Beyond the classics: The emerging value of anti-phosphatidylserine/prothrombin antibodies in antiphospholipid syndrome

Association of anti-phosphatidylserine/prothrombin antibodies with adverse in vitro fertilization outcomes

Anti-phosphatidylserine/prothrombin antibodies (aPS/PT) are classified as non-criteria antiphospholipid antibodies (aPL), and are strongly associated with thrombosis and pregnancy complications linked to antiphospholipid syndrome (APS). This study aimed to investigate whether aPS/PT positivity is associated with adverse outcomes in vitro fertilization (IVF). The study included infertile women who tested positive aPS/PT and underwent IVF cycles, as well as infertile controls with pure tubal etiology. We compared the impact of aPS/PT on baseline and clinical characteristics, immune-related indicators, IVF laboratory metrics, and pregnancy outcomes. Women with aPS/PT exhibited lower numbers of retrieved oocytes, embryos, and both perfect and available embryos, as well as reduced rates of blastocyst formation. Furthermore, an imbalanced Th17/Treg ratio and significantly elevated serum IL-17A levels were observed in women with aPS/PT compared to controls. In conclusion, the presence of aPS/PT is associated with adverse IVF and pregnancy outcomes. Early screening for aPS/PT and appropriate consultation for couples undergoing IVF-ET should be considered. Additionally, specific immune and inflammatory mechanisms related to aPS/PT warrant further investigation.

Non-Criteria Obstetric Antiphospholipid Syndrome: Myth or Reality?

Women with adverse pregnancy outcomes suggestive of obstetric antiphospholipid syndrome (OAPS), but not fulfilling clinical and/or laboratory international classification criteria, are increasingly recognized both in clinical practice and in the literature. This entity is termed non-criteria OAPS (NC-OAPS). It includes clinical scenarios such as two unexplained pregnancy losses, three non-consecutive pregnancy losses, late pre-eclampsia/eclampsia/signs of placental insufficiency, or recurrent implantation failure, as well as positive low-titers of antiphospholipid antibodies (aPLs) and non-classical aPLs. To address the NC-OAPS heterogeneity, a nomenclature proposal was developed. In recent years, retrospective and prospective cohort studies have been designed to clarify the characteristics and outcomes of the different subsets of NC-OAPS. In general, the studies support that NC-OAPS may benefit from treatment with antithrombotic, anticoagulant and/or immunomodulator agents, but several considerations must be made on the robustness and nuances of the scientific evidence. The objective of this review is to critically analyze the available evidence supporting the diagnosis of NC-OAPS, categorize its subsets, and evaluate the impact of treatment strategies on its outcome. We also remark on questions that are still unanswered, such as the lack of consensus on diagnostic criteria or treatment protocols.

The relation of anti-phosphatidylserine/prothrombin antibodies and premature rupture of membranes: A retrospective cohort study

BACKGROUND

Existing literature supports the association between atypical phospholipid antibodies - anti-phosphatidylserine/prothrombin antibodies (aPS/PT) and adverse pregnancy outcomes. This study aimed to investigate the relationship between aPS/PT and premature rupture of membranes (PROM).

METHODS

A retrospective cohort study analysis was conducted on 408 pregnant women who had experienced at least one unexplained miscarriage. They were tested for aPS/PT IgM and IgG, and clinical data, test results, and follow-up pregnancy outcomes were collected.

RESULTS

A positive correlation was observed between aPS/PT IgM or IgG and PROM in both single-factor and multi-factor regression analysis. After adjusting for potential confounders, the odds ratio (OR) values for aPS/PT IgM and aPS/PT IgG were 1.03 (95 % CI: 1-1.05, P = 0.025) and 1.03 (95 % CI: 1.01-1.06, P = 0.016) respectively. When aPS/PT was divided in three groups, djusted OR values for aPS/PT IgG of the third tertiles compared to the first tertiles (were 2.11(95 % CI: 1.11-4, P = 0.022). Subgroup analysis supported these findings. Curve fitting revealed a linear relationship between aPS/PT IgM and aPS/PT IgG with PROM.

CONCLUSION

This study suggests that aPS/PT IgG and aPS/PT IgM are independent risk factors for premature rupture of membranes, with aPS/PT IgG showing a higher significance compared to aPS/PT IgM.

Navigating antiphospholipid syndrome: from personalized therapies to cutting-edge research

APS is an autoimmune disorder characterized by thrombosis and pregnancy complications, primarily driven by aPLs such as LA, aCL and anti-β2 glycoprotein I (a-β2GPI). Despite advances in anticoagulation therapies, managing refractory APS cases remains challenging. Emerging therapies, including rituximab, eculizumab and HCQ, show potential in addressing the underlying mechanisms of APS. Additionally, research into genetic and environmental factors, particularly the gut microbiome's role through molecular mimicry, suggests new therapeutic pathways. Diagnostic advancements, such as the adjusted Global Antiphospholipid Syndrome Score (aGAPSS), metabolomic profiling and MRI, have improved risk stratification and early detection. Non-traditional biomarkers like anti-phosphatidylserine/prothrombin (aPS/PT) and anti-Domain I antibodies further enhance risk assessment. Future research should aim to validate these approaches, optimizing patient outcomes and minimizing long-term APS complications.

Phosphatidylserine externalization as immune checkpoint in cancer

Cancer is the second leading cause of mortality worldwide. Despite recent advances in cancer treatment including immunotherapy with immune checkpoint inhibitors, new unconventional biomarkers and targets for the detection, prognosis, and treatment of cancer are still in high demand. Tumor cells are characterized by mutations that allow their unlimited growth, program their local microenvironment to support tumor growth, and spread towards distant sites. While a major focus has been on altered tumor genomes and proteomes, crucial signaling molecules such as lipids have been underappreciated. One of these molecules is the membrane phospholipid phosphatidylserine (PS) that is usually found at cytosolic surfaces of cellular membranes but can be rapidly and massively shuttled to the extracellular leaflet of the plasma membrane during apoptosis to serve as a limiting factor for immune responses. These immunosuppressive interactions are exploited by tumor cells to evade the immune system. In this review, we describe mechanisms of immune regulation in tumors, discuss if PS may constitute an inhibitory immune checkpoint, and describe current and future strategies for targeting PS to reactivate the tumor-associated immune system.