is a system of enzymes and regulatory proteins of the innate immune system that plays a key role in the inflammatory response to pathogenic stimuli. The complement and coagulation pathways are closely linked, and expanding data indicate that complement may be activated in patients with aPL and function as a cofactor in the pathogenesis of aPL-associated clinical events. Complement activation by aPL generates C5a, which induces neutrophil tissue factor-dependent procoagulant activity. Beta-2-glycoprotein I, the primary antigen for pathogenic aPL, has complement regulatory effects in vitro. Moreover, aPL induce fetal loss in wild-type mice but not in mice deficient in specific complement components (C3, C5). Antiphospholipid antibodies also induce thrombosis in wild type mice and this effect is attenuated in C3 or C6 deficient mice, or in the presence of a C5 inhibitor. Increased levels of complement activation products have been demonstrated in sera of patients with aPL, though the association with clinical events remains unclear. Eculizumab, a terminal complement inhibitor, has successfully been used to treat catastrophic APS and prevent APS-related thrombotic microangiopathy in the setting of renal transplant. However, the mechanisms of complement activation in APS, its role in the pathogenesis of aPL related complications in humans, and the potential of complement inhibition as a therapeutic target in APS require further study.
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Affiliation(s)
- Shruti Chaturvedi
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Robert A Brodsky
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Keith R McCrae
- Hematologic Oncology and Blood Disorders, Taussig Cancer Institute, Cleveland, OH, United States.,Department of Cellular and Molecular Medicine, Cleveland Clinic, Cleveland, OH, United States
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56
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Kello N, Khoury LE, Marder G, Furie R, Zapantis E, Horowitz DL. Secondary thrombotic microangiopathy in systemic lupus erythematosus and antiphospholipid syndrome, the role of complement and use of eculizumab: Case series and review of literature. Semin Arthritis Rheum 2018; 49:74-83. [PMID: 30598332 DOI: 10.1016/j.semarthrit.2018.11.005] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/25/2018] [Accepted: 11/26/2018] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Thrombotic microangiopathy (TMA) is a life-threatening, albeit infrequent, complication of systemic lupus erythematosus (SLE) and anti-phospholipid syndrome (APS). Recommendations for the treatment of SLE- and APS-related secondary TMA are currently based solely on case reports and expert opinion. Unfortunately, interventions may not yield timely results or effectively halt the progression of TMA. Since complement activation plays a key role in the pathogenesis of secondary TMA due to SLE, APS, a therapy that targets the complement pathway is an attractive intervention. Eculizumab, a recombinant, fully humanized IgG2/IgG4 monoclonal antibody inhibits C5 activation and is FDA-approved for PNH and atypical HUS (aHUS). However, limited case reports are available on its use in treatment of secondary TMA. CASE PRESENTATION AND RESULTS We present the largest case series to date that includes 9 patients with SLE and/or APS who were successfully treated with eculizumab for refractory secondary TMA. In this case series, we report significant responses in hematology values, renal function and other organs following treatment with eculizumab. At 4 weeks, 75% improvement in platelet counts was observed in 78% of patients. Two-thirds of patients demonstrated >75% improvement of haptoglobin and LDH at four weeks. At 4 weeks, eGFR improved by 25% in half of the patients, and 43% had reductions in proteinuria. Two of 3 patients that required hemodialysis were able to be taken off hemodialysis. CONCLUSION Based on these observations, we suggest that eculizumab may be a potential treatment option for acutely ill patients with secondary TMA due to SLE and/or APS who have failed standard of care. A collective approach is needed to better elucidate the role and optimal timing of eculizumab use in the management of TMA complicating SLE and/or APS.
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Affiliation(s)
- Nina Kello
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 865 Northern Boulevard, Suite 302, Great Neck, NY 11021, USA.
| | - Lara El Khoury
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 865 Northern Boulevard, Suite 302, Great Neck, NY 11021, USA
| | - Galina Marder
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 865 Northern Boulevard, Suite 302, Great Neck, NY 11021, USA
| | - Richard Furie
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 865 Northern Boulevard, Suite 302, Great Neck, NY 11021, USA
| | - Ekaterini Zapantis
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 865 Northern Boulevard, Suite 302, Great Neck, NY 11021, USA
| | - Diane Lewis Horowitz
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 865 Northern Boulevard, Suite 302, Great Neck, NY 11021, USA
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57
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Stachowicz A, Zabczyk M, Natorska J, Suski M, Olszanecki R, Korbut R, Wiśniewski JR, Undas A. Differences in plasma fibrin clot composition in patients with thrombotic antiphospholipid syndrome compared with venous thromboembolism. Sci Rep 2018; 8:17301. [PMID: 30470809 PMCID: PMC6251889 DOI: 10.1038/s41598-018-35034-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/26/2018] [Indexed: 12/13/2022] Open
Abstract
The prothrombotic fibrin clot phenotype has been reported in patients with thrombotic antiphospholipid syndrome (APS) and venous thromboembolism (VTE). Protein composition of plasma fibrin clots in APS has not been studied. We evaluated 23 patients with thrombotic APS, 19 with VTE alone, and 20 well-matched controls. A proteomic analysis of fibrin clots generated from citrated plasma was based on liquid chromatography-mass spectrometry. Plasma levels of thrombospondin-1 (TSP1), apolipoprotein(a), A-I, and B-100, complement components (C)3a, C5b-C9, histidine-rich glycoprotein (HRG), and prothrombin were evaluated using immunoenzymatic tests. In plasma fibrin clots of APS patients, compared with VTE subjects and controls, we identified decreased amounts of (pro)thrombin, antithrombin-III, apolipoprotein A-I, and HRG with no differences in plasma levels of antithrombin, prothrombin, along with lower plasma HRG and apolipoprotein A-I. In APS patients, plasma HRG positively correlated with amounts of clot-bound HRG, while apolipoprotein A-I was inversely associated with clot-bound levels of this protein. The most predominant proteins within the clots of APS patients were bone marrow proteoglycan, C5-C9, immunoglobulins, apolipoprotein B-100, platelet-derived proteins, and TSP1. Our study is the first to demonstrate differences in the protein composition of fibrin clots generated from plasma of thrombotic APS patients versus those with VTE alone.
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Affiliation(s)
- Aneta Stachowicz
- Chair of Pharmacology, Jagiellonian University Medical College, Krakow, Poland.,Biochemical Proteomics Group, Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Michal Zabczyk
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Joanna Natorska
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.,Krakow Center for Medical Research and Technology, John Paul II Hospital, Krakow, Poland
| | - Maciej Suski
- Chair of Pharmacology, Jagiellonian University Medical College, Krakow, Poland
| | - Rafał Olszanecki
- Chair of Pharmacology, Jagiellonian University Medical College, Krakow, Poland
| | - Ryszard Korbut
- Chair of Pharmacology, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek R Wiśniewski
- Biochemical Proteomics Group, Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Anetta Undas
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland. .,Krakow Center for Medical Research and Technology, John Paul II Hospital, Krakow, Poland.
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58
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Kato M, Hisada R, Atsumi T. Clinical profiles and risk assessment in patients with antiphospholipid antibodies. Expert Rev Clin Immunol 2018; 15:73-81. [PMID: 30381978 DOI: 10.1080/1744666x.2019.1543025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Antiphospholipid syndrome (APS) is an acquired autoimmune thrombophilia associated with the presence of persistent antiphospholipid antibodies (aPL). Owing to recent studies, not only APS patients but also incidentally-identified, asymptomatic aPL carriers are able to be stratified in terms of the risk of future thrombotic events, according to the variety and the titer of positive aPL tests and to the non-thrombotic, aPL-associated clinical manifestations. Areas covered: Here, we critically review (1) criteria manifestations of APS, (2) non-criteria manifestations of APS, (3) risk assessment in patients with APS and in aPL carriers, and (4) the potential role of primary thrombosis prophylaxis in aPL carriers. In addition, we discuss what we are currently able to do and what we need to do in the future for primary prophylaxis against a first thrombotic event. Expert commentary: We suggest a comprehensive algorithm to stratify thrombotic risk in aPL carriers, including criteria aPL, non-criteria aPL, their scoring systems, and non-criteria manifestations. However, further studies, particularly prospective randomized controlled trials, are highly warranted to establish an effective and tolerable treatment regimen for high risk aPL carriers.
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Affiliation(s)
- Masaru Kato
- a Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine , Hokkaido University , Sapporo , Japan
| | - Ryo Hisada
- a Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine , Hokkaido University , Sapporo , Japan
| | - Tatsuya Atsumi
- a Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine , Hokkaido University , Sapporo , Japan
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59
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Plüß M, Zeisberg M, Müller GA, Vasko R, Korsten P. Therapeutic response to glucocorticoids, anticoagulation and plasma exchange in a patient with primary antiphospholipid syndrome presenting with purpura fulminans. Lupus 2018; 27:2170-2173. [DOI: 10.1177/0961203318804884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report the case of a 25-year-old female patient who presented with purpura fulminans as a manifestation of primary antiphospholipid syndrome. Purpura fulminans is considered a rare cutaneous manifestation of antiphospholipid syndrome. Most frequently, it occurs in the context of catastrophic antiphospholipid syndrome and is associated with significant morbidity and mortality, either due to loss of affected extremities or thromboembolic damage to internal organs. After insufficient efficacy of parenteral anticoagulation and oral glucocorticosteroid treatment, we escalated treatment to high-dose intravenous glucocorticosteroid and five consecutive sessions of plasma exchange with good and sustained clinical response. At follow-up six months after admission, skin manifestations had healed with scarring, and no additional thrombotic events had occurred. Plasma exchange may hold promise as a therapeutic option in refractory or severe cases of antiphospholipid syndrome-related purpura fulminans with extensive cutaneous necrosis, although evidence is limited.
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Affiliation(s)
- M Plüß
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, Germany
| | - M Zeisberg
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, Germany
| | - G A Müller
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, Germany
| | - R Vasko
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, Germany
| | - P Korsten
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, Germany
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60
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García-Carrasco M, Jiménez-Herrera EA, Gálvez-Romero JL, Mendoza-Pinto C, Méndez-Martínez S, Etchegaray-Morales I, Munguía-Realpozo P, Vázquez de Lara-Cisneros L, Santa Cruz FJ, Cervera R. The anti-thrombotic effects of vitamin D and their possible relationship with antiphospholipid syndrome. Lupus 2018; 27:2181-2189. [DOI: 10.1177/0961203318801520] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The importance of the immunomodulatory effects of vitamin D has recently been associated with autoimmune and chronic inflammatory diseases. Vitamin D deficiency has been linked to the development of autoimmune conditions. Antiphospholipid syndrome is an autoimmune disease characterized by thrombotic events and obstetric complications in patients with antiphospholipid antibodies. Current data show that patients with antiphospholipid syndrome have a high prevalence of vitamin D deficiency even without classic risk factors. Several studies have suggested vitamin D may have anti-thrombotic functions. In antiphospholipid syndrome, low vitamin D serum levels have been associated with thrombotic manifestations, suggesting a possible protective role of vitamin D in antiphospholipid syndrome. This literature review presents current evidence on the haemostatic functions of vitamin D and their possible relationship with the clinical manifestations of antiphospholipid syndrome.
