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高 睿, 秦 朗. [Obstetric Antiphospholipid Syndrome: Insights on the Diagnosis, Treatment, and Hot Issues]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2024; 55:513-520. [PMID: 38948301 PMCID: PMC11211787 DOI: 10.12182/20240560104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Indexed: 07/02/2024]
Abstract
Obstetric antiphospholipid syndrome (OAPS) is an autoimmune disorder associated with various pathological pregnancies, such as recurrent miscarriage, stillbirth, severe pre-eclampsia and severe placental insufficiency. The persistent presence of antiphospholipid antibodies (aPLs) is the most important laboratory characteristic of OAPS. OAPS severely affects the reproductive health of women of childbearing age in China. Reports indicate that approximately 9.6% stillbirths, 11.5% severe pre-eclampsia, and 54% recurrent miscarriages are associated with OAPS or aPLs. However, the pathogenesis of OAPS remains unclear. Previously, thrombosis at the maternal-fetal interface (MFI) was considered the main mechanism of OAPS-related pathological pregnancies. Consequently, the use of low molecular weight heparin and aspirin throughout pregnancy was recommended to improve outcomes in OAPS patient. In recent years, many studies have found that thrombosis in MFI is uncommon, but various inflammatory factors are significantly increased in the MFI of OAPS patients. Based on these findings, some clinicians have started using anti-inflammatory treatments for OAPS, which have preliminarily improved the pregnancy outcomes. Nevertheless, there is no consensus on these second-line treatments of OAPS. Another troubling issue is the clinical diagnosis of OAPS. Similar to other autoimmune diseases, there are only classification criteria for OAPS, and clinical diagnosis of OAPS depends on the clinicians' experience. The present classification criteria of OAPS were established for clinical and basic research purposes, not for patient clinical management. In clinical practice, many patients with both positive aPLs and pathological pregnancy histories do not meet the strict OAPS criteria. This has led to widespread issues of incorrect diagnosis and treatment. Timely and accurate diagnosis of OAPS is crucial for effective treatment. In this article, we reviewed the epidemiological research progress on OAPS and summarized its classification principles, including: 1) the persistent presence of aPLs in circulation; 2) manifestations of OAPS, excluding other possible causes. For the first point, accurate assessment of aPLs is crucial; for the latter, previous studies regarded only placenta-related pregnancy complications as characteristic manifestations of OAPS. However, recent studies have indicated that adverse pregnancy outcomes related to trophoblast damage, such as recurrent miscarriage and stillbirth, also need to be considered in OAPS. We also discussed several key issues in the diagnosis and treatment of OAPS. First, we addressed the definition of non-standard OAPS and offered our opinion on defining non-standard OAPS within the framework of the 2023 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) APS criteria. Then, we discussed the advantages and disadvantages of different aPL testing methods, emphasizing that harmonizing results across platforms and establishing specific reference values are keys to resolving controversies in aPL testing results. We also introduced the application of non-criteria aPLs, especially anti-phosphatidylserine/prothrombin antibody (aPS/PT) and anti-β2 glycoprotein Ⅰ domain Ⅰ antibody (aβ2GPⅠDⅠ). Additionally, we discussed aPL-based OAPS risk classification strategies. Finally, we proposed potential treatment methods for refractory OAPS. The goal is to provide a reference for the clinical management of OAPS.
