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Song X, Fan Y, Jia Y, Li G, Liu M, Xu Y, Zhang J, Li C. A novel aGAPSS-based nomogram for the prediction of ischemic stroke in patients with antiphospholipid syndrome. Front Immunol 2022; 13:930087. [PMID: 35967319 PMCID: PMC9372272 DOI: 10.3389/fimmu.2022.930087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background Ischemic stroke (IS) is the most common and life-threatening arterial manifestation of antiphospholipid syndrome (APS). It is related to high mortality and severe permanent disability in survivors. Thus, it is essential to identify patients with APS at high risk of IS and adopt individual-level preventive measures. This study was conducted to identify risk factors for IS in patients with APS and to develop a nomogram specifically for IS prediction in these patients by combining the adjusted Global Anti-Phospholipid Syndrome Score (aGAPSS) with additional clinical and laboratory data. Methods A total of 478 consecutive patients with APS were enrolled retrospectively. All patients were randomly assigned to the training and validation cohorts. Univariate and multivariate binary logistic analyses were conducted to identify predictors of IS in the training cohort. Then, a nomogram was developed based on these predictors. The predictive performance of the nomogram for the training and validation cohorts was evaluated by determining areas under the receiver operating characteristic curve (AUROC) and creating calibration plots. A decision curve analysis (DCA) was conducted to compare the potential net benefits of the nomogram with those of the aGAPSS. Results During a mean follow-up period of 2.7 years, 26.9% (129/478) of the patients were diagnosed with IS. Binary logistic regression analysis revealed that five risk factors were independent clinical predictors of IS: age (P < 0.001), diabetes (P = 0.030), hyperuricemia (P < 0.001), the platelet count (P = 0.001), and the aGAPSS (P = 0.001). These predictors were incorporated into the nomogram, named the aGAPSS-IS. The nomogram showed satisfactory performance in the training [AUROC = 0.853 (95% CI, 0.802–0.896] and validation [AUROC = 0.793 (95% CI, 0.737–0.843)] cohorts. Calibration curves showed good concordance between observed and nomogram-predicted probability in the training and validation cohorts. The DCA confirmed that the aGAPSS-IS provided more net benefits than the aGAPSS in both cohorts. Conclusion Age, diabetes, hyperuricemia, the platelet count, and the aGAPSS were risk factors for IS in patients with APS. The aGAPSS-IS may be a good tool for IS risk stratification for patients with APS based on routinely available data.
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Affiliation(s)
- Xiaodong Song
- Department of Neurology, Peking University People’s Hospital, Beijing, China
| | - Yangyi Fan
- Department of Neurology, Peking University People’s Hospital, Beijing, China
| | - Yuan Jia
- Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing, China
| | - Gongming Li
- Department of Rheumatology and Immunology, Linyi Traditional Chinese Medicine Hospital, Linyi, China
| | - Meige Liu
- Department of Neurology, Peking University People’s Hospital, Beijing, China
| | - Yicheng Xu
- Department of Neurology, Aerospace Center Hospital, Beijing, China
| | - Jun Zhang
- Department of Neurology, Peking University People’s Hospital, Beijing, China
- *Correspondence: Chun Li, ; Jun Zhang,
| | - Chun Li
- Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing, China
- *Correspondence: Chun Li, ; Jun Zhang,
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Zmira O, Gofrit SG, Aharoni SA, Weiss R, Shavit-Stein E, Chapman J. Teriflunomide normalizes anti-anxiety effect in anti-ANXA2 APS mice model teriflunomide in anti-ANXA2 mice model. Lupus 2022; 31:855-863. [PMID: 35575144 DOI: 10.1177/09612033221095150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Antiphospholipid syndrome (APS) affects the brain by both hypercoagulation and immunological mechanisms. APS is characterized by several autoantibodies binding to a thrombolytic complex including beta-2-glycoprotein I (β2-GPI) and annexin A2 (ANXA2). Teriflunomide, an oral drug for the treatment of multiple sclerosis (MS), has a cytostatic effect on B cells and is therefore a potential antibody-targeting treatment for APS. In this study, we assessed the effect of teriflunomide in two APS mouse models by inducing autoantibody formation against β2-GPI and ANXA2 in female BALB/c mice. The ANXA2 model displayed a behavioral change suggesting an anti-anxiety effect in open field and forced swim tests, early in the course of the disease. This effect was normalized following teriflunomide treatment. Conversely, behavioral tests done later during the study demonstrated depression-like behavior in the ANXA2 model. No behavioral changes were seen in the β2-GPI model. Total brain IgG levels were significantly elevated in the ANXA2 model but not in the teriflunomide treated group. No such change was noted in the brains of the β2-GPI model. High levels of serum autoantibodies were induced in both models, and their levels were not lowered by teriflunomide treatment. Teriflunomide ameliorated behavioral changes in mice immunized with ANXA2 without a concomitant change in serum antibody levels. These findings are compatible with the effect of teriflunomide on neuroinflammation.Teriflunomide ameliorated behavioral and brain IgG levels in mice immunized with ANXA2 without a concomitant change in serum antibody levels. These findings are compatible with an effect of teriflunomide on the IgG permeability to the brain and neuroinflammation.