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Affiliation(s)
- M García-Carrasco
- Systemic Autoimmune Diseases Research Unit, General Regional Hospital No. 36, Puebla, Mexico
- Department of Rheumatology, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
- Department of Immunology, Benemérita Universidad Autónomade Puebla, Puebla, Mexico
| | | | - J L Gálvez-Romero
- Department of Immunology, Benemérita Universidad Autónomade Puebla, Puebla, Mexico
- Department of Immunology and Allergology, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Puebla, Mexico
| | - C Mendoza-Pinto
- Systemic Autoimmune Diseases Research Unit, General Regional Hospital No. 36, Puebla, Mexico
- Department of Rheumatology, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
- Department of Immunology, Benemérita Universidad Autónomade Puebla, Puebla, Mexico
| | - S Méndez-Martínez
- Puebla Research Coordination, Instituto Mexicano del Seguro Social, Puebla, Mexico
| | - I Etchegaray-Morales
- Systemic Autoimmune Diseases Research Unit, General Regional Hospital No. 36, Puebla, Mexico
| | - P Munguía-Realpozo
- Department of Rheumatology, Instituto Mexicano del Seguro Social, Puebla, Mexico
| | | | - F J Santa Cruz
- Dermatology Centre ‘Dr Ladislao de la Pascua’, México, Mexico
| | - R Cervera
- Department of Autoimmune Diseases, Institut Clínic de Medicina I Dermatologia, Barcelona, Spain
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61
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Fujieda Y, Amengual O, Atsumi T. Pathogenic role of antiphospholipid antibodies: an update. Lupus 2018; 27:2012-2013. [PMID: 30282558 DOI: 10.1177/0961203318802016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Y Fujieda
- Department of Rheumatology, Nephrology and Endocrinology, Hokkaido University, Sapporo, Japan
| | - O Amengual
- Department of Rheumatology, Nephrology and Endocrinology, Hokkaido University, Sapporo, Japan
| | - T Atsumi
- Department of Rheumatology, Nephrology and Endocrinology, Hokkaido University, Sapporo, Japan
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62
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Antovic A, Sennström M, Bremme K, Svenungsson E. Obstetric antiphospholipid syndrome. Lupus Sci Med 2018; 5:e000197. [PMID: 30364418 PMCID: PMC6195166 DOI: 10.1136/lupus-2016-000197] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 12/20/2022]
Abstract
The present clinical and laboratory classification criteria for antiphospholipid syndrome (APS) were established in Sydney, Australia, in 2006. In this review, we focus on the obstetric subset of APS (OAPS), defined by persistent positivity for antiphospholipid antibodies together with either early recurrent pregnancy loss, early fetal death, stillbirth or premature birth <34 gestational weeks due to pre-eclampsia, eclampsia and placental insufficiency. It is important to diagnose these cases since most women suffering from OAPS can, when given appropriate treatment, have successful pregnancies. Furthermore, patients with OAPS may, depending on the antibody profile, be at enhanced risk of thrombotic events later in life. We present an update on the present knowledge of possible underlying pathogenesis, risk factors and risk estimations for adverse pregnancy outcomes before and during pregnancy, current treatment concepts, and long-term outcomes for women with OAPS and their children.
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Affiliation(s)
- Aleksandra Antovic
- Unit of Rheumatology, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Maria Sennström
- Division of Obstetrics and Gynaecology, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Katarina Bremme
- Division of Obstetrics and Gynaecology, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Elisabet Svenungsson
- Unit of Rheumatology, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Paule R, Morel N, Le Guern V, Fredi M, Coutte L, Belhocine M, Mouthon L, le Jeunne C, Chauvin A, Piette JC, Costedoat-Chalumeau N. Classification of primary antiphospholipid syndrome as systemic lupus erythematosus: Analysis of a cohort of 214 patients. Autoimmun Rev 2018; 17:866-872. [DOI: 10.1016/j.autrev.2018.03.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 03/04/2018] [Indexed: 12/21/2022]
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Mitander A, Fei Y, Trysberg E, Mohammad M, Hu Z, Sakiniene E, Pullerits R, Jin T. Complement Consumption in Systemic Lupus Erythematosus Leads to Decreased Opsonophagocytosis In Vitro. J Rheumatol 2018; 45:1557-1564. [PMID: 30173146 DOI: 10.3899/jrheum.171325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Infections remain a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). The high prevalence of infections in SLE is attributed to both the disease and its treatments. The complement system plays an important role in host immune responses against invading microorganisms. We sought to provide the experimental and clinical evidence supporting the hypothesis that low levels of complement factors cause defective complement-mediated opsonization in patients with SLE. METHODS Staphylococcus aureus was opsonized with sera from healthy individuals (n = 16), SLE patients with normal (n = 5) or low complement (n = 8) levels. Phagocytosis of S. aureus by healthy human neutrophils was analyzed by an imaging flow cytometry-based method. We retrospectively examined the infection incidence in relation to complement levels in a cohort of 165 patients with SLE during a 1.5-year period. The association was analyzed for infection incidence and disease-related variables. RESULTS Uptake of S. aureus by neutrophils was decreased when S. aureus was opsonized with sera from SLE patients with low complement levels compared to sera from healthy individuals and SLE patients with normal complement. In our SLE cohort, 44% of patients had at least 1 infection during the 1.5 years. No significant association was observed between complement levels and infection risk. Importantly, high-dose glucocorticoids (GC; prednisone ≥ 10 mg/day) were the most important predictive factor for infections in patients with SLE. CONCLUSION Low complement levels affect bacterial opsonization in SLE blood and lead to downregulated phagocytosis by neutrophils. High-dose GC increase the infection risk in patients with SLE.
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Affiliation(s)
- Amanda Mitander
- From the Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University, Guiyang, China; Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.,A. Mitander, MD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; Y. Fei, MSc, Professor, Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Trysberg, MD, PhD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; M. Mohammad, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg; Z. Hu, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Sakiniene, MD, PhD, Department of Rheumatology, Sahlgrenska University Hospital; R. Pullerits, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital; T. Jin, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital
| | - Ying Fei
- From the Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University, Guiyang, China; Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.,A. Mitander, MD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; Y. Fei, MSc, Professor, Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Trysberg, MD, PhD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; M. Mohammad, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg; Z. Hu, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Sakiniene, MD, PhD, Department of Rheumatology, Sahlgrenska University Hospital; R. Pullerits, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital; T. Jin, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital
| | - Estelle Trysberg
- From the Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University, Guiyang, China; Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.,A. Mitander, MD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; Y. Fei, MSc, Professor, Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Trysberg, MD, PhD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; M. Mohammad, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg; Z. Hu, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Sakiniene, MD, PhD, Department of Rheumatology, Sahlgrenska University Hospital; R. Pullerits, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital; T. Jin, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital
| | - Majd Mohammad
- From the Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University, Guiyang, China; Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.,A. Mitander, MD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; Y. Fei, MSc, Professor, Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Trysberg, MD, PhD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; M. Mohammad, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg; Z. Hu, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Sakiniene, MD, PhD, Department of Rheumatology, Sahlgrenska University Hospital; R. Pullerits, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital; T. Jin, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital
| | - Zhicheng Hu
- From the Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University, Guiyang, China; Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.,A. Mitander, MD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; Y. Fei, MSc, Professor, Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Trysberg, MD, PhD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; M. Mohammad, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg; Z. Hu, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Sakiniene, MD, PhD, Department of Rheumatology, Sahlgrenska University Hospital; R. Pullerits, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital; T. Jin, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital
| | - Egidija Sakiniene
- From the Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University, Guiyang, China; Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.,A. Mitander, MD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; Y. Fei, MSc, Professor, Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Trysberg, MD, PhD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; M. Mohammad, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg; Z. Hu, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Sakiniene, MD, PhD, Department of Rheumatology, Sahlgrenska University Hospital; R. Pullerits, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital; T. Jin, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital
| | - Rille Pullerits
- From the Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University, Guiyang, China; Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.,A. Mitander, MD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; Y. Fei, MSc, Professor, Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Trysberg, MD, PhD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; M. Mohammad, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg; Z. Hu, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Sakiniene, MD, PhD, Department of Rheumatology, Sahlgrenska University Hospital; R. Pullerits, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital; T. Jin, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital
| | - Tao Jin
- From the Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University, Guiyang, China; Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Göteborg, Sweden. .,A. Mitander, MD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; Y. Fei, MSc, Professor, Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Trysberg, MD, PhD, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital; M. Mohammad, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg; Z. Hu, MSc, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Microbiology and Immunology, The Affiliated Hospital of GuiZhou Medical University; E. Sakiniene, MD, PhD, Department of Rheumatology, Sahlgrenska University Hospital; R. Pullerits, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, and Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital; T. Jin, MD, PhD, Associate Professor, Department of Rheumatology and Inflammation Research, Institution of Medicine, Sahlgrenska Academy at University of Gothenburg, and Department of Rheumatology, Sahlgrenska University Hospital.
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Tedesco F, Borghi MO, Gerosa M, Chighizola CB, Macor P, Lonati PA, Gulino A, Belmonte B, Meroni PL. Pathogenic Role of Complement in Antiphospholipid Syndrome and Therapeutic Implications. Front Immunol 2018; 9:1388. [PMID: 29971066 PMCID: PMC6018396 DOI: 10.3389/fimmu.2018.01388] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/05/2018] [Indexed: 12/17/2022] Open
Abstract
Antiphospholipid syndrome (APS) is an acquired autoimmune disease characterized by thromboembolic events, pregnancy morbidity, and the presence of antiphospholipid (aPL) antibodies. There is sound evidence that aPL act as pathogenic autoantibodies being responsible for vascular clots and miscarriages. However, the exact mechanisms involved in the clinical manifestations of the syndrome are still a matter of investigation. In particular, while vascular thrombosis is apparently not associated with inflammation, the pathogenesis of miscarriages can be explained only in part by the aPL-mediated hypercoagulable state and additional non-thrombotic effects, including placental inflammation, have been described. Despite this difference, evidence obtained from animal models and studies in APS patients support the conclusion that complement activation is a common denominator in both vascular and obstetric APS. Tissue-bound aPL rather than circulating aPL-beta2 glycoprotein I immune complexes seem to be responsible for the activation of the classical and the alternative complement pathways. The critical role of complement is supported by the finding that complement-deficient animals are protected from the pathogenic effect of passively infused aPL and similar results have been obtained blocking complement activation. Moreover, elevated levels of complement activation products in the absence of abnormalities in regulatory molecules have been found in the plasma of APS patients, strongly suggesting that the activation of complement cascade is the result of aPL binding to the target antigen rather than of a defective regulation. Placental complement deposits represent a further marker of complement activation both in animals and in patients, and there is also some suggestive evidence that complement activation products are deposited in the affected vessels. The aim of this review is to analyze the state of the art of complement involvement in the pathogenesis of APS in order to provide insights into the role of this system as predictive biomarker for the clinical manifestations and as therapeutic target.
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Affiliation(s)
- Francesco Tedesco
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milan, Italy
| | - Maria Orietta Borghi
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Maria Gerosa
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Cecilia Beatrice Chighizola
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paolo Macor
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Paola Adele Lonati
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milan, Italy
| | - Alessandro Gulino
- Tumor Immunology Unit, Human Pathology Section, Department of Health Sciences, University of Palermo, Palermo, Italy
| | - Beatrice Belmonte
- Tumor Immunology Unit, Human Pathology Section, Department of Health Sciences, University of Palermo, Palermo, Italy
| | - Pier Luigi Meroni
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milan, Italy
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Radic M, Pattanaik D. Cellular and Molecular Mechanisms of Anti-Phospholipid Syndrome. Front Immunol 2018; 9:969. [PMID: 29867951 PMCID: PMC5949565 DOI: 10.3389/fimmu.2018.00969] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 04/18/2018] [Indexed: 01/10/2023] Open
Abstract
The primary anti-phospholipid syndrome (APS) is characterized by the production of antibodies that bind the phospholipid-binding protein β2 glycoprotein I (β2GPI) or that directly recognize negatively charged membrane phospholipids in a manner that may contribute to arterial or venous thrombosis. Clinically, the binding of antibodies to β2GPI could contribute to pathogenesis by formation of immune complexes or modification of coagulation steps that operate along cell surfaces. However, additional events are likely to play a role in pathogenesis, including platelet and endothelial cell activation. Recent studies focus on neutrophil release of chromatin in the form of neutrophil extracellular traps as an important disease contributor. Jointly, the participation of both the innate and adaptive arms of the immune system in aspects of the APS make the complete understanding of crucial steps in pathogenesis extremely difficult. Only coordinated and comprehensive analyses, carried out in different clinical and research settings, are likely to advance the understanding of this complex disease condition.