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Affiliation(s)
- 睿 高
- 四川大学华西第二医院 妇产科 生殖医学中心 (成都 610041)The Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610041, China
- 出生缺陷与相关妇儿疾病教育部重点实验室(四川大学) (成都 610041)Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu 610041, China
| | - 朗 秦
- 四川大学华西第二医院 妇产科 生殖医学中心 (成都 610041)The Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610041, China
- 出生缺陷与相关妇儿疾病教育部重点实验室(四川大学) (成都 610041)Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu 610041, China
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Mu F, Wang C, Liu L, Wang F. Preconception anti-annexin A5 antibodies are associated with subsequent live birth in women with recurrent miscarriage: A retrospective study from China. Am J Reprod Immunol 2024; 91:e13822. [PMID: 38407361 DOI: 10.1111/aji.13822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 01/24/2024] [Accepted: 02/02/2024] [Indexed: 02/27/2024] Open
Abstract
PROBLEM To evaluate the correlation between the antiannexin A5 antibodies (aAnxA5) multiples of median (MOM) and subsequent pregnancy outcomes in women with recurrent miscarriage (RM). METHODS Totally, 310 RM women were included in this study and grouped into tertiles according to their MOM of preconception aAnxA5 circulating levels determined by ELISA. The effect of aAnxA5 on the pregnancy outcomes was performed using multiple logistic regression. The outcomes included early miscarriage (before 10 weeks of gestation), late miscarriage (between 10 and 24 weeks), ongoing pregnancy (beyond 10 weeks), and live birth (after 24 weeks) characterized by pregnancy with fetal heartbeat. RESULTS For each unit increase in aAnxA5 MOM, the odds of live birth after 24 weeks and ongoing pregnancy were reduced by 40.2% (OR = .598; 95%CI 0.406-0.882, P = .010) and 38.1% (OR = .619; 95%CI 0.424-0.904, P = .013), respectively, after adjusting for demographic and clinical characteristics. The rise in aAnxA5 MOM was associated with an increased risk of early miscarriage (OR = 1.616; 95%CI 1.106-2.361, P = .013) and miscarriage (early + late miscarriage) (OR = 1.671; 95%CI 1.134-2.464, P = .010). Further subgroup analyses showed a decreased risk of live birth rates after 24 weeks of gestation in the two subgroups: maternal age ≥35 years (OR = .131; 95%CI 0.026-0.652), and previous pregnancy loss ≥ 3 (OR = .381; 95%CI 0.173-0.837). CONCLUSIONS Higher preconception aAnxA5 MOM levels in women with RM may be linked with a decreased risk of live birth after 24 weeks and an increased risk of early miscarriage, especially in individuals aged ≥35 years or with previous pregnancy losses ≥3.
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Affiliation(s)
- Fangxiang Mu
- Department of Reproductive Medicine, Lanzhou University Second Hospital, Lanzhou, China
| | - Chen Wang
- Department of Reproductive Medicine, Lanzhou University Second Hospital, Lanzhou, China
| | - Ling Liu
- Department of Reproductive Medicine, Lanzhou University Second Hospital, Lanzhou, China
| | - Fang Wang
- Department of Reproductive Medicine, Lanzhou University Second Hospital, Lanzhou, China
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Mu F, Wang M, Zeng X, Liu L, Wang F. Preconception Non-criteria Antiphospholipid Antibodies and Risk of Subsequent Early Pregnancy Loss: a Retrospective Study. Reprod Sci 2024; 31:746-753. [PMID: 37932551 PMCID: PMC10912122 DOI: 10.1007/s43032-023-01388-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
The aim of this study was to investigate the subsequent early pregnancy outcomes in women positive for non-criteria antiphospholipid antibodies (NC-aPLs) before pregnancy. A total of 273 patients who had experienced sporadic or recurrent pregnancy loss and had been screened for 13 NC-aPLs at preconception were recruited in this study from September 2019 to February 2022. Serum levels of NC-aPLs were measured by ELISA using specific kits. The primary outcome was early pregnancy loss, and the secondary outcomes were biochemical pregnancy, clinically confirmed pregnancy loss, and ongoing pregnancy. Among these subjects, 56 patients had one previous pregnancy loss, and 217 had recurrent pregnancy loss (RPL). The NC-aPLs (+) and NC-aPLs (-) groups had similar rates of early pregnancy loss (EPL) after adjustment, regardless of the number of positive NC-aPLs (aOR = 1.054, 95% CI 0.602-1.846). Other outcomes were comparable in both groups, including the rates of biochemical pregnancy (aOR = 1.344, 95% CI 0.427-4.236), clinically confirmed pregnancy loss (aOR = 0.744, 95% CI 0.236-2.344), and ongoing pregnancy (aOR = 0.949, 95% CI 0.542-1.660). Based on sensitivity analysis, the NC-aPLs (+) were not associated with adverse early pregnancy outcomes in women with RPL. Furthermore, the difference in gestational weeks of pregnancy loss between the two groups was also insignificant. This study found no evidence linking preconception NC-aPL positivity to early pregnancy outcomes but offers a reference for future research to clarify NC-aPLs' potential clinical impact.