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Affiliation(s)
- Ofir Zmira
- Department of Neurology, 26744Sheba Medical Center, Ramat Gan, Israel.,Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shany Guly Gofrit
- Department of Neurology, 26744Sheba Medical Center, Ramat Gan, Israel
| | - Shay Anat Aharoni
- Department of Neurology, 26744Sheba Medical Center, Ramat Gan, Israel
| | - Ronen Weiss
- Department of Neurology, 26744Sheba Medical Center, Ramat Gan, Israel.,Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Joseph Sagol Neuroscience Center, 26744Sheba Medical Center, Tel HaShomer, Israel
| | - Efrat Shavit-Stein
- Department of Neurology, 26744Sheba Medical Center, Ramat Gan, Israel.,Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Joseph Sagol Neuroscience Center, 26744Sheba Medical Center, Tel HaShomer, Israel.,The TELEM Rubin Excellence in Biomedical Research Program, The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Joab Chapman
- Department of Neurology, 26744Sheba Medical Center, Ramat Gan, Israel.,Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Joseph Sagol Neuroscience Center, 26744Sheba Medical Center, Tel HaShomer, Israel.,Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Robert and Martha Harden Chair in Mental and Neurological Diseases, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Gris JC, Guillotin F, Chéa M, Fortier M, Bourguignon C, Mercier É, Bouvier S. Antiphospholipid syndrome in pregnancy: Neuro-psychiatric aspects. THROMBOSIS UPDATE 2021. [DOI: 10.1016/j.tru.2021.100078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Shen H, Huang X, Fan C. Clinical Characteristics and Management of Cerebral Venous Sinus Thrombosis in Patients With Antiphospholipid Syndrome: A Single-Center Retrospective Study. Clin Appl Thromb Hemost 2021; 27:1076029621999104. [PMID: 33872100 PMCID: PMC8058809 DOI: 10.1177/1076029621999104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Antiphospholipid syndrome (APS) with cerebral venous sinus thrombosis (CVST) is a relatively rare phenomenon, and this observational study aimed to investigate the clinical characteristics of APS patients complicated with CVST. We retrospectively investigated the clinical characteristics of CVST events in APS and compared differential characteristics and associated factors between APS patients with and without CVST. Twenty-one CVST patients with APS were enrolled including 14 females (9.4%) and 7 males (5.8%). The median age and disease duration at onset of CVST was 33 years (IQR 28-48) old and 1.3 months (IQR 0.7-4), respectively. Among APS patients with CVST, 12 (57.1%) cases presented with neurologic symptoms of CVST as the initial manifestation. Onset of CVST was mainly chronic (52.4%). Headache (90.5%) was the most common neurological symptom. The common locations of CVST were transverse sinus (76.2%) and superior sagittal sinus (57.1%), with more frequently (76.2%) dual or multiple sinuses involved. All patients with CVST were treated with anticoagulant, and 5 (23.8%) patients received endovascular therapy. Sixteen (84.2%) patients had good outcomes and 3 (15.8%) patients died at last follow-up. There were no significant differences (P > 0.05) between two groups in the analysis of related APS indicators. There were no significant differences (P > 0.05) between two groups in the analysis of related APS indicators. Although APS complicated with CVST is rare and predominately chronic developed. The evaluation of CVST should be performed for APS patients with intracranial hypertension syndrome. The routine screening of antiphospholipid antibodies (aPLs) is highly recommended in unexplained CVST patients. Most CVST patients with APS will have a good prognosis after treatment, and endovascular therapy is an alternative treatment.