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Affiliation(s)
- Marko Radic
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Debendra Pattanaik
- Division of Rheumatology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
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Nakamura H, Oku K, Ogata Y, Ohmura K, Yoshida Y, Kitano E, Fujieda Y, Kato M, Bohgaki T, Amengual O, Yasuda S, Fujimura Y, Seya T, Atsumi T. Alternative pathway activation due to low level of complement factor H in primary antiphospholipid syndrome. Thromb Res 2018; 164:63-68. [PMID: 29494857 DOI: 10.1016/j.thromres.2018.02.142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/25/2018] [Accepted: 02/19/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Although complement activation has been proposed as a possible thrombophilic mechanism in antiphospholipid syndrome (APS), the origin of complement activation in APS remains unclear. Here, we focused on complement regulatory factors (CRF), which control the complement system to prevent damage to host tissue. We evaluated the function of two major CRF, membrane cofactor protein (MCP) and factor H (FH), in APS patients. MATERIALS AND METHODS In this study, we analyzed preserved serum samples from 27 patients with primary APS (PAPS), 20 with APS complicated with SLE (APS + SLE), 24 with SLE (SLE), and 25 with other connective tissue diseases (Other CTD). Serum MCP and FH levels were tested by ELISA. Autoantibodies against FH were determined by both ELISA and western-blotting. RESULTS Serum complement levels of PAPS were lower than those of other CTD (median C3: 82 vs 112 mg/dL, p < 0.01, C4: 15 vs 22 mg/dL, p < 0.05). Serum MCP levels did not significantly differ among the groups. Serum FH levels were significantly lower in PAPS patients compared with SLE or other CTD (median 204, 1275, and 1220 μg/mL, respectively, p < 0.01). In PAPS patients, serum FH levels were positively correlated with serum C3 levels (p < 0.01, R = 0.55), but no correlation was found with serum C4 levels (p = 0.22, R = 0.33). Autoantibodies against FH were not detected in any of our patients. CONCLUSIONS Activation of the alternative complement pathway due to low level of FH is one of the possible thrombophilic mechanisms in PAPS.
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Affiliation(s)
- Hiroyuki Nakamura
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North-15 West-7, Kita-ku, Sapporo 060-8638, Japan
| | - Kenji Oku
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North-15 West-7, Kita-ku, Sapporo 060-8638, Japan.
| | - Yusuke Ogata
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North-15 West-7, Kita-ku, Sapporo 060-8638, Japan
| | - Kazumasa Ohmura
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North-15 West-7, Kita-ku, Sapporo 060-8638, Japan
| | - Yoko Yoshida
- Department of Blood Transfusion Medicine, Nara Medical University, Shijo-cho 840, Kashihara 634-8521, Japan
| | - Etsuko Kitano
- Department of Clinical Laboratory Science, Kobe Tokiwa University, Ohtani-cho 2-6-6, Nagata-ku, Kobe 653-0838, Japan
| | - Yuichiro Fujieda
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North-15 West-7, Kita-ku, Sapporo 060-8638, Japan
| | - Masaru Kato
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North-15 West-7, Kita-ku, Sapporo 060-8638, Japan
| | - Toshiyuki Bohgaki
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North-15 West-7, Kita-ku, Sapporo 060-8638, Japan
| | - Olga Amengual
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North-15 West-7, Kita-ku, Sapporo 060-8638, Japan
| | - Shinsuke Yasuda
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North-15 West-7, Kita-ku, Sapporo 060-8638, Japan
| | - Yoshihiro Fujimura
- Department of Blood Transfusion Medicine, Nara Medical University, Shijo-cho 840, Kashihara 634-8521, Japan
| | - Tsukasa Seya
- Department of Vaccine Immunology, Faculty of Medicine, Hokkaido University, North-15 West-7, Kita-ku, Sapporo 060-8638, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North-15 West-7, Kita-ku, Sapporo 060-8638, Japan
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Abstract
The antiphospholipid syndrome (APS) is an autoimmune disorder characterized by the occurrence of venous and arterial thromboses, often multiple, and obstetric-related adverse events in the presence of antiphospholipid antibodies (aPL). APS, first described in 1983, as thrombosis, abortion and cerebral disease, is nowadays recognised as a systemic disease with a wide constellation of clinical manifestations related to acute and chronic vascular lesions. The presence of aPL is the serological hallmark of APS representing a heterogeneous population of autoantibodies with many antigenic specificities directed to phospholipid-binding proteins, either alone or in combination with phospholipids. Many assays have been developed for aPL detection. Particularly, anticardiolipin antibodies, anti-β2-glycoprotein I antibodies and lupus anticoagulant are essential tools for APS diagnosis. The cumulative evidence indicates that aPL are pathogenic autoantibodies binding to target cells and promoting thrombosis and pregnancy complications through a wide range of pathological mechanisms not yet fully understood. Finally, the recognition of the important role of aPL to assess the individual risk of thrombosis or pregnancy complications has expanded the concept of aPL, and currently aPL profile is regarded as a major risk factor for clinical thrombotic events.
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Affiliation(s)
- Olga Amengual
- a Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine , Hokkaido University , Sapporo , Japan
| | - Tatsuya Atsumi
- a Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine , Hokkaido University , Sapporo , Japan
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Kim MY, Guerra MM, Kaplowitz E, Laskin CA, Petri M, Branch DW, Lockshin MD, Sammaritano LR, Merrill JT, Porter TF, Sawitzke A, Lynch AM, Buyon JP, Salmon JE. Complement activation predicts adverse pregnancy outcome in patients with systemic lupus erythematosus and/or antiphospholipid antibodies. Ann Rheum Dis 2018; 77:549-555. [PMID: 29371202 DOI: 10.1136/annrheumdis-2017-212224] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/07/2017] [Accepted: 12/10/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Studies in mouse models implicate complement activation as a causative factor in adverse pregnancy outcomes (APOs). We investigated whether activation of complement early in pregnancy predicts APOs in women with systemic lupus erythematosus (SLE) and/or antiphospholipid (aPL) antibodies. METHODS The PROMISSE Study enrolled pregnant women with SLE and/or aPL antibodies (n=487) and pregnant healthy controls (n=204) at <12 weeks gestation and evaluated them monthly. APOs were: fetal/neonatal death, preterm delivery <36 weeks because of placental insufficiency or preeclampsia and/or growth restriction <5th percentile. Complement activation products were measured on serial blood samples obtained at each monthly visit. RESULTS APO occurred in 20.5% of SLE and/or aPL pregnancies. As early as 12-15 weeks, levels of Bb and sC5b-9 were significantly higher in patients with APOs and remained elevated through 31 weeks compared with those with normal outcomes. Moreover, Bb and sC5b-9 were significantly higher in patients with SLE and/or aPL without APOs compared with healthy controls. In logistic regression analyses, Bb and sC5b-9 at 12-15 weeks remained significantly associated with APO (ORadj=1.41 per SD increase; 95% CI 1.06 to 1.89; P=0.019 and ORadj=1.37 per SD increase; 95% CI 1.05 to 1.80; P=0.022, respectively) after controlling for demographic and clinical risk factors for APOs in PROMISSE. When analyses were restricted to patients with aPL (n=161), associations between Bb at 12-15 weeks and APOs became stronger (ORadj=2.01 per SD increase; 95% CI 1.16 to 3.49; P=0.013). CONCLUSION In pregnant patients with SLE and/or aPL, increased Bb and sC5b-9 detectable early in pregnancy are strongly predictive of APOs and support activation of complement, particularly the alternative pathway, as a contributor to APOs.
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Affiliation(s)
- Mimi Y Kim
- Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Marta M Guerra
- Medicine, Hospital for Special Surgery, New York, New York, USA
| | | | - Carl A Laskin
- Medicine, Mount Sinai Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Michelle Petri
- Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - D Ware Branch
- Obstetrics and Gynecology, University of Utah Health Sciences Center and Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Michael D Lockshin
- Medicine, Hospital for Special Surgery, New York, New York, USA.,Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Lisa R Sammaritano
- Medicine, Hospital for Special Surgery, New York, New York, USA.,Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Joan T Merrill
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation and the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - T Flint Porter
- Obstetrics and Gynecology, University of Utah Health Sciences Center and Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Allen Sawitzke
- Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Anne M Lynch
- Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jill P Buyon
- Medicine, New York University School of Medicine, New York, New York, USA
| | - Jane E Salmon
- Medicine, Hospital for Special Surgery, New York, New York, USA.,Medicine, Weill Cornell Medicine, New York, New York, USA
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Abstract
Antiphospholipid syndrome (APS) is an autoimmune disease characterized by the presence of antiphospholipid antibodies, such as lupus anticoagulant, anticardiolipin antibodies and anti-β2-glycoprotein 1 antibodies. APS can present with a variety of clinical phenotypes, including thrombosis in the veins, arteries and microvasculature as well as obstetrical complications. The pathophysiological hallmark is thrombosis, but other factors such as complement activation might be important. Prevention of thrombotic manifestations associated with APS includes lifestyle changes and, in individuals at high risk, low-dose aspirin. Prevention and treatment of thrombotic events are dependent mainly on the use of vitamin K antagonists. Immunosuppression and anticomplement therapy have been used anecdotally but have not been adequately tested. Pregnancy morbidity includes unexplained recurrent early miscarriage, fetal death and late obstetrical manifestation such as pre-eclampsia, premature birth or fetal growth restriction associated with placental insufficiency. Current treatment to prevent obstetrical morbidity is based on low-dose aspirin and/or low-molecular-weight heparin and has improved pregnancy outcomes to achieve successful live birth in >70% of pregnancies. Although hydroxychloroquine and pravastatin might further improve pregnancy outcomes, prospective clinical trials are required to confirm these findings.
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71
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Vlagea A, Pascual-Salcedo D, Álvarez Doforno R, Lavilla P, Diez J, Padilla Merlano B, Cuesta MV, Gil A. IgA anti-β2 glycoprotein I antibodies: Experience from a large center. Thromb Res 2017; 162:38-43. [PMID: 29274563 DOI: 10.1016/j.thromres.2017.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 11/16/2017] [Accepted: 12/11/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE IgG and IgM antibodies directed at β2-glycoprotein I are included in the classification criteria for the antiphospholipid syndrome (APS) while the IgA antibodies against β2-glycoprotein I (IgA aβ2GPI) are not. Conflicting data about the significance of IgA aβ2GPI and APS manifestation can be found and more studies are necessary in order to define the diagnostic value of IgA aβ2GPI. In the present article, we investigated the possible role of IgA aβ2GPI as marker of APS. METHODS A cohort of 314 patients with APS and systemic autoimmune disease was investigated for the presence of IgA aβ2GPI and its association with clinical manifestation of APS. RESULTS Eighty-nine patients presented IgA aβ2GPI, 68 cases associated with others antiphospholipid antibodies (aPL) and in 21 cases being the only aPL present. In primary APS IgA aβ2GPI are highly coincidental with other aPL (92,2%) while most of the isolated IgA aβ2GPI were present in the SLE group (16/21). No association between IgA aβ2GPI and APS manifestations: thrombosis and pregnancy morbidity was found, while a positive association between IgA aβ2GPI and the presence of anti-nDNA, anti-RNP, anti-Sm, anti-SSA, anti-SSB antibodies was encountered. CONCLUSION Our study does not show association between IgA aβ2GPI and APS manifestations and does not support the inclusion of IgA aβ2GPI as a classification criteria for APS.