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Affiliation(s)
- Fangxiang Mu
- Department of Reproductive Medicine, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, China
| | - Mei Wang
- Department of Reproductive Medicine, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, China
| | - Xianghui Zeng
- Department of Reproductive Medicine, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, China
| | - Ling Liu
- Department of Reproductive Medicine, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, China
| | - Fang Wang
- Department of Reproductive Medicine, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, China.
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Mineo C, Shaul PW, Bermas BL. The pathogenesis of obstetric APS: a 2023 update. Clin Immunol 2023; 255:109745. [PMID: 37625670 DOI: 10.1016/j.clim.2023.109745] [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: 06/19/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023]
Abstract
The antiphospholipid syndrome (APS) is an autoimmune disease characterized by the persistent presence of antibodies directed against phospholipids and phospholipid-binding proteins that are associated with thrombosis and pregnancy-related morbidity. The latter includes fetal deaths, premature birth and maternal complications. In the early 1990s, a distinct set of autoantibodies, termed collectively antiphospholipid antibodies (aPL), were identified as the causative agents of this disorder. Subsequently histological analyses of the placenta from APS pregnancies revealed various abnormalities, including inflammation at maternal-fetal interface and poor placentation manifested by reduced trophoblast invasion and limited uterine spiral artery remodeling. Further preclinical investigations identified the molecular targets of aPL and the downstream intracellular pathways of key placental cell types. While these discoveries suggest potential therapeutics for this disorder, definitive clinical trials have not been completed. This concise review focuses on the recent developments in the field of basic and translational research pursuing novel mechanisms underlying obstetric APS.
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Affiliation(s)
- Chieko Mineo
- Center for Pulmonary and Vascular Biology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, United States.
| | - Philip W Shaul
- Center for Pulmonary and Vascular Biology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, United States
| | - Bonnie L Bermas
- Division of Rheumatic Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Castellanos Gutierrez AS, Figueras F, Espinosa G, Youssef L, Crispi F, Santana M, Nadal A, Baños N. Correlation of placental lesions in patients with systemic lupus erythematosus, antiphospholipid syndrome and non-criteria obstetric antiphospholipid syndrome and adverse perinatal outcomes. Placenta 2023; 139:92-98. [PMID: 37354691 DOI: 10.1016/j.placenta.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION We aimed to describe the pattern of placental injuries in women with systemic lupus erythematosus (SLE), antiphospholipid antibody syndrome (APS) and non-criteria obstetric APS (NC-OAPS), and to correlate the placental findings with the occurrence of adverse perinatal outcomes. METHODS The perinatal outcomes and placental findings of pregnancies of women with SLE, APS, and NC-OAPS and gestational-age matched healthy controls were analyzed and classified according to the 2015 Redline - Classification of placental lesions. RESULTS 91 women with SLE, APS, and NC-OAPS and 91 controls were included. Mean values of placental weight differed between groups, being significantly lower in NC-OAPS and APS groups compared to controls. Furthermore, 14.3% of placentas in the APS group were under the 3rd percentile, which was significantly higher in comparison with other groups. Regarding histopathological placental findings, maternal-side malperfusion was significantly increased in APS (46.4%) compared to NC-OAPS (14.3%) and SLE (9.5%). Fetal-side maldevelopment was significantly increased in NC-OAPS (19.1%) compared to controls (1.1%) and SLE (2.4%). A significantly increased prevalence of adverse perinatal outcomes (APOs) was observed in all studied groups compared to healthy controls (controls 3.3%, SLE 52.4%, NC-OAPS 57.1%, APS 64.3%). Overall, both maternal (OR 6.8, 95%CI 2.1-22) and fetal-side (OR 4.1, 95%CI 1.3-13.5) lesions were significantly associated with APO. Maternal malperfusion and fetal maldevelopment were the lesions most strongly associated with APOs. DISCUSSION Pregnant women with SLE, APS, or NC-OAPS showed a different pattern of histopathological findings. Compared to controls, SLE, APS, and NC-OAPS conferred an increased risk of APOs that was strongly associated with placental maternal-side malperfusion and fetal-side maldevelopment.