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Affiliation(s)
- Huixin Shen
- Department of Neurology, Xuanwu Hospital, 12517Capital Medical University, Beijing, China
| | - Xiaoqin Huang
- Department of Neurology, Xuanwu Hospital, 12517Capital Medical University, Beijing, China
| | - Chunqiu Fan
- Department of Neurology, Xuanwu Hospital, 12517Capital Medical University, Beijing, China
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Non-Criteria Manifestations of Juvenile Antiphospholipid Syndrome. J Clin Med 2021; 10:jcm10061240. [PMID: 33802787 PMCID: PMC8002433 DOI: 10.3390/jcm10061240] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 01/07/2023] Open
Abstract
Antiphospholipid syndrome (APS) is a systemic autoimmune disorder mainly characterised by increased risks of thrombosis and pregnancy morbidity and persistent positive test results for antiphospholipid antibodies (aPLs). The criteria for diagnosing juvenile APS have yet to be validated, while the Sydney classification criteria do not contain several non-thrombotic clinical manifestations associated with the presence of aPLs. As such, difficulties have been encountered in the diagnosis of patients who have no certain thrombotic occlusions. Moreover, extra-criteria manifestations (i.e., clinical manifestations not listed in the classification criteria), including neurologic manifestations (chorea, myelitis and migraine), haematologic manifestations (thrombocytopenia and haemolytic anaemia), livedo reticularis, nephropathy and valvular heart disease have been reported, which suggests that the clinical spectrum of aPL-related manifestations extends beyond that indicated in the classification criteria. Studies have demonstrated that more than 40% of children with aPLs demonstrated non-thrombotic aPL-related clinical manifestations alone. Moreover, our results showed that the pathogenesis of non-criteria manifestations is characterised by “APS vasculopathy”. The present review introduces the characteristics and findings of non-criteria manifestations observed in juvenile APS.
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Weiss R, Bushi D, Mindel E, Bitton A, Diesendruck Y, Gera O, Drori T, Zmira O, Aharoni SA, Agmon-Levin N, Kashi O, Benhar I, Golderman V, Orion D, Chapman J, Shavit-Stein E. Autoantibodies to Annexin A2 and cerebral thrombosis: Insights from a mouse model. Lupus 2021; 30:775-784. [PMID: 33554716 PMCID: PMC8020307 DOI: 10.1177/0961203321992117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Antiphospholipid syndrome (APS) is an autoimmune disorder manifested by
thromboembolic events, recurrent spontaneous abortions and elevated titers
of circulating antiphospholipid antibodies. In addition, the presence of
antiphospholipid antibodies seems to confer a fivefold higher risk for
stroke or transient ischemic attack. Although the major antigen of APS is
β2 glycoprotein I, it is now well established that
antiphospholipid antibodies are heterogeneous and bind to various targets.
Recently, antibodies to Annexin A2 (ANXA2) have been reported in APS. This
is of special interest since data indicated ANXA2 as a key player in
fibrinolysis. Therefore, in the present study we assessed whether anti-ANXA2
antibodies play a pathological role in thrombosis associated disease. Materials and Methods Mice were induced to produce anti-ANXA2 antibodies by immunization with ANXA2
(iANXA2) and control mice were immunized with adjuvant only. A middle
cerebral artery occlusion stroke model was applied to the mice. The outcome
of stroke severity was assessed and compared between the two groups. Results Our results indicate that antibodies to ANXA2 lead to a more severe stroke as
demonstrated by a significant larger stroke infarct volume (iANXA2
133.9 ± 3.3 mm3 and control 113.7 ± 7.4 mm3;
p = 0.017) and a more severe neurological outcome (iANXA2 2.2 ± 0.2, and
control 1.5 ± 0.18; p = 0.03). Conclusions This study supports the hypothesis that auto-antibodies to ANXA2 are an
independent risk factor for cerebral thrombosis. Consequently, we propose
screening for anti-ANXA2 antibodies should be more widely used and patients
that exhibit the manifestations of APS should be closely monitored by
physicians.