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Affiliation(s)
- Alexandru Vlagea
- Immunology Department, Hospital Clinic, Barcelona, Spain; Immunology Department, Hospital La Paz, Madrid, Spain.
| | | | | | - Paz Lavilla
- Internal Medicine Department, Hospital La Paz, Madrid, Spain
| | - Jesús Diez
- Department of Biostatistics in Medicine, Hospital La Paz, Madrid, Spain
| | | | | | - Antonio Gil
- Internal Medicine Department, Hospital La Paz, Madrid, Spain
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Seed P, Parmar K, Moore GW, Stuart-Smith SE, Hunt BJ, Breen KA. Complement activation in patients with isolated antiphospholipid antibodies or primary antiphospholipid syndrome. Thromb Haemost 2017; 107:423-9. [DOI: 10.1160/th11-08-0554] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 11/18/2011] [Indexed: 11/05/2022]
Abstract
SummaryThe antiphospholipid syndrome (APS) is the association of thrombosis and recurrent pregnancy loss and/or pregnancy morbidity with persistent antiphospholipid antibodies (aPL). Increased complement activation has been implicated in the pathogenesis of APS in animal models. It was our objective to evaluate complement activation in patients with aPL or primary antiphospholipid syndrome (PAPS). We measured complement activation products, fragments Bb and C3a–desArg by ELISA in 186 aPL/PAPS patients and 30 healthy controls. All patients with aPL had significantly increased levels of complement activation products. Fragment Bb levels (mean, 95% CI); (thrombotic APS 0.54 units/ml, 0.31–0.83, obstetric APS 0.60 units/ml,0.39–1.02, isolated aPL 0.48 units/ml, 0.29–0.85, overall 0.39 units/ml, 0.33–0.47) and C3a–desArg levels (mean, 95% CI): (thrombotic APS 261 ng/ml, 219–311, obstetric APS 308 ng/ml, 243–391, isolated aPL 258 ng/ml, 193–337, overall 225 ng/ml, 202–251) were significantly higher compared to controls (fragment Bb 0.06 units/ml, 0.03–0.11, C3a–desArg 69 ng/ml, 50–92). There were correlations between Fragment Bb and C3a–desArg levels in all patients with aPL. Receiver operator characteristic (ROC) analysis showed increased fragment Bb and C3a–desArg levels had strong associations with the presence of persistent lupus anticoagulant (area under ROC: Bb 0.89, and C3a–desArg 0.90), dual and triple aPL positivity (Bb 0.71–0.82, C3a–desArg 0.71–0.80) but not with high titre anti-cardiolipin antibodies (Bb 0.62, C3a–desArg 0.65), or anti β2-glycoprotein 1 antibodies (Bb 0.66, C3a–desArg 0.67). Complement activation is present in all patient groups within this large cohort of patients aPL. This suggests it may have a major role in the pathogenesis of APS and merits further study.
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Oku K, Atsumi T, Akiyama Y, Amano H, Azuma N, Bohgaki T, Asanuma YF, Horita T, Hosoya T, Ichinose K, Kato M, Katsumata Y, Kawaguchi Y, Kawakami A, Koga T, Kohsaka H, Kondo Y, Kubo K, Kuwana M, Mimori A, Mimori T, Mimura T, Murakami K, Nakano K, Nakayamada S, Ogishima H, Ohmura K, Saito K, Sano H, Shibuya M, Takahashi Y, Takasaki Y, Takeuchi T, Tamura N, Tanaka Y, Tsuboi H, Tsunoda S, Yukawa N, Yamakawa N, Yamamoto K, Sumida T. Evaluation of the alternative classification criteria of systemic lupus erythematosus established by Systemic Lupus International Collaborating Clinics (SLICC). Mod Rheumatol 2017; 28:642-648. [PMID: 29120258 DOI: 10.1080/14397595.2017.1385154] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the performance of the 2012 Systemic Lupus International Collaborating Clinics criteria (SLICC-12) on classifying systemic lupus erythematosus (SLE) in an uncontrolled multi-centered study with real-life scenario of the patients in Japan. METHODS This study comprised 495 patients with SLE or non-SLE rheumatic diseases and allied conditions from 12 institutes in Japan. Chart review of each patient was performed by the 27 expert rheumatologists and diagnosis of 487 cases reached to the consensus. Value of the SLICC-12 on SLE classification was analyzed comparing with the 1997 revised American College of Rheumatology SLE classification criteria (ACR-97) employing the expert-consented diagnoses. RESULTS Compared to the ACR-97, the SLICC-12 had a higher sensitivity (ACR-97 vs. SLICC-12: 0.88 vs. 0.99, p < .01) and comparable specificity (0.85 vs. 0.80). The rate of misclassification (0.14 vs. 0.11) or the area under the receiver operating characteristic curves (0.863 vs. 0.894) was not statistically different. In the cases that diagnoses corresponded in high rates among experts, both criteria showed high accordance of SLE classification over 85% with the expert diagnoses. CONCLUSION Although employment of SLICC-12 for the classification for SLE should be carefully considered, the SLICC-12 showed the higher sensitivity on classifying SLE in Japanese population.
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Affiliation(s)
- Kenji Oku
- a Division of Rheumatology, Endocrinology and Nephrology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Tatsuya Atsumi
- a Division of Rheumatology, Endocrinology and Nephrology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Yuji Akiyama
- b Department of Rheumatology and Applied Immunology , Saitama Medical University , Saitama , Japan
| | - Hirofumi Amano
- c Department of Internal Medicine and Rheumatology, Faculty of Medicine , Juntendo University , Tokyo , Japan
| | - Naoto Azuma
- d Division of Rheumatology, Department of Internal Medicine , Hyogo College of Medicine , Nishinomiya , Japan
| | - Toshiyuki Bohgaki
- a Division of Rheumatology, Endocrinology and Nephrology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Yu Funakubo Asanuma
- b Department of Rheumatology and Applied Immunology , Saitama Medical University , Saitama , Japan
| | - Tetsuya Horita
- a Division of Rheumatology, Endocrinology and Nephrology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Tadashi Hosoya
- e Department of Rheumatology, Graduate School of Medical and Dental Sciences , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| | - Kunihiro Ichinose
- f Department of Immunology and Rheumatology , Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Masaru Kato
- a Division of Rheumatology, Endocrinology and Nephrology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Yasuhiro Katsumata
- g Institute of Rheumatology , Tokyo Women's Medical University , Tokyo , Japan
| | - Yasushi Kawaguchi
- g Institute of Rheumatology , Tokyo Women's Medical University , Tokyo , Japan
| | - Atsushi Kawakami
- f Department of Immunology and Rheumatology , Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Tomohiro Koga
- f Department of Immunology and Rheumatology , Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Hitoshi Kohsaka
- e Department of Rheumatology, Graduate School of Medical and Dental Sciences , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| | - Yuya Kondo
- h Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine , University of Tsukuba , Tsukuba , Japan
| | - Kanae Kubo
- i Department of Allergy and Rheumatology, Faculty of Medical Sciences , The University of Tokyo , Tokyo , Japan
| | - Masataka Kuwana
- j Department of Allergy and Rheumatology , Nippon Medical School , Tokyo , Japan
| | - Akio Mimori
- k Division of Rheumatic Diseases , National Center for Global Health and Medicine , Tokyo , Japan
| | - Tsuneyo Mimori
- l Department of Rheumatology and Clinical Immunology , Kyoto University , Kyoto , Japan
| | - Toshihide Mimura
- b Department of Rheumatology and Applied Immunology , Saitama Medical University , Saitama , Japan
| | - Kosaku Murakami
- l Department of Rheumatology and Clinical Immunology , Kyoto University , Kyoto , Japan
| | - Kazuhisa Nakano
- m The First Department of Internal Medicine, School of Medicine , University of Occupational and Environmental Health , Kitakyushu , Japan
| | - Shingo Nakayamada
- m The First Department of Internal Medicine, School of Medicine , University of Occupational and Environmental Health , Kitakyushu , Japan
| | - Hiroshi Ogishima
- h Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine , University of Tsukuba , Tsukuba , Japan
| | - Kazumasa Ohmura
- a Division of Rheumatology, Endocrinology and Nephrology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Kazuyoshi Saito
- m The First Department of Internal Medicine, School of Medicine , University of Occupational and Environmental Health , Kitakyushu , Japan
| | - Hajime Sano
- d Division of Rheumatology, Department of Internal Medicine , Hyogo College of Medicine , Nishinomiya , Japan
| | - Mihoko Shibuya
- i Department of Allergy and Rheumatology, Faculty of Medical Sciences , The University of Tokyo , Tokyo , Japan
| | - Yuko Takahashi
- k Division of Rheumatic Diseases , National Center for Global Health and Medicine , Tokyo , Japan
| | - Yoshinari Takasaki
- c Department of Internal Medicine and Rheumatology, Faculty of Medicine , Juntendo University , Tokyo , Japan
| | - Tsutomu Takeuchi
- n Department of Internal Medicine , Keio University School of Medicine , Tokyo , Japan
| | - Naoto Tamura
- c Department of Internal Medicine and Rheumatology, Faculty of Medicine , Juntendo University , Tokyo , Japan
| | - Yoshiya Tanaka
- m The First Department of Internal Medicine, School of Medicine , University of Occupational and Environmental Health , Kitakyushu , Japan
| | - Hiroto Tsuboi
- h Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine , University of Tsukuba , Tsukuba , Japan
| | - Shinichiro Tsunoda
- d Division of Rheumatology, Department of Internal Medicine , Hyogo College of Medicine , Nishinomiya , Japan
| | - Naoichiro Yukawa
- l Department of Rheumatology and Clinical Immunology , Kyoto University , Kyoto , Japan
| | - Noriyuki Yamakawa
- l Department of Rheumatology and Clinical Immunology , Kyoto University , Kyoto , Japan.,o Department of Rheumatology , Kyoto-Katsura Hospital , Kyoto , Japan
| | - Kazuhiko Yamamoto
- i Department of Allergy and Rheumatology, Faculty of Medical Sciences , The University of Tokyo , Tokyo , Japan
| | - Takayuki Sumida
- h Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine , University of Tsukuba , Tsukuba , Japan
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Thurman JM, Frazer-Abel A, Holers VM. The Evolving Landscape for Complement Therapeutics in Rheumatic and Autoimmune Diseases. Arthritis Rheumatol 2017; 69:2102-2113. [PMID: 28732131 PMCID: PMC5659941 DOI: 10.1002/art.40219] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 07/18/2017] [Indexed: 12/13/2022]
Abstract
The complement system is increasingly understood to play major roles in the pathogenesis of human inflammatory and autoimmune diseases. Because of this situation, there are rapidly expanding commercial efforts to develop novel complement inhibitors and effector pathway-modulating drugs. This review provides insights into the evolving understanding of the complement system components, mechanisms of activation within and across the 3 pathways (classical, alternative, and lectin), how the pathways are normally controlled and then dysregulated in target tissues, and what diseases are known to be, in large part, complement-dependent through the successful development and approval of complement therapeutics in patients. Mechanisms of complement activation in rheumatoid arthritis, lupus, and thrombotic microangiopathies are also illustrated. In addition, the specific therapeutic drugs that are both approved and under development are discussed in the context of both nonrheumatic and rheumatic diseases. Finally, the methods by which the complement system can be assessed in humans through biomarker studies are outlined, with the goal of understanding, in specific patients, how the system is functioning.