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Affiliation(s)
- Aleida Susana Castellanos Gutierrez
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu. Universitat de Barcelona), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; Placenta Lab, Department of Obstetrics, Jena University Hospital, 07747, Jena, Germany
| | - Francesc Figueras
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu. Universitat de Barcelona), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; Centre for Biomedical Research on Rare Diseases (CIBER-ER), Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clínic Barcelona, Universitat de Barcelona, Spain
| | - Lina Youssef
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu. Universitat de Barcelona), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain
| | - Fàtima Crispi
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu. Universitat de Barcelona), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; Centre for Biomedical Research on Rare Diseases (CIBER-ER), Spain
| | - Marta Santana
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu. Universitat de Barcelona), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain
| | - Alfons Nadal
- Department of Pathology, Hospital Clinic Barcelona, Universitat de Barcelona, Spain
| | - Núria Baños
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu. Universitat de Barcelona), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain.
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Warren BB, Moyer GC, Manco-Johnson MJ. Hemostasis in the Pregnant Woman, the Placenta, the Fetus, and the Newborn Infant. Semin Thromb Hemost 2023; 49:319-329. [PMID: 36750218 DOI: 10.1055/s-0042-1760332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The hemostasis system is composed of procoagulant, anticoagulant, and fibrinolytic proteins that interact with endothelial and blood cells and with each other in a complex system of checks and balances to maintain blood flow while preventing both hemorrhage and thrombosis. Pregnancy is a unique physiological state in which biological alterations predispose both mother and fetus to both bleeding and clotting. The placenta is a vascular interface for maternal and fetal blood exchange which predisposes the mother to hemorrhage. Maternal hemostasis presents a compensatory hypercoagulability including elevated factor VIII, von Willebrand factor, fibrinogen and thrombin generation, decreased thrombin regulation with resistance to activated protein C and decreased free protein S, and decreased fibrinolysis with increased plasminogen activator inhibitors. The placental vascular surface is of fetal trophoblastic origin that derives many characteristics of endothelium but differs in that tissue factor is constitutively expressed. Ontogeny of fetal hemostasis is characteristic. Platelets, von Willebrand factor, factor VIII, and fibrinogen are expressed and mature early in gestation, while vitamin K-dependent and contact factors exhibit delayed development. The fetal hemostatic system has a decreased capacity to generate or regulate thrombin, resulting in a fragile balance with little capacity to compensate under stress conditions, particularly in the infant born prematurely. Dysfunction of the maternal/placental/fetal unit gives rise to gestational disorders including preeclampsia, fetal growth restriction, placental abruption, and premature delivery. Knowledge of normal hemostasis levels and function are critical to evaluate bleeding or clotting syndromes in the pregnant woman and her fetus or newborn infant.
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Affiliation(s)
- Beth Boulden Warren
- University of Colorado Hemophilia and Thrombosis Center, Aurora, Colorado
- Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado
| | - Genevieve C Moyer
- University of Colorado Hemophilia and Thrombosis Center, Aurora, Colorado
- Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado
| | - Marilyn J Manco-Johnson
- University of Colorado Hemophilia and Thrombosis Center, Aurora, Colorado
- Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado
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Motomura K, Hara M, Ito I, Morita H, Matsumoto K. Roles of human trophoblasts' pattern recognition receptors in host defense and pregnancy complications. J Reprod Immunol 2023; 156:103811. [PMID: 36669386 DOI: 10.1016/j.jri.2023.103811] [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: 08/03/2022] [Revised: 12/24/2022] [Accepted: 01/12/2023] [Indexed: 01/14/2023]
Abstract
The immune system in pregnancy is able to protect pregnant mothers and fetuses from pathogenic microorganisms even while permitting the mother to tolerate the semi-allogenic fetus. Trophoblasts, which are fetal-derived placental cells, play a central role on both sides of this duality at the maternal-fetal interface. In brief, the trophoblasts express pattern recognition receptors (PRRs) and are involved in the local innate immune response in the placenta. That response eliminates pathogenic microbes but also causes tissue damage. In this review, we summarize the research findings to date regarding the roles of those human trophoblast PRRs. Multiple types of PRRs (Toll-like receptors, Nod-like receptors, and RIG-I-like receptors) are expressed in the placenta and on trophoblasts. Trophoblasts' PRRs participate in protecting the fetus against viruses, bacteria, and parasites by triggering production of proinflammatory cytokines and chemokines in the placenta. On the negative side, PRR signaling in trophoblasts can also initiate inflammation and trophoblast cell death, which can lead to placental inflammation-associated pregnancy complications such as preeclampsia, anti-phospholipid antibody syndrome, and miscarriage. Further elucidation of these dual roles of trophoblasts' PRRs may shed light on the mechanisms by which fetuses are protected against congenital infections and also give us a better understanding of the etiologies of pregnancy complications, which can help us prevent/reduce adverse prenatal/neonatal outcomes.