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Affiliation(s)
- Ronen Weiss
- Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Doron Bushi
- Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Neurology, Comprehensive Stroke Center, Sheba Medical Center, Sackler Faculty of Medicine, Ramat Gan, Israel
| | - Ekaterina Mindel
- Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Almog Bitton
- Department of Molecular Microbiology and Biotechnology, School of Molecular Cell Biology and Biotechnology, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Diesendruck
- Department of Molecular Microbiology and Biotechnology, School of Molecular Cell Biology and Biotechnology, Tel-Aviv University, Tel-Aviv, Israel
| | - Orna Gera
- Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tali Drori
- Department of Neurology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Ofir Zmira
- Department of Neurology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Shay Anat Aharoni
- Department of Neurology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Nancy Agmon-Levin
- Angioedema and Allergy Department, Sheba Medical Center, Ramat Gan, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oren Kashi
- Robert and Martha Harden Chair in Mental and Neurological Diseases, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itai Benhar
- Department of Molecular Microbiology and Biotechnology, School of Molecular Cell Biology and Biotechnology, Tel-Aviv University, Tel-Aviv, Israel
| | - Valery Golderman
- Department of Neurology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - David Orion
- Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Neurology, Comprehensive Stroke Center, Sheba Medical Center, Sackler Faculty of Medicine, Ramat Gan, Israel
| | - Joab Chapman
- Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Department of Neurology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel.,Robert and Martha Harden Chair in Mental and Neurological Diseases, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Shavit-Stein
- Department of Neurology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
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7
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Comparison of patients with transient and sustained increments of antiphospholipid antibodies after acute ischemic stroke. J Neurol 2021; 268:2541-2549. [PMID: 33547954 DOI: 10.1007/s00415-021-10432-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE Antiphospholipid syndrome (APS) is one of the uncommon causes of ischemic stroke, and is associated with young and female patients. However, the significance of antiphospholipid antibody (aPL) in older ischemic stroke patients is uncertain. We aimed to examine the significance of aPLs in ischemic stroke in these older patients. MATERIALS AND METHODS A total of 739 patients with acute ischemic stroke within 7 days of initial symptoms were collected consecutively. Clinical and laboratory data were obtained from medical records. aPLs (lupus anticoagulant, anti-cardiolipin antibody, anti-β2glycoprotein-I antibody) were measured the day after admission and the presence of at least one antibody was regarded as positive aPL. Patients with positive aPL were rechecked after at least 12 weeks for confirmation of APS. RESULT Of the 739 patients, 103 (13.9%) had at least one aPL initially. These patients were older, had more atrial fibrillation and higher levels of inflammatory markers. Among the 103 aPL positive patients, 41 remained positive at 3 months, 23 showed negative conversion, and 39 were not available for follow-up. Patients diagnosed with APS had higher numbers of aPL and had specifically anti-β2glycoprotein-I IgG antibody. The patients with aPLs did not differ significantly from the others in terms of stroke subtype. CONCLUSION aPL was rather common in ischemic stroke patients regardless of age. Although the influence of transient positive aPL on ischemic stroke remains uncertain, two or more aPLs and the presence of anti-β2glycoprotein-I IgG may predict a diagnosis of APS.
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8
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Al-Khateeb M, Adem F, Moqbel A, Baz S. Schizophrenia following new-onset refractory status epilepticus secondary to antiphospholipid syndrome. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2019; 24:240-244. [PMID: 31380826 PMCID: PMC8015520 DOI: 10.17712/nsj.2018.3.20180014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
New-onset refractory status epilepticus (NORSE) is a drug-resistant status epilepticus that often has a catastrophic outcome. Our patient was diagnosed with NORSE and had an EEG reading that showed status epilepticus persisting for 8 months in general anesthesia. After autoimmune workup showed positive antiphospholipid antibodies, his seizure was controlled, and he was discharged with good condition apart from moderate cognitive impairment. However, he later developed schizophrenia. Although psychiatric disorders have been associated with antiphospholipid syndrome, to the best of our knowledge, it has not been reported to be associated with status epilepticus. We recommend vigilance of psychological complications of refractory status epilepticus’ patients for early psychiatric referral, diagnosis, and treatment.
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Affiliation(s)
- Mashael Al-Khateeb
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia. E-mail:
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Gris JC, Cyprien F, Bouvier S, Cochery-Nouvellon E, Lavigne-Lissalde G, Mercier E, Balducchi JP. Antiphospholipid antibodies are associated with positive screening for common mental disorders in women with previous pregnancy loss. The NOHA-PSY observational study. World J Biol Psychiatry 2019; 20:51-63. [PMID: 28532221 DOI: 10.1080/15622975.2017.1333146] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Case reports describe neuropsychiatric manifestations associated with antiphospholipid antibodies (aPlAbs). In patients sharing the same symptoms fulfilling the antiphospholipid syndrome (APS) clinical criteria, the prevalence of common mental disorders has, however, never been studied. METHODS We observed women with three consecutive abortions before the 10th week of gestation or one foetal loss at or beyond the 10th week. We compared the prevalence of common psychiatric disorders detected through screening using the Mini International Neuropsychiatric Interview, 10 years after inclusion, in women with APS (n = 506), women negative for aPlAbs but carrying the F5rs6025 or F2rs1799963 thrombogenic polymorphism (n = 269), and women with negative thrombophilia screening results as controls (n = 764). RESULTS Similar prevalence values were obtained for controls and women bearing one of the two thrombogenic polymorphisms. Women with APS more frequently had mood disorders (relative risk (RR) 1.57 (1.262-1.953), P = .0001) and anxiety (RR 1.645 (1.366-1.979), P < .0001). Within the APS group, lupus anticoagulant (LA) and anti-β2GP1 IgG, or triple positivity, were strong risk factors for mood disorders. CONCLUSIONS Women with obstetric APS have a higher risk of positive screening for common mental disorders than women without APS.