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Affiliation(s)
- Joshua M. Thurman
- University of Colorado Denver, Division of Nephrology and Hypertension, Aurora, CO, USA
| | - Ashley Frazer-Abel
- University of Colorado Denver, Division of Rheumatology, Aurora, CO, USA
- Exsera BioLabs, University of Colorado Denver, Aurora, CO, USA
| | - V. Michael Holers
- University of Colorado Denver, Division of Rheumatology, Aurora, CO, USA
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da Silva Saraiva S, de Moraes Mazetto B, Quinteiro Tobaldine L, Pereira Colella M, Vinícius De Paula E, Annichinno-Bizzachi J, Andrade Orsi F. The impact of antibody profile in thrombosis associated with primary antiphospholipid syndrome. Am J Hematol 2017; 92:1163-1169. [PMID: 28762539 DOI: 10.1002/ajh.24875] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/22/2017] [Accepted: 07/26/2017] [Indexed: 12/18/2022]
Abstract
Triple positivity (TP) for antiphospholipid antibodies(aPL) may identify aPL carriers with poorer prognosis. The clinical impact of TP in primary antiphospholipid syndrome(PAPS) remains unclear and further clinical evidences are needed to validate TP as a marker of severity. The aim of this study was to evaluate the impact of TP on the clinical course of PAPS with thrombosis(t-PAPS). We performed a retrospective analysis of a cohort of t-PAPS patients, comparing groups of patients with TP and non-TP profiles according to their demographic, clinical and laboratory features. We included 105 patients with t-PAPS, the median follow-up time of 3.7 years. Twenty-two patients(21%) had TP; the demographic distribution, the presence of cardiovascular risk factors and the site of thrombosis were similar between TP and non-TP patients. The frequency of thrombotic events did not differ between TP and non-TP patients during the study period. Pregnancy morbidities were more frequent in women with t-PAPS and TP than in those with non-TP profile (80% vs. 52.8%, P = 0.05). Patients with t-PAPS and TP presented, at diagnosis, higher dRVVT ratio (median R = 2.44 vs. 1.57, P < 0.0001), higher aCL titer (median = 50UI vs. 35 UI, P < 0.0001), lower C3 levels (median = 1.08 vs. 1.30 mg dL-1 , P = 0.001), lower C4 levels (median = 0.22 vs. 0.25 mg dL-1 , P = 0.05) and higher frequency of positive ANA test (50% vs. 20%, P = 0.008) than patients with t-PAPS and non-TP. Lower-than-normal levels of C3 was independently associated with TP (OR = 5.1, P = 0.02). The presence of TP in patients with t-PAPS was associated with immune derangement, with no effect on the clinical course of the disease.
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Affiliation(s)
- Sabrina da Silva Saraiva
- Thrombosis and Haemostasis Unit, Hematology and Hemotherapy Center; University of Campinas, Rua Carlos Chagas, 480. Cidade Universitária “ZeferinoVaz” CEP: 13083-970; Campinas SP Brazil
| | - Bruna de Moraes Mazetto
- Thrombosis and Haemostasis Unit, Hematology and Hemotherapy Center; University of Campinas, Rua Carlos Chagas, 480. Cidade Universitária “ZeferinoVaz” CEP: 13083-970; Campinas SP Brazil
| | - Lais Quinteiro Tobaldine
- Thrombosis and Haemostasis Unit, Hematology and Hemotherapy Center; University of Campinas, Rua Carlos Chagas, 480. Cidade Universitária “ZeferinoVaz” CEP: 13083-970; Campinas SP Brazil
| | - Marina Pereira Colella
- Thrombosis and Haemostasis Unit, Hematology and Hemotherapy Center; University of Campinas, Rua Carlos Chagas, 480. Cidade Universitária “ZeferinoVaz” CEP: 13083-970; Campinas SP Brazil
| | - Erich Vinícius De Paula
- Thrombosis and Haemostasis Unit, Hematology and Hemotherapy Center; University of Campinas, Rua Carlos Chagas, 480. Cidade Universitária “ZeferinoVaz” CEP: 13083-970; Campinas SP Brazil
- Discipline of Hematology and Hemotherapy, Department of Internal Medicine, Faculty of Medical Sciences; University of Campinas, Campinas, Brazil RuaTessália Vieira de Camargo, 126. Cidade Universitária “Zeferino Vaz” CEP: 13083-887; Campinas SP Brazil
| | - Joyce Annichinno-Bizzachi
- Thrombosis and Haemostasis Unit, Hematology and Hemotherapy Center; University of Campinas, Rua Carlos Chagas, 480. Cidade Universitária “ZeferinoVaz” CEP: 13083-970; Campinas SP Brazil
- Discipline of Hematology and Hemotherapy, Department of Internal Medicine, Faculty of Medical Sciences; University of Campinas, Campinas, Brazil RuaTessália Vieira de Camargo, 126. Cidade Universitária “Zeferino Vaz” CEP: 13083-887; Campinas SP Brazil
| | - Fernanda Andrade Orsi
- Thrombosis and Haemostasis Unit, Hematology and Hemotherapy Center; University of Campinas, Rua Carlos Chagas, 480. Cidade Universitária “ZeferinoVaz” CEP: 13083-970; Campinas SP Brazil
- Department of Clinical Pathology, Faculty of Medical Sciences; University of Campinas, Campinas, Brazil RuaTessália Vieira de Camargo, 126. CidadeUniversitária “ZeferinoVaz” CEP: 13083-887; Campinas SP Brazil
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76
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Thrombin activatable fibrinolysis inhibitor (TAFI) — A possible link between coagulation and complement activation in the antiphospholipid syndrome (APS). Thromb Res 2017; 158:168-173. [DOI: 10.1016/j.thromres.2017.06.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/19/2017] [Accepted: 06/22/2017] [Indexed: 11/23/2022]
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77
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Brocklebank V, Kavanagh D. Complement C5-inhibiting therapy for the thrombotic microangiopathies: accumulating evidence, but not a panacea. Clin Kidney J 2017; 10:600-624. [PMID: 28980670 PMCID: PMC5622895 DOI: 10.1093/ckj/sfx081] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 06/21/2017] [Indexed: 02/07/2023] Open
Abstract
Thrombotic microangiopathy (TMA), characterized by organ injury occurring consequent to severe endothelial damage, can manifest in a diverse range of diseases. In complement-mediated atypical haemolytic uraemic syndrome (aHUS) a primary defect in complement, such as a mutation or autoantibody leading to over activation of the alternative pathway, predisposes to the development of disease, usually following exposure to an environmental trigger. The elucidation of the pathogenesis of aHUS resulted in the successful introduction of the complement inhibitor eculizumab into clinical practice. In other TMAs, although complement activation may be seen, its role in the pathogenesis remains to be confirmed by an interventional trial. Although many case reports in TMAs other than complement-mediated aHUS hint at efficacy, publication bias, concurrent therapies and in some cases the self-limiting nature of disease make broader interpretation difficult. In this article, we will review the evidence for the role of complement inhibition in complement-mediated aHUS and other TMAs.
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Affiliation(s)
- Vicky Brocklebank
- The National Renal Complement Therapeutics Centre (NRCTC), Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David Kavanagh
- The National Renal Complement Therapeutics Centre (NRCTC), Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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78
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Ames PRJ, Alves JD, Gentile F. Coagulation and complement in antiphospholipid syndrome. Thromb Res 2017; 158:149-151. [PMID: 28917113 DOI: 10.1016/j.thromres.2017.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/08/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Paul R J Ames
- Immune Response & Vascular Disease Unit, CEDOC, NOVA Medical School/Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisboa, Portugal; Dumfries & Galloway Royal Infirmary, Dumfries, UK; Multimedica SRL, Naples, Italy.
| | - José Delgado Alves
- Immune Response & Vascular Disease Unit, CEDOC, NOVA Medical School/Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Fabrizio Gentile
- Department of Medicine & Health Sciences, Universita' del Molise, Campobasso, Italy
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Mobarrez F, Gunnarsson I, Svenungsson E. Altered β 2 -glycoprotein I expression on microparticles in the presence of antiphospholipid antibodies. J Thromb Haemost 2017; 15:1799-1806. [PMID: 28667788 DOI: 10.1111/jth.13765] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/08/2017] [Indexed: 01/15/2023]
Abstract
Essentials β2 glycoprotein-I (β2 GPI) is a scavenger molecule that binds to microparticles (MPs). β2 GPI expression on MPs was measured in systemic lupus erythematosus (SLE) patients and controls. β2 GPI positive MPs is depressed among SLE patients positive for antiphospholipid antibodies. Complex formation between β2 GPI on MPs and patients own anti-β2 GPI may disturb MP clearance. Click to hear an ISTH Academy presentation on antiphospholipid antibody syndrome by Drs de Laat and Bertolaccini SUMMARY: Background Antiphospholipid antibodies (aPLs) together with thrombosis and/or pregnancy morbidities characterize the antiphospholipid syndrome. β2 -Glycoprotein I (β2 GPI), the most important antigen for aPLs, is a scavenger molecule that specifically binds to phosphatidylserine (PS) expressed on microparticles (MPs). Objectives To evaluate β2 GPI-expressing MPs in patients with systemic lupus erythematosus (SLE) stratified for aPL status, and in healthy controls. Patients/Methods We investigated 18 aPL/anti-β2 GPI-positive and 22 aPL-negative patients from a large SLE cohort and 19 healthy controls. β2 GPI-positive MPs and IgG-positive MPs were detected by flow cytometry. We measured plasma levels of β2 GPI, and performed in vitro experiments to investigate the binding properties of β2 GPI on MPs. Results SLE patients had more MPs and IgG-positive MPs than controls. We observed fewer β2 GPI-positive MPs in aPL/anti-β2 GPI-positive patients than in aPL/anti-β2 GPI-negative patients and controls (approximately two-fold). β2 GPI levels in plasma did not differ with aPL/anti-β2 GPI status in patients; however, controls had slightly higher levels of β2 GPI than aPL/anti-β2 GPI-positive patients. In vitro experiments revealed that β2 GPI preferentially binds to PS-positive MPs. Conclusions Despite abundant total MPs and MPs in immune complexes, β2 GPI-positive MPs were depleted in SLE patients, and the levels were especially low in aPL/anti-β2 GPI-positive patients. We suggest that anti-β2 GPI antibodies bind to β2 GPI-PS complexes expressed on MPs. Consequent loss of β2 GPI-PS expression on MPs may impair scavenging and contribute to the accumulation of circulating PS-negative MPs, a possible source of autoantigens. Autoantibodies delaying MP clearance may thus constitute an important mechanism underlying autoimmunity.
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Affiliation(s)
- F Mobarrez
- Unit of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - I Gunnarsson
- Unit of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - E Svenungsson
- Unit of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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80
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Sciascia S, Amigo MC, Roccatello D, Khamashta M. Diagnosing antiphospholipid syndrome: 'extra-criteria' manifestations and technical advances. Nat Rev Rheumatol 2017; 13:548-560. [PMID: 28769114 DOI: 10.1038/nrrheum.2017.124] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
First described in the early 1980s, antiphospholipid syndrome (APS) is a unique form of acquired autoimmune thrombophilia in which patients present with clinical features of recurrent thrombosis and pregnancy morbidity and persistently test positive for the presence of antiphospholipid antibodies (aPL). At least one clinical (vascular thrombosis or pregnancy morbidity) and one lab-based (positive test result for lupus anticoagulant, anticardiolipin antibodies and/or anti-β2-glycoprotein 1 antibodies) criterion have to be met for a patient to be classified as having APS. However, the clinical spectrum of APS encompasses additional manifestations that can affect many organs and cannot be explained exclusively by patients being in a prothrombotic state; clinical manifestations not listed in the classification criteria (known as extra-criteria manifestations) include neurologic manifestations (chorea, myelitis and migraine), haematologic manifestations (thrombocytopenia and haemolytic anaemia), livedo reticularis, nephropathy and valvular heart disease. Increasingly, research interest has focused on the development of novel assays that might be more specific for APS than the current aPL tests. This Review focuses on the current classification criteria for APS, presenting the role of extra-criteria manifestations and lab-based tests. Diagnostic approaches to difficult cases, including so-called seronegative APS, are also discussed.