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Affiliation(s)
- Kenichiro Motomura
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo 157-8535, Japan; Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo 157-8535, Japan.
| | - Mariko Hara
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo 157-8535, Japan; Department of Otorhinolaryngology, National Center for Child Health and Development, Tokyo 157-8535, Japan
| | - Ikuyo Ito
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo 157-8535, Japan; Department of Pediatrics, School of Medicine, Yokohama City University, Kanagawa 236-0004, Japan
| | - Hideaki Morita
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo 157-8535, Japan; Allergy Center, National Center for Child Health and Development, Tokyo 157-8535, Japan
| | - Kenji Matsumoto
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo 157-8535, Japan.
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Fogarty S, Werner R, James JL. Applying Scientific Rationale to the Current Perceptions and Explanations of Massage and Miscarriage in the First Trimester. Int J Ther Massage Bodywork 2023; 16:30-43. [PMID: 36866184 PMCID: PMC9949615 DOI: 10.3822/ijtmb.v16i1.771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Miscarriage is a relatively common occurrence, impacting 8-15% of clinically recognised pregnancies, and up to 30% of all conceptions. The public perception of the risk factors associated with miscarriage does not match the evidence. Evidence indicates that there are very few modifiable factors to prevent miscarriage, and the majority of the time little could have been done to prevent a spontaneous miscarriage. However, the public perception is that consuming drugs, lifting a heavy object, previous use of an intrauterine device, or massage can all contribute to miscarriage. While misinformation about the causes and risk factors of miscarriage continues to circulate, pregnant women will experience confusion about what activities they can (and cannot) do in early pregnancy, including receiving a massage. Pregnancy massage is an important component of massage therapy education. The resources that underpin pregnancy massage coursework consist of educational print content that includes direction and caution that massage in the first trimester, if done 'incorrectly' or in the 'wrong' location, can contribute to adverse outcomes such as miscarriage. The most common statements, perceptions and explanations for massage and miscarriage cover three broad areas: 1) maternal changes from massage affects the embryo/fetus; 2) massage leads to damage of the fetus/placenta; and 3) aspects of the massage treatment in the first trimester initiate contractions. The goal of this paper is to use scientific rationale to critically consider the validity of the current perceptions and explanations of massage therapy and miscarriage. Whilst direct evidence from clinical trials was lacking, considerations of physiological mechanisms regulating pregnancy and known risk factors associated with miscarriage provide no evidence that massage in pregnancy would increase a patient's risk of miscarriage. This scientific rationale should be addressed when teaching pregnancy massage courses.