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Affiliation(s)
- Jean-Christophe Gris
- a Department of Hematology , University Hospital , Nîmes , France.,b Research team UPRES EA2992 , 'Caractéristiques féminines des dysfonctions des interfaces vasculaires CaFe-DIVa', University of Montpellier , Montpellier , France.,c Laboratory of Hematology, Faculty of Pharmacy and Biological Sciences , University of Montpellier , Montpellier , France
| | - Fabienne Cyprien
- d Department of Neurosurgery , University Hospital , Montpellier , France.,e Inserm U1061 , "Neuropsychiatrie: recherche épidémiologique et clinique" , Montpellier , France
| | - Sylvie Bouvier
- a Department of Hematology , University Hospital , Nîmes , France.,b Research team UPRES EA2992 , 'Caractéristiques féminines des dysfonctions des interfaces vasculaires CaFe-DIVa', University of Montpellier , Montpellier , France.,c Laboratory of Hematology, Faculty of Pharmacy and Biological Sciences , University of Montpellier , Montpellier , France
| | - Eva Cochery-Nouvellon
- a Department of Hematology , University Hospital , Nîmes , France.,b Research team UPRES EA2992 , 'Caractéristiques féminines des dysfonctions des interfaces vasculaires CaFe-DIVa', University of Montpellier , Montpellier , France
| | - Géraldine Lavigne-Lissalde
- a Department of Hematology , University Hospital , Nîmes , France.,b Research team UPRES EA2992 , 'Caractéristiques féminines des dysfonctions des interfaces vasculaires CaFe-DIVa', University of Montpellier , Montpellier , France
| | - Erick Mercier
- a Department of Hematology , University Hospital , Nîmes , France.,b Research team UPRES EA2992 , 'Caractéristiques féminines des dysfonctions des interfaces vasculaires CaFe-DIVa', University of Montpellier , Montpellier , France.,c Laboratory of Hematology, Faculty of Pharmacy and Biological Sciences , University of Montpellier , Montpellier , France
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Radin M, Schreiber K, Cecchi I, Roccatello D, Cuadrado MJ, Sciascia S. The risk of ischaemic stroke in primary antiphospholipid syndrome patients: a prospective study. Eur J Neurol 2017; 25:320-325. [PMID: 29082583 DOI: 10.1111/ene.13499] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/20/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE The most common neurological manifestation of antiphospholipid syndrome (APS) is ischaemic stroke. Identifying patients with APS at high risk for developing any thrombotic event remains a major challenge. In this study, the aim was to identify predictive factors of ischaemic stroke in a cohort of primary APS (PAPS) patients who presented with new onset symptoms suggestive of acute stroke. METHODS This prospective multicentre study included 36 consecutive PAPS patients who presented with new onset symptoms suggestive of an acute stroke. Patients were prospectively followed up for 12 months. RESULTS In 10 (28%) out of 36 PAPS patients [mean age 41 years (SD 13.4), 70% female], the suspicion of an acute stroke was confirmed by brain magnetic resonance imaging. Sixty per cent of these patients were <50 years old. Eight of the 10 patients had a history of previous venous thrombosis and were receiving vitamin K antagonist (VKA), with international normalized ratio target 2-3; one patient had a history of a previous arterial event receiving treatment with VKA target international normalized ratio 2-3 plus low dose aspirin; and one patient had a history of previous pregnancy morbidity receiving only low dose aspirin. Time in the therapeutic range for patients receiving VKA was 77.7% (SD 6.6%). Hypercholesterolaemia was significantly higher in patients with confirmed stroke compared to those without (P < 0.05). Similarly, a significantly higher rate of anti-β2 glycoprotein-I (β2GPI) antibodies (immunoglobulin G/immunoglobulin M; P < 0.05) and higher adjusted global APS score (aGAPSS) values were found in patients with a confirmed stroke [mean aGAPSS 8.9 (SD 4.7) vs. mean aGAPSS 6.4 (SD 2.5); P < 0.05]. CONCLUSIONS Patients with PAPS, including young patients, have a high risk of recurrent thrombosis despite anticoagulation treatment. A careful risk assessment is mandatory to identify patients at risk for recurrence.