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Affiliation(s)
- Savino Sciascia
- Centre of Research of Immunopathology and Rare Diseases (CMID), Coordinating Centre of Piedmont and Aosta Valley Network for Rare Diseases, Department of Clinical and Biological Sciences, St Giovanni Bosco Hospital and the University of Turin, Piazza del Donatore di Sangue 3, 10154 Turin, Italy.,SCDU Nephrology and Dialysis, Department of Clinical and Biological Sciences, St Giovanni Bosco Hospital and the University of Turin, Piazza del Donatore di Sangue 3, 10154 Turin, Italy
| | - Mary-Carmen Amigo
- Service of Rheumatology, ABC Medical Center, Sur 136 No. 116, Colonia Las Américas, Mexico City 01220, Mexico
| | - Dario Roccatello
- Centre of Research of Immunopathology and Rare Diseases (CMID), Coordinating Centre of Piedmont and Aosta Valley Network for Rare Diseases, Department of Clinical and Biological Sciences, St Giovanni Bosco Hospital and the University of Turin, Piazza del Donatore di Sangue 3, 10154 Turin, Italy.,SCDU Nephrology and Dialysis, Department of Clinical and Biological Sciences, St Giovanni Bosco Hospital and the University of Turin, Piazza del Donatore di Sangue 3, 10154 Turin, Italy
| | - Munther Khamashta
- Department of Rheumatology, Dubai Hospital, PO box 7272, Dubai, UAE.,Graham Hughes Lupus Research Laboratory, Division of Women's Health, King's College London, The Rayne Institute, 4th Floor Lambeth Wing, St Thomas' Hospital, London SE1 7EH, UK
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81
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Abrahams VM, Chamley LW, Salmon JE. Emerging Treatment Models in Rheumatology: Antiphospholipid Syndrome and Pregnancy: Pathogenesis to Translation. Arthritis Rheumatol 2017; 69:1710-1721. [PMID: 28445926 DOI: 10.1002/art.40136] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 04/20/2017] [Indexed: 02/06/2023]
Affiliation(s)
| | | | - Jane E Salmon
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
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Antibodies Against Complement Components: Relevance for the Antiphospholipid Syndrome-Biomarkers of the Disease and Biopharmaceuticals. Curr Rheumatol Rep 2017. [PMID: 28631067 DOI: 10.1007/s11926-017-0669-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Laboratory criterion for the diagnosis of antiphospholipid syndrome (APS) is the presence of antiphospholipid antibodies (aPL Abs). Complement system has a role in mediating aPL Abs-induced thrombosis in animal models. The importance of antibodies against complement components (potential biomarkers of APS) and the importance of antibodies with beneficial anti-complement effects in APS (as biopharmaceuticals) are reviewed. RECENT FINDINGS Antibodies against complement components described in APS patients, so far, are anti-C1q and anti-factor H Abs, although anti-factor B Abs and anti-C5a Abs were described in animal models of APS. Clinical studies in APS patients are limited to a small number of case reports. Studies that would confirm potential role of Abs against complement components (as potential biomarkers of APS) are lacking. Lack of randomized clinical trials (that would provide complete data for confirmation of beneficial effects of biopharmaceuticals in complement inhibition) in APS is alarming.
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83
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Rand JH, Wu XX, Wolgast LR, Lei V, Conway EM. A novel 2-stage approach that detects complement activation in patients with antiphospholipid antibody syndrome. Thromb Res 2017. [PMID: 28628799 DOI: 10.1016/j.thromres.2017.06.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The antiphospholipid syndrome (APS) is marked by autoantibodies that recognize anionic phospholipids in a cofactor-dependent manner. A role for complement has been implicated in the pathophysiology, however, elevations of complement activation markers have not been consistently demonstrated in clinical studies. We therefore designed a proof-of-principle study to determine whether complement activation might be detectable in APS by first exposing plasmas to phospholipid vesicles. METHODS We examined complement activation markers in patients with APS, non-APS thrombosis, systemic lupus erythematosus, cancer, patients with antiphospholipid antibodies without thrombosis (APL) and healthy controls. Direct measurements of plasma C5a and sC5b-9 levels were compared to levels that were generated in normal serum by phospholipid vesicles that had been pre-incubated with the same plasmas. We then determined the effects of the C5 inhibitor, eculizumab, examined the complement pathways involved, and determined whether the effects could be reproduced with purified IgGs and β2-glycoprotein I (β2GPI). RESULTS Plasma levels of C5a and sC5b-9 were higher, but not significantly increased in APS patients compared to healthy controls. In contrast, phospholipid vesicles pre-incubated with APS plasmas generated significantly higher levels than healthy controls and the other groups, except for APL patients. Complement activation was abrogated by addition of eculizumab. The results with substrate sera indicated that the alternative and classical/lectin pathways were involved. The results were reproducible with purified IgGs and β2GPI. CONCLUSION This proof-of-principle study confirms a role for complement in APS and opens the possibility of monitoring complement activation by including phospholipid vesicles in assay systems.
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Affiliation(s)
- Jacob H Rand
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065, United States
| | - Xiao-Xuan Wu
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY 10065, United States
| | - Lucia R Wolgast
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Victor Lei
- Centre for Blood Research, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Edward M Conway
- Centre for Blood Research, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
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84
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Up-regulated Complement 3 Production by Toll-like receptor 9/ Transforming Growth Factor-Beta 1/Complement 3 Pathway in Whole Blood Cells of Lupus Thrombocytopenia. Arch Rheumatol 2017; 32:275-283. [PMID: 29901007 DOI: 10.5606/archrheumatol.2017.6279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 01/18/2017] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to assess the complement 3 (C3) expressions in whole blood cells and verify a pathway toll-like receptor 9 (TLR9)/ transforming growth factor-beta 1 (TGF-β1)/C3 for C3 regulation in mediating thrombocytopenia (TCP) in patients with systemic lupus erythematosus (SLE). Patients and methods The study included 63 newly diagnosed SLE patients (2 males, 61 females; mean age 39.5 years; range 15 to 67 years). Whole blood messenger ribonucleic acid expression for C3, TLR9 and TGF-β1 were measured by quantitative reverse transcription real-time polymerase chain reaction in SLE patients with TCP (n=38) and age- and sex-matched SLE patients without TCP (n=25) at baseline and in 10 SLE patients with TCP after four weeks of treatment. Whole blood cells from SLE patients with TCP were cultured in the presence of TLR9 ligand cytosine-phosphate- guanine, recombinant human TGF-β1, TGF-β receptor inhibitor/activin receptor-like kinase inhibitor SB431542. TGF-β1 and C3 levels in whole blood cells cultures were determined by quantitative reverse transcription real-time polymerase chain reaction and enzyme-linked immunosorbent assay. Results Whole blood cells from SLE patients with TCP displayed an enhanced gene expression for C3, TLR9 and TGF-β1 compared with that of SLE patients without TCP (p<0.01 for C3, p<0.05 for TLR9 and TGF-β1). SLE patients with TCP had decreased plasma levels of C3 suggesting excessive consumption. In whole blood cell culture, engagement of TLR9 led to the increased gene expression of C3. Furthermore, TGF-β1 inhibitor abolished TLR9 stimulation on C3 gene expression. Conclusion These results suggest that blood cells are the source of extra-hepatic synthesis of C3 in SLE patients with TCP and this synthesis of C3 was up-regulated by TLR9 via induction of TGF-β1. Thus TLR9/TGF-β1/C3 pathway might be in operation mediating lupus thrombocytopenia.
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85
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Arachchillage DRJ, Laffan M. Pathogenesis and management of antiphospholipid syndrome. Br J Haematol 2017; 178:181-195. [PMID: 28339096 DOI: 10.1111/bjh.14632] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Antiphospholipid antibodies are a heterogeneous group of autoantibodies that have clear associations with thrombosis and pregnancy morbidity, and which together constitute the 'antiphospholipid syndrome' (APS). However, the pathophysiology of these complications is not well understood and their heterogeneity suggests that more than one pathogenic process may be involved. Diagnosis remains a combination of laboratory analysis and clinical observation but there have been significant advances in identifying specific pathogenic features, such as domain I-specific anti-β2-glycoprotein-I antibodies. This in turn has pointed to endothelial and complement activation as important factors in the pathogenesis of APS. Consequently, although anticoagulation remains the standard treatment for thrombotic APS and during pregnancy, the realisation that these additional pathways are involved in the pathogenesis of APS has significant implications for treatment: agents acting outside the coagulation system, such as hydroxychloroquine for pregnancy complications and sirolimus as an inhibitor of the mammalian target of rapamycin (mTOR) pathway, are now under evaluation and represent a radical change in thinking for haematologists. Conventional anticoagulation is also under challenge from new, direct acting anticoagulants. This review will provide a comprehensive overview of the evolving understanding of APS pathogenesis and how this and novel therapeutics will alter diagnosis and management.
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Affiliation(s)
- Deepa R J Arachchillage
- Department of Haematology, Imperial College Healthcare NHS Trust and Imperial College London, Hammersmith Hospital, London, UK
| | - Mike Laffan
- Department of Haematology, Imperial College Healthcare NHS Trust and Imperial College London, Hammersmith Hospital, London, UK
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86
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Ferluga J, Kouser L, Murugaiah V, Sim RB, Kishore U. Potential influences of complement factor H in autoimmune inflammatory and thrombotic disorders. Mol Immunol 2017; 84:84-106. [PMID: 28216098 DOI: 10.1016/j.molimm.2017.01.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 01/11/2017] [Accepted: 01/13/2017] [Indexed: 01/01/2023]
Abstract
Complement system homeostasis is important for host self-protection and anti-microbial immune surveillance, and recent research indicates roles in tissue development and remodelling. Complement also appears to have several points of interaction with the blood coagulation system. Deficiency and altered function due to gene mutations and polymorphisms in complement effectors and regulators, including Factor H, have been associated with familial and sporadic autoimmune inflammatory - thrombotic disorders, in which autoantibodies play a part. These include systemic lupus erythematosus, rheumatoid arthritis, atypical haemolytic uremic syndrome, anti-phospholipid syndrome and age-related macular degeneration. Such diseases are generally complex - multigenic and heterogeneous in their symptoms and predisposition/susceptibility. They usually need to be triggered by vascular trauma, drugs or infection and non-complement genetic factors also play a part. Underlying events seem to include decline in peripheral regulatory T cells, dendritic cell, and B cell tolerance, associated with alterations in lymphoid organ microenvironment. Factor H is an abundant protein, synthesised in many cell types, and its reported binding to many different ligands, even if not of high affinity, may influence a large number of molecular interactions, together with the accepted role of Factor H within the complement system. Factor H is involved in mesenchymal stem cell mediated tolerance and also contributes to self-tolerance by augmenting iC3b production and opsonisation of apoptotic cells for their silent dendritic cell engulfment via complement receptor CR3, which mediates anti-inflammatory-tolerogenic effects in the apoptotic cell context. There may be co-operation with other phagocytic receptors, such as complement C1q receptors, and the Tim glycoprotein family, which specifically bind phosphatidylserine expressed on the apoptotic cell surface. Factor H is able to discriminate between self and nonself surfaces for self-protection and anti-microbe defence. Factor H, particularly as an abundant platelet protein, may also modulate blood coagulation, having an anti-thrombotic role. Here, we review a number of interaction pathways in coagulation and in immunity, together with associated diseases, and indicate where Factor H may be expected to exert an influence, based on reports of the diversity of ligands for Factor H.
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Affiliation(s)
- Janez Ferluga
- Biosciences, College of Health and Life Sciences, Brunel University London, Uxbridge, UB8 3PH, United Kingdom
| | - Lubna Kouser
- Biosciences, College of Health and Life Sciences, Brunel University London, Uxbridge, UB8 3PH, United Kingdom
| | - Valarmathy Murugaiah
- Biosciences, College of Health and Life Sciences, Brunel University London, Uxbridge, UB8 3PH, United Kingdom
| | - Robert B Sim
- Department of Pharmacology, University of Oxford, Mansfield Road, Oxford OX1 3QT, United Kingdom
| | - Uday Kishore
- Biosciences, College of Health and Life Sciences, Brunel University London, Uxbridge, UB8 3PH, United Kingdom.
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87
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Vignesh P, Rawat A, Sharma M, Singh S. Complement in autoimmune diseases. Clin Chim Acta 2017; 465:123-130. [PMID: 28040558 DOI: 10.1016/j.cca.2016.12.017] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 12/15/2016] [Accepted: 12/17/2016] [Indexed: 12/18/2022]
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88
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Abstract
Antiphospholipid syndrome (APS), also known as Hughes Syndrome, is a systemic autoimmune disease characterized by thrombosis and/or pregnancy morbidity in the presence of persistently positive antiphospholipid antibodies. A patient with APS must meet at least one of two clinical criteria (vascular thrombosis or complications of pregnancy) and at least one of two laboratory criteria including the persistent presence of lupus anticoagulant (LA), anticardiolipin antibodies (aCL), and/or anti-b2 glycoprotein I (anti-b2GPI) antibodies of IgG or IgM isotype at medium to high titres in patient’s plasma. However, several other autoantibodies targeting other coagulation cascade proteins (i.e. prothrombin) or their complex with phospholipids (i.e. phosphatidylserine/prothrombin complex), or to some domains of β2GPI, have been proposed to be also relevant to APS. In fact, the value of testing for new aPL specificities in the identification of APS in thrombosis and/or pregnancy morbidity patients is currently being investigated.