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Affiliation(s)
- M Radin
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, University of Turin and S. Giovanni Bosco Hospital, Turin, Italy
| | - K Schreiber
- Department of Thrombosis and Haemophilia, Guy's and St Thomas' Hospital, London, UK.,Department of Rheumatology, Copenhagen University Hospital, Copenhagen, Denmark
| | - I Cecchi
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, University of Turin and S. Giovanni Bosco Hospital, Turin, Italy
| | - D Roccatello
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, University of Turin and S. Giovanni Bosco Hospital, Turin, Italy
| | - M J Cuadrado
- Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S Sciascia
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, University of Turin and S. Giovanni Bosco Hospital, Turin, Italy
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11
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Mehta T, Hussain M, Sheth K, Ding Y, McCullough LD. Risk of hemorrhagic transformation after ischemic stroke in patients with antiphospholipid antibody syndrome. Neurol Res 2017; 39:477-483. [PMID: 28475479 DOI: 10.1080/01616412.2017.1323382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE Several rheumatologic conditions including systemic lupus erythematosus, antiphospholipid antibody (APS) syndrome, rheumatoid arthritis, and scleroderma are known risk factors for stroke. The risk of hemorrhagic transformation after an acute ischemic stroke (AIS) in these patients is not known. METHODS We queried the Nationwide Inpatient Sample (NIS) data between 2010 and 2012 with ICD 9 diagnostic codes for AIS. The primary outcome was the development of hemorrhagic transformation. Multivariate predictors for hemorrhagic transformation were identified with a logistic regression model. Using SAS 9.2, Survey procedures were used to accommodate for hierarchical two stage cluster design of NIS. RESULTS APS (OR 2.57, 95% CI 1.14-5.81, p = 0.0228) independently predicted risk of hemorrhagic transformation in multivariate regression analysis. Similarly, in multivariate regression models for the outcome variables of total charges of the hospitalization and length of stay (LOS), patients with APS had the highest charges ($56,286, p = 0.0228) and LOS (3.87 days, p = 0.0164) compared to other co-variates. Univariate analysis showed increased mortality in the APS compared to the non-APS group (11.68% vs. 7.16%, p = 0.0024). CONCLUSION APS is an independent risk factor for hemorrhagic transformation in both thrombolytic and non-thrombolytic treated patients. APS is also associated with longer length and cost of hospital stay. Further research is warranted to identify the unique risk factors in these patients to identify strategies to reduce the risk of hemorrhagic transformation in this subgroup of the population.
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Affiliation(s)
- Tapan Mehta
- a Department of Neurology , University of Connecticut Health Center-Hartford Hospital , Hartford , CT , USA
| | - Mohammed Hussain
- a Department of Neurology , University of Connecticut Health Center-Hartford Hospital , Hartford , CT , USA
| | - Khushboo Sheth
- b Department of Internal Medicine , University of Connecticut , Farmington , CT , USA
| | - Yuchuan Ding
- c Department of Neurosurgery , Wayne State University , Detroit , MI , USA
| | - Louise D McCullough
- d Department of Neurology , McGovern Medical School, University of Texas Health Science Center , Houston , TX , USA
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Maalouly G, Ward C, Smayra V, Saliba Y, Aftimos G, Haddad F, Farès N. Fish oil attenuates neurologic severity of antiphospholipid syndrome in a mice experimental model. Nutr Neurosci 2016; 20:563-570. [PMID: 27426873 DOI: 10.1080/1028415x.2016.1206165] [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: 01/23/2023]
Abstract
INTRODUCTION Murine experimental models of antiphospholipid syndrome (eAPLS) showed neurologic dysfunction and therapeutic effect of the anticoagulant enoxaparin is well established. Omega-3 fatty acids and curcumin, tested in neuroinflammation and auto-immunity diseases, might be interesting therapeutic candidates. The aim of this study was to evaluate the effects of these candidates on neurologic severity in eAPLS. METHODS One month after immunization of BALB/c mice with beta-2-glycoprotein I, daily treatments were initiated with enoxaparin (1 mg/kg), omega-3 fatty acids (0.5 g/kg), and curcumin (200 mg/kg) for 3 months. RESULTS Mortality was significantly decreased by enoxaparin and omega-3 treatments. Fish oil and curcumin group exhibited the highest mean of swimming behavior in forced swim test in surviving mice. Mice under omega-3 fatty acids or curcumin presented low anxiety-like behavior in the elevated plus-maze test. Cerebral histopathology revealed heavy inflammatory infiltrates in cortical and subcortical regions with vacuolization, swelling, and degeneration of astrocytes in the control group, with aggravation under curcumin; no infiltrate was retrieved in enoxaparin and omega-3 groups. CONCLUSION Our study is the first to demonstrate a potential therapeutic effect of omega-3 fatty acids in eAPLS. Enoxaparin and omega-3 fatty acids combination would be interesting for further investigation.
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Affiliation(s)
- Georges Maalouly
- a Laboratoire de Recherche en Physiologie et Physiopathologie, Pôle Technologie Santé, Faculté de Médecine , Université Saint Joseph , Beirut , Lebanon
| | - Céline Ward
- b Faculté de Médecine , Université Saint Joseph , Beirut , Lebanon
| | - Viviane Smayra
- c Faculté de Médecine, service d'anatomopathologie , Université Saint Joseph , Beirut , Lebanon
| | - Youakim Saliba
- a Laboratoire de Recherche en Physiologie et Physiopathologie, Pôle Technologie Santé, Faculté de Médecine , Université Saint Joseph , Beirut , Lebanon
| | | | - Fadi Haddad
- e Faculté de Médecine, Département de Médecine interne , Université Saint Joseph , Beirut , Lebanon
| | - Nassim Farès
- a Laboratoire de Recherche en Physiologie et Physiopathologie, Pôle Technologie Santé, Faculté de Médecine , Université Saint Joseph , Beirut , Lebanon
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Rodríguez-Sanz A, Martínez-Sánchez P, Prefasi D, Fuentes B, Pascual-Salcedo D, Blanco-Bañares MJ, Díez-Tejedor E. Antiphospholipid antibodies correlate with stroke severity and outcome in patients with antiphospholipid syndrome. Autoimmunity 2014; 48:275-81. [PMID: 25434364 DOI: 10.3109/08916934.2014.988329] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Our goal was to analyze the association of the level of antiphospholipid antibodies (aPLs) with stroke severity and outcome in patients with antiphospholipid syndrome (APS). METHODS Observational study included consecutive patients with ischemic stroke younger than 55 years (2007-2012). We analyzed serum levels of aPLs, including anticardiolipin (aCL) antibodies, anti-β2-glycoprotein I antibodies (anti-β2GPI) and antiprothrombin antibodies (aPS/PT) within the first 48 h after admission, and again, in the case of a positive result, at least 12 weeks after the first measurement. Stroke severity was measured by the National Institutes of Health Stroke Scale (NIHSS), and the three-month stroke outcome by the modified Rankin Scale (mRS). Multiple linear regression models were used to analyze the correlation between the aPLs and stroke severity and outcome. RESULTS Overall 255 stroke patients were included, 22 (8.6%) with APS. Among them, a positive correlation was found between immunoglobulin M (IgM) aCL levels within 48 h and NIHSS (rho = 0.471; p = 0.027), as well as a tendency toward a positive correlation between immunoglobulin G (IgG) anti-β2GPI levels within 48 h and three-month mRS (rho = 0.364; p = 0.096). Multiple linear regression analyses showed a positive correlation between levels of IgM aCL < 48 h and the NIHSS (β-coefficient [standard error; SE] = 0.127 [0.044]), as well as the levels of IgG anti-β2GPIwithin 48 h and the three-month mRS (β-coefficient [SE] = 0.034 [0.011]). CONCLUSIONS In young stroke patients with APS, serum levels of IgM aCL within 48 h are correlated with stroke severity and levels of IgG anti-β2GPI within 48 h are correlated with three-month outcomes.