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Affiliation(s)
- Maria Laura Bertolaccini
- Academic Department of Vascular Surgery, Cardiovascular Division, King's College London, London, UK
| | - Giovanni Sanna
- Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
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89
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Arachchillage DRJ, Mackie IJ, Efthymiou M, Chitolie A, Hunt BJ, Isenberg DA, Khamashta M, Machin SJ, Cohen H. Rivaroxaban limits complement activation compared with warfarin in antiphospholipid syndrome patients with venous thromboembolism. J Thromb Haemost 2016; 14:2177-2186. [PMID: 27541499 DOI: 10.1111/jth.13475] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Indexed: 12/19/2022]
Abstract
Essentials Complement activation has a pathogenic role in thrombotic antiphospholipid syndrome (APS). Coagulation proteases such as factor Xa can activate complement proteins. Complement activation markers were elevated in anticoagulated thrombotic APS patients. Complement activation decreased in APS patients switching from warfarin to rivaroxaban. SUMMARY Background Complement activation may play a major role in the pathogenesis of thrombotic antiphospholipid syndrome (APS). Coagulation proteases such as factor Xa can activate complement proteins. Aims To establish whether rivaroxaban, a direct factor Xa inhibitor, limits complement activation compared with warfarin in APS patients with previous venous thromboembolism (VTE). Methods A total of 111 APS patients with previous VTE, on warfarin target INR 2.5, had blood samples taken at baseline and at day 42 after randomization in the RAPS (Rivaroxaban in Antiphospholipid Syndrome) trial. Fifty-six patients remained on warfarin and 55 switched to rivaroxaban. Fifty-five normal controls (NC) were also studied. Markers of complement activation (C3a, C5a, terminal complement complex [SC5b-9] and Bb fragment) were assessed. Results APS patients had significantly higher complement activation markers compared with NC at both time-points irrespective of the anticoagulant. There were no differences between the two patient groups at baseline, or patients remaining on warfarin at day 42. In 55 patients randomized to rivaroxaban, C3a, C5a and SC5b-9 were lower at day 42 (median (ng mL-1 ) [confidence interval] 64 [29-125] vs. 83 [35-147], 9 [2-15] vs. 12 [4-18] and 171 [56-245] vs. 201 [66-350], respectively) but levels of Bb fragment were unchanged. There were no correlations between rivaroxaban levels and complement activation markers. Conclusions APS patients with previous VTE on warfarin exhibit increased complement activation, which is likely to occur via the classical pathway and is decreased by rivaroxaban administration. Rivaroxaban may therefore potentially provide an additional benefit to its anticoagulant effect in this patient group by limiting complement activation.
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Affiliation(s)
- D R J Arachchillage
- Department of Haematology, Haemostasis Research Unit, University College London, London, UK
| | - I J Mackie
- Department of Haematology, Haemostasis Research Unit, University College London, London, UK
| | - M Efthymiou
- Department of Haematology, Haemostasis Research Unit, University College London, London, UK
| | - A Chitolie
- Department of Haematology, Haemostasis Research Unit, University College London, London, UK
| | - B J Hunt
- Thrombosis and Haemophilia, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Haematology, Kings College London, London, UK
| | - D A Isenberg
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - M Khamashta
- Lupus Research Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Rheumatology, Kings College London, London, UK
| | - S J Machin
- Department of Haematology, Haemostasis Research Unit, University College London, London, UK
| | - H Cohen
- Department of Haematology, Haemostasis Research Unit, University College London, London, UK
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
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TNF-alpha and annexin A2: inflammation in thrombotic primary antiphospholipid syndrome. Rheumatol Int 2016; 36:1649-1656. [PMID: 27704162 DOI: 10.1007/s00296-016-3569-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/19/2016] [Indexed: 12/22/2022]
Abstract
Antiphospholipid syndrome (APS) is characterized by thromboses and/or pregnancy losses. Laboratory criterion for the diagnosis of APS is the presence of antiphospholipid antibodies (anticardiolipin, anti-beta2-glycoprotein I (aβ2gpI) and lupus anticoagulant). On the one hand, the latest classification criteria for the diagnosis of APS emphasized that thrombotic manifestations of the syndrome should be without any signs of an inflammatory process, while on the other hand, some recent reports have suggested that APS is a "pro-inflammatory state." This article is focused on the importance of TNF-alpha and annexin A2 (anxA2) for patients with vascular (thrombotic) manifestations of the primary APS. The classic antithrombotic and antiplatelet therapy does not protect APS patients from the development of recurrent thrombosis. Therefore, an urgent need for the introduction of new therapeutic approaches in the treatment of APS patients is obvious. This review provides a rationale for the necessity for the use of immunomodulatory medications that could interfere with β2gpI binding to its receptor(s), such as anxA2, and/or inhibit TNF-alpha activity.
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91
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Complement and thrombosis in the antiphospholipid syndrome. Autoimmun Rev 2016; 15:1001-4. [DOI: 10.1016/j.autrev.2016.07.020] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 07/09/2016] [Indexed: 02/05/2023]
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92
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Proinflammatory proteins in female and male patients with primary antiphospholipid syndrome: preliminary data. Clin Rheumatol 2016; 35:2477-83. [PMID: 27370963 DOI: 10.1007/s10067-016-3345-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/10/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Abstract
The latest classification criteria for the diagnosis of the antiphospholipid syndrome (APS, an autoimmune disease characterized by thromboses, miscarriages and presence of antiphospholipid antibodies (Abs)) emphasized that thrombotic manifestations of APS should be without any signs of an inflammatory process. However, atherosclerosis (a chronic inflammatory response to the accumulation of lipoproteins in the walls of arteries) and APS are characterized by some similar features. We evaluated whether proinflammatory proteins were associated with the features of the primary APS (PAPS). PAPS patients without obstetric complications and with impaired lipid profile were included in the study. Antiphospholipid antibodies, TNF-alpha, and apo(a) were determined by ELISA. Complement components and hsCRP were measured by immunonephelometry. Decreased C3c was observed in female patients with increased titers of IgG anti-β2gpI (χ(2) = 3.939, P = 0.047) and in male patients with increased IgM anticardiolipin Abs (χ(2) = 4.286, P = 0.038). Pulmonary emboli were associated with interleukin (IL)-6 in male (χ(2) = 6.519, P = 0.011) and in female (χ(2) = 10.405, P = 0.001) patients. Cerebrovascular insults were associated with LDL-cholesterol (P = 0.05, 95 % CI: 1.003 - 12.739) in female and with apo(a) (P = 0.016, 95 % CI: 0.000-0.003) in male patients. Older female patients had increased LDL-cholesterol levels and frequency of myocardial infarctions. Proinflammatory proteins were associated with features of primary APS. No real gender differences in regard to proinflammatory protein levels were observed. Premenopausal state of female PAPS patients confers lower cardiovascular risk.
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Magro-Checa C, Schaarenburg RA, Beaart HJL, Huizinga TWJ, Steup-Beekman GM, Trouw LA. Complement levels and anti-C1q autoantibodies in patients with neuropsychiatric systemic lupus erythematosus. Lupus 2016; 25:878-88. [DOI: 10.1177/0961203316643170] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective The objective of this paper is to analyse serum levels of anti-C1q, C1q circulating immune complexes (CIC), complement activation and complement components in systemic lupus erythematosus (SLE) patients during the first central nervous system neuropsychiatric (NP) event and to define the possible association between these results and clinical and laboratory characteristics. Methods A total of 280 patients suspected of having NP involvement due to SLE were recruited in the Leiden NPSLE-clinic. All SLE patients were classified according to the ACR 1982 revised criteria for the classification of SLE. The clinical disease activity was measured by the SLE Disease Activity Index 2000 (SLEDAI-2K) and NP diagnoses were classified according to the 1999 ACR case definitions for NPSLE. We measured in serum of all patients anti-C1q and C1q CIC levels, the activation capacity of complement (CH50 and AP50) and different complement components (C1q, C3, C4). Results In 92 patients the symptoms were attributed to SLE. NPSLE patients consisted of 63 patients with focal NPSLE and 34 patients with diffuse NPSLE. Anti-C1q antibodies were significantly higher and CH50, AP50 and C3 were significantly lower in NPSLE patients compared with SLE patients without NPSLE. This association was specially marked for diffuse NPSLE while no differences were found for focal NPSLE. After using potential predictors, decreased C4 remained significantly associated with focal NPSLE, but only when antiphospholipid antibodies (aPL) were included in the model. C3 and AP50 were independently associated with diffuse NPSLE. When SLEDAI-2K was included in the model these two associations were lost. When individual NPSLE syndromes were analysed, psychosis and cognitive dysfunction showed significantly lower values of complement activation capacity and all complement components. No significant associations were seen for other individual NPSLE syndromes. Conclusion The associations between diffuse NPSLE and anti-C1q, C3/AP50 and focal NPSLE and C4 may be explained by disease activity and the presence of aPL, respectively. The role of complement activation and complement components in lupus psychosis and cognitive dysfunction merits further research.
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Affiliation(s)
- C Magro-Checa
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - R A Schaarenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - H J L Beaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - T W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - G M Steup-Beekman
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - L A Trouw
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
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94
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Oku K, Amengual O, Hisada R, Ohmura K, Nakagawa I, Watanabe T, Bohgaki T, Horita T, Yasuda S, Atsumi T. Autoantibodies against a complement component 1 q subcomponent contribute to complement activation and recurrent thrombosis/pregnancy morbidity in anti-phospholipid syndrome. Rheumatology (Oxford) 2016; 55:1403-11. [PMID: 27084309 DOI: 10.1093/rheumatology/kew196] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the prevalence and significance of the autoantibodies against complement component 1 q subcomponent (C1q) in patients with APS. METHODS In all, 40 consecutive primary APS patients, 42 patients with non-SLE CTDs and 20 SLE patients negative for aPL were enrolled in this retrospective analysis. Refractory APS was defined as a clinical status of recurring thrombosis or pregnancy morbidity during adequate secondary prophylaxis. An ELISA was used to measure serum levels of anti-C1q antibodies and anaphylatoxins (C3a, C4a). RESULTS Anti-C1q antibodies were found in 36% (15/42) and 2.5% (1/40) of primary APS patients and controls, respectively. Among primary APS patients, anti-C1q antibody titres were significantly correlated with serum C4a levels (P = 0.013). Neither the prevalence nor the titre of anti-C1q antibodies was associated with any specific clinical manifestations of APS, nor titres of aPL. Refractory APS patients (n = 10) had a higher prevalence of anti-C1q antibodies (9/10 vs 6/32, P = 0.01) than APS patients without recurrence (n = 32). CONCLUSION Anti-C1q antibodies are associated with complement activation in APS and may contribute to the pathogenesis, particularly in refractory cases.
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Affiliation(s)
- Kenji Oku
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Olga Amengual
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ryo Hisada
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazumasa Ohmura
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ikuma Nakagawa
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Toshiyuki Watanabe
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Toshiyuki Bohgaki
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Tetsuya Horita
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Shinsuke Yasuda
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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95
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Martínez-Flores JA, Serrano M, Pérez D, Cámara A GDL, Lora D, Morillas L, Ayala R, Paz-Artal E, Morales JM, Serrano A. Circulating Immune Complexes of IgA Bound to Beta 2 Glycoprotein are Strongly Associated with the Occurrence of Acute Thrombotic Events. J Atheroscler Thromb 2016; 23:1242-1253. [PMID: 27063992 PMCID: PMC5098924 DOI: 10.5551/jat.34488] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim: Antiphospholipid syndrome (APS) is characterized by recurrent thrombosis and/or gestational morbidity in patients with antiphospholipid autoantibodies (aPL). Over recent years, IgA anti-beta2-glycoprotein I (B2GPI) antibodies (IgA aB2GPI) have reached similar clinical relevance as IgG or IgM isotypes. We recently described the presence of immune complexes of IgA bounded to B2GPI (B2A-CIC) in the blood of patients with antecedents of APS symptomalology. However, B2A-CIC's clinical associations with thrombotic events (TEV) have not been described yet. Methods: A total of 145 individuals who were isolate positive for IgA aB2GPI were studied: 50 controls without any APS antecedent, 22 patients with recent TEV (Group-1), and 73 patients with antecedents of old TEV (Group-2). Results: Mean B2A-CIC levels and prevalence in Group-1 were 29.6 ± 4.1 AU and 81.8%, respectively, and were significantly higher than those of Group-2 and controls (p < 0.001). In a multivariable analysis, positivity of B2A-CIC was an independent variable for acute thrombosis with a 22.7 odd ratio (confidence interval 5.1 –101.6, 95%, p < 0.001). Levels of B2A-CIC dropped significantly two months after the TEV. B2A-CIC positive patients had lower platelet levels than B2A-CIC-negative patients (p < 0.001) and more prevalence of thrombocytopenia (p < 0.019). Group-1 had no significant differences in C3 and C4 levels compared with other groups. Conclusion: B2A-CIC is strongly associated with acute TEV. Patients who did not develop thrombosis and were B2A-CIC positive had lower platelet levels, which suggest a hypercoagulable state. This mechanism is unrelated to complement-fixing aPL. B2A-CIC could potentially select IgA aB2GPI-positive patients at risk of developing a thrombotic event.
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Affiliation(s)
- José A Martínez-Flores
- Department of Immunology, Instituto de Investigación, Hospital Universitario 12 de Octubre
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96
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Lintner KE, Wu YL, Yang Y, Spencer CH, Hauptmann G, Hebert LA, Atkinson JP, Yu CY. Early Components of the Complement Classical Activation Pathway in Human Systemic Autoimmune Diseases. Front Immunol 2016; 7:36. [PMID: 26913032 PMCID: PMC4753731 DOI: 10.3389/fimmu.2016.00036] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/24/2016] [Indexed: 01/06/2023] Open
Abstract
The complement system consists of effector proteins, regulators, and receptors that participate in host defense against pathogens. Activation of the complement system, via the classical pathway (CP), has long been recognized in immune complex-mediated tissue injury, most notably systemic lupus erythematosus (SLE). Paradoxically, a complete deficiency of an early component of the CP, as evidenced by homozygous genetic deficiencies reported in human, are strongly associated with the risk of developing SLE or a lupus-like disease. Similarly, isotype deficiency attributable to a gene copy-number (GCN) variation and/or the presence of autoantibodies directed against a CP component or a regulatory protein that result in an acquired deficiency are relatively common in SLE patients. Applying accurate assay methodologies with rigorous data validations, low GCNs of total C4, and heterozygous and homozygous deficiencies of C4A have been shown as medium to large effect size risk factors, while high copy numbers of total C4 or C4A as prevalent protective factors, of European and East-Asian SLE. Here, we summarize the current knowledge related to genetic deficiency and insufficiency, and acquired protein deficiencies for C1q, C1r, C1s, C4A/C4B, and C2 in disease pathogenesis and prognosis of SLE, and, briefly, for other systemic autoimmune diseases. As the complement system is increasingly found to be associated with autoimmune diseases and immune-mediated diseases, it has become an attractive therapeutic target. We highlight the recent developments and offer a balanced perspective concerning future investigations and therapeutic applications with a focus on early components of the CP in human systemic autoimmune diseases.
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Affiliation(s)
- Katherine E Lintner
- Center for Molecular and Human Genetics, Division of Pediatric Rheumatology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University , Columbus, OH , USA
| | - Yee Ling Wu
- Center for Molecular and Human Genetics, Division of Pediatric Rheumatology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University , Columbus, OH , USA
| | - Yan Yang
- Center for Molecular and Human Genetics, Division of Pediatric Rheumatology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University , Columbus, OH , USA
| | - Charles H Spencer
- Center for Molecular and Human Genetics, Division of Pediatric Rheumatology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University , Columbus, OH , USA
| | - Georges Hauptmann
- Laboratoire d'Immuno-Rhumatologie Moleculaire, INSERM UMR_S 1109, LabEx Transplantex, Faculté de Médecine, Université de Strasbourg , Strasbourg , France
| | - Lee A Hebert
- Division of Nephrology, College of Medicine, The Ohio State University , Columbus, OH , USA
| | - John P Atkinson
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine , St. Louis, MO , USA
| | - C Yung Yu
- Center for Molecular and Human Genetics, Division of Pediatric Rheumatology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University , Columbus, OH , USA
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97
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Menzhinskaya IV, Van’ko LV, Kashentseva MM, Kiryushchenkov PA, Sukhikh GT. Incidence of Autoantibodies to C1Q Complement Component in Women with Miscarriages and Autoantibodies to Phospholipids and Chorionic Gonadotropin. Bull Exp Biol Med 2015; 160:260-3. [DOI: 10.1007/s10517-015-3144-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Indexed: 11/30/2022]
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98
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van den Hoogen LL, van Roon JAG, Radstake TRDJ, Fritsch-Stork RDE, Derksen RHWM. Delineating the deranged immune system in the antiphospholipid syndrome. Autoimmun Rev 2015; 15:50-60. [PMID: 26318678 DOI: 10.1016/j.autrev.2015.08.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 08/24/2015] [Indexed: 12/16/2022]
Abstract
The antiphospholipid syndrome (APS) is a systemic autoimmune disease that is characterized serologically by the presence of antiphospholipid antibodies (aPL) and clinically by vascular thrombosis and obstetric complications. The protein β2 glycoprotein I (β2GPI) is identified as the most important autoantigen in this syndrome. Activation of endothelial cells, thrombocytes and placental tissue by anti-β2GPI antibodies relates to the clinical manifestations of APS. This review describes genetic and environmental factors in relation to APS and summarizes the current knowledge on abnormalities in components of both the innate and adaptive immune system in APS. The role of dendritic cells, T-cells, B-cells, monocytes, neutrophils and NK-cells as well as the complement system in APS are discussed. Several gaps in our knowledge on the pathophysiology of APS are identified and a plea is made for future extensive immune cell profiling by a systems medicine approach in order to better unravel the pathogenesis of APS, to gain more insight in the role of the immune system in APS as well as having the potential to reveal biomarkers or novel therapeutic targets.
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Affiliation(s)
- Lucas L van den Hoogen
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Laboratory of Translational Immunology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Joël A G van Roon
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Laboratory of Translational Immunology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Timothy R D J Radstake
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Laboratory of Translational Immunology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Ruth D E Fritsch-Stork
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Ronald H W M Derksen
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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99
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Foltyn Zadura A, Memon AA, Stojanovich L, Perricone C, Conti F, Valesini G, Bogdanovic G, Hillarp A, Shoenfeld Y, Sundquist J, Leffler J, Svensson PJ, Trouw LA, Blom AM. Factor H Autoantibodies in Patients with Antiphospholipid Syndrome and Thrombosis. J Rheumatol 2015; 42:1786-93. [PMID: 26276971 DOI: 10.3899/jrheum.150185] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2015] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Autoantibodies to complement factor H (FH) are associated with atypical hemolytic uremic syndrome, but can also be detected in patients with rheumatoid arthritis and in patients positive for lupus anticoagulants and thus potentially antiphospholipid syndrome (APS). To our knowledge, no data are available on the association between the presence of FH autoantibodies in APS and clinical manifestations. METHODS We determined FH autoantibody levels using ELISA in 2 cohorts of patients with primary (PAPS) and secondary APS (SAPS) from Serbia and Italy, and an additional cohort including patients with venous thromboembolism (VTE) from Sweden. RESULTS FH autoantibodies were detected in 13.7% of patients (n = 73) with PAPS and 30.3% of patients (n = 33) with SAPS in the Serbian cohort. FH autoantibody frequency in the Italian cohort was 33.3% (n = 15) and 36% (n = 25) in PAPS and SAPS, respectively. Both FH autoantibody levels and frequencies observed in both APS cohorts were significantly higher than in matched healthy controls (5%). Further, patients with PAPS with venous thrombosis in the Serbian cohort had significantly higher levels of FH autoantibodies. Therefore, we analyzed a dedicated Swedish thrombosis cohort and found that patients with FH autoantibody positivity had higher risk of VTE recurrence (HR 2.0, 95% CI 1.2-3.3, p = 0.011) compared with the reference group of FH autoantibody-negative patients. CONCLUSION Overall, the data indicate that in patients with APS and recurrent venous thrombosis, there are increased levels of FH autoantibodies, a finding associated with poor clinical outcome.
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Affiliation(s)
- Anna Foltyn Zadura
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University
| | - Ashfaque A Memon
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University
| | - Ljudmila Stojanovich
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University
| | - Carlo Perricone
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University
| | - Fabrizio Conti
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University
| | - Guido Valesini
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University
| | - Gordana Bogdanovic
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University
| | - Andreas Hillarp
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University
| | - Yehuda Shoenfeld
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University
| | - Jan Sundquist
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University
| | - Jonatan Leffler
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University
| | - Peter J Svensson
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University
| | - Leendert A Trouw
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University
| | - Anna M Blom
- From the Department of Translational Medicine, and Department of Clinical Sciences, Lund University; Center for Primary Health Care Research, Skåne University Hospital, Malmö; Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital, Halmstad, Sweden; Internal Medicine, "Bezhanijska Kosa," University Medical Center, Belgrade, Serbia; Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Aviv, Israel; Telethon Kids Institute, University of Western Australia, Perth, Australia; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.A. Foltyn Zadura, MSc, Department of Translational Medicine, Lund University; A.A. Memon, PhD, Center for Primary Health Care Research, Skåne University Hospital; L. Stojanovich, MD, PhD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; C. Perricone, MD; F. Conti, MD, PhD; G. Valesini, MD, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma; G. Bogdanovic, MD, PHD, Internal Medicine, "Bezhanijska Kosa," University Medical Center; A. Hillarp, PhD, Department of Clinical Chemistry and Transfusion Medicine, Halland Hospital; Y. Shoenfeld, MD, PhD, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center; J. Sundquist, MD, PhD, Center for Primary Health Care Research, Skåne University Hospital; J. Leffler, PhD, Telethon Kids Institute, University of Western Australia; P.J. Svensson, MD, PhD, Department of Translational Medicine, Lund University; L.A. Trouw, PhD, Department of Rheumatology, Leiden University Medical Center; A.M. Blom, PhD, Department of Translational Medicine, Lund University.
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Evasion and interactions of the humoral innate immune response in pathogen invasion, autoimmune disease, and cancer. Clin Immunol 2015; 160:244-54. [PMID: 26145788 DOI: 10.1016/j.clim.2015.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 06/22/2015] [Accepted: 06/26/2015] [Indexed: 02/07/2023]
Abstract
The humoral innate immune system is composed of three major branches, complement, coagulation, and natural antibodies. To persist in the host, pathogens, such as bacteria, viruses, and cancers must evade parts of the innate humoral immune system. Disruptions in the humoral innate immune system also play a role in the development of autoimmune diseases. This review will examine how Gram positive bacteria, viruses, cancer, and the autoimmune conditions systemic lupus erythematosus and anti-phospholipid syndrome, interact with these immune system components. Through examining evasion techniques it becomes clear that an interplay between these three systems exists. By exploring the interplay and the evasion/disruption of the humoral innate immune system, we can develop a better understanding of pathogenic infections, cancer, and autoimmune disease development.
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