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Liu A, Zhang H. Detection of antiphospholipid antibody in children with Henoch-Schönlein purpura and central nervous system involvement. Pediatr Neurol 2012; 47:167-70. [PMID: 22883280 DOI: 10.1016/j.pediatrneurol.2012.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 05/29/2012] [Indexed: 11/25/2022]
Abstract
To explore the mechanisms of central nervous system involvement in children with Henoch-Schönlein purpura, levels of lupus anticoagulant, anticardiolipin antibodies, and anti-β2 glycoprotein I antibodies in serum and cerebrospinal fluid were determined in 46 cases of Henoch-Schönlein purpura with central nervous system involvement. Results indicated that Henoch-Schönlein purpura with central nervous system involvement produced a higher total percentage of antiphospholipid antibodies in serum and cerebrospinal fluid, compared with viral encephalitis control subjects (76.1% vs 10.0% and 71.7% vs 0.0%, respectively; P < 0.05). Henoch-Schönlein purpura may be associated with antiphospholipid syndrome or antiphospholipid antibodies, which may account for the neurologic damage in Henoch-Schönlein purpura.
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Affiliation(s)
- Ailin Liu
- Department of Pediatrics, Peking University First Hospital, Beijing, China; Department of Pediatrics, First People's Hospital of Yunnan Province, Kunming, China
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Dementia, ataxia and parkinsonism associated with the antiphospholipid syndrome. Parkinsonism Relat Disord 2011; 17:215-6. [DOI: 10.1016/j.parkreldis.2010.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 11/13/2010] [Accepted: 11/22/2010] [Indexed: 11/20/2022]
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Arnson Y, Shoenfeld Y, Alon E, Amital H. The Antiphospholipid Syndrome as a Neurological Disease. Semin Arthritis Rheum 2010; 40:97-108. [DOI: 10.1016/j.semarthrit.2009.05.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Revised: 04/08/2009] [Accepted: 05/03/2009] [Indexed: 02/06/2023]
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Motta M, Rodriguez-Perez C, Tincani A, Lojacono A, Nacinovich R, Chirico G. Neonates born from mothers with autoimmune disorders. Early Hum Dev 2009; 85:S67-70. [PMID: 19765919 DOI: 10.1016/j.earlhumdev.2009.08.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 07/29/2009] [Accepted: 07/29/2009] [Indexed: 11/26/2022]
Abstract
Systemic autoimmune disorders have a higher prevalence in women, particularly during their childbearing age. A growing interest is being paid to the possible consequences of maternal disease and associated treatment on the fetus and newborn infant. If maternal disease is characterized by the presence of IgG isotype auto-antibodies, these can cross the placenta with possible antibody-mediated damage to the fetus. The risk of gestational complications, including preterm delivery, intrauterine growth retardation and low birth weight is higher in autoimmune diseases rather than in the general population and probably this finding is related to both maternal disorder and immunosuppressive therapy. Recently, results of our studies suggest that the antenatal exposure to immunosuppressive drugs given to mothers during pregnancy to treat autoimmune diseases does not impair significantly the development of immunity in exposed children. Finally, mothers disease and/or treatment could be related to neuropsychological dysfunctions reported in some of their children.
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Affiliation(s)
- Mario Motta
- Neonatal Intensive Care Unit, Children's Hospital of Brescia, Brescia, Italy.
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Tincani A, Rebaioli CB, Andreoli L, Lojacono A, Motta M. Neonatal effects of maternal antiphospholipid syndrome. Curr Rheumatol Rep 2009; 11:70-6. [PMID: 19171114 DOI: 10.1007/s11926-009-0010-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Antiphospholipid antibodies (aPL) can impair the physiologic development of a fetus during pregnancy not only by causing thrombosis of the placental vessels, but also by directly binding throphoblast cells and modifying their functions. Consequently, the presence of aPL in pregnant women is linked to an increased rate of pregnancy complications. These include recurrent early miscarriages, late fetal losses, and hypertensive disorders of gestation. In this clinical setting, preeclampsia is usually early and severe and can be complicated by the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome). The close association between aPL and obstetric pathology supports the inclusion of these manifestations in the clinical classification criteria of antiphospholipid syndrome. About 30% of children born to mothers with aPL passively acquire these autoantibodies; fortunately, the occurrence of thrombosis seems extremely rare in these babies. The prospective ongoing studies of children born to antiphospholipid syndrome patients reassure us about their general good health; however, some data suggest that learning difficulties might occur, possibly related to in utero exposure to aPL.
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Affiliation(s)
- Angela Tincani
- Reumatologia e Immunologia Clinica, Spedali Civili e Università di Brescia, Brescia, Italy.
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Current World Literature. Curr Opin Rheumatol 2009; 21:85-92. [DOI: 10.1097/bor.0b013e32832355a7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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