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Affiliation(s)
- Sarah Fogarty
- Department of Medicine, School of Medicine, Western Sydney University, Sydney, Australia,Corresponding author: Sarah Fogarty, Department of Medicine, School of Medicine, Western Sydney University Campbelltown Campus, Narellan Road & Gilchrist Drive, Campbelltown, NSW 2560, Australia,
| | - Ruth Werner
- Author of A Massage Therapist’s Guide to Pathology, and Board Certified in Therapeutic Massage and Bodywork, USA
| | - Joanna L James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Li J, Hou Y, Zhang L, Li F, Liu Q, Li Y, Shen H, Xiong Z, Huang L, Qiao C. Clinical phenotype, treatment strategy and pregnancy outcome of non-criteria obstetric antiphospholipid syndrome. Am J Reprod Immunol 2023; 89:e13684. [PMID: 36756665 DOI: 10.1111/aji.13684] [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: 08/26/2022] [Revised: 12/10/2022] [Accepted: 01/28/2023] [Indexed: 02/10/2023] Open
Abstract
PROBLEM To illustrate the clinical features, treatment strategy, and pregnancy outcome of patients with obstetric antiphospholipid syndrome (OAPS), non-criteria obstetric antiphospholipid syndrome (NC-OAPS) METHOD OF STUDY: A single-center nested case-control study was designed. Patients with a diagnosis of OAPS and NC-OAPS were enrolled. The medical history, coagulation status, and antibody profile data were collected. Patients were given standard anticoagulation therapy with or without glucocorticoids (GC) and/or hydroxychloroquine (HCQ) during pregnancy and were observed for their pregnancy outcome. RESULTS A total of 47 patients with OAPS and 120 patients with NC-OAPS were finally included, of whom 55 patients met the clinical criteria (subgroup C) and 65 met the laboratory criteria (subgroup L). Pregnancy morbidity showed significant differences: gravida, pregnancy loss in OAPS versus NC-OAPS. The coagulation function was not significantly different between OAPS and NC-OAPS groups, while TT and FIB were significantly higher in the subgroup C. Thromboelastography (TEG) results showed a significantly lower ANGEL in the NC-OAPS group, a higher ANGEL and lower EPL, LY30 in the subgroup L. No differences between groups were observed in treatment strategy. The pregnancy outcomes were not significantly different between NC-OAPS and OAPS groups. CONCLUSIONS Clinical and laboratory differences were found between OAPS and NC-OAPS groups in this study. Patients in different subgroups of NC-OAPS could be identified with different clinical phenotypes. A relatively hypercoagulable status existed in the OAPS group compared to NC-OAPS, and also in the subgroup L.
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Affiliation(s)
- Jiapo Li
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.,Key Laboratory of Reproductive and Genetic Medicine, National Health Commission, Shenyang, China.,Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Shenyang, China.,Research Center of China Medical University Birth Cohort, Shenyang, China
| | - Yue Hou
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.,Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Shenyang, China.,Research Center of China Medical University Birth Cohort, Shenyang, China
| | - Liyang Zhang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.,Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Shenyang, China.,Research Center of China Medical University Birth Cohort, Shenyang, China
| | - Fan Li
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.,Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Shenyang, China.,Research Center of China Medical University Birth Cohort, Shenyang, China
| | - Qian Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.,Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Shenyang, China.,Research Center of China Medical University Birth Cohort, Shenyang, China
| | - Yuanyuan Li
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.,Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Shenyang, China.,Research Center of China Medical University Birth Cohort, Shenyang, China
| | - Hongfei Shen
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.,Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Shenyang, China.,Research Center of China Medical University Birth Cohort, Shenyang, China
| | - Ziyue Xiong
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.,Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Shenyang, China.,Research Center of China Medical University Birth Cohort, Shenyang, China
| | - Ling Huang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.,Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Shenyang, China.,Research Center of China Medical University Birth Cohort, Shenyang, China
| | - Chong Qiao
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.,Key Laboratory of Reproductive and Genetic Medicine, National Health Commission, Shenyang, China.,Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Shenyang, China.,Research Center of China Medical University Birth Cohort, Shenyang, China
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Manukyan G, Kriegova E, Slavik L, Mikulkova Z, Ulehlova J, Martirosyan A, Papajik T. Antiphospholipid antibody-mediated NK cell cytotoxicity. J Reprod Immunol 2023; 155:103791. [PMID: 36621092 DOI: 10.1016/j.jri.2022.103791] [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: 09/07/2022] [Revised: 12/01/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022]
Abstract
Antiphospholipid syndrome (APS) is an autoimmune thrombophilia that is characterised by thrombosis and obstetric complications in the presence of antiphospholipid antibodies (aPL). Pregnancy complications remain a challenging problem for patients with APS, especially during the first trimester. Although natural killer (NK) cells constitute up to 70% of decidual lymphocytes during the first trimester, their contribution to early pregnancy loss in APS is largely unknown. We aimed to analyse whether aPL are able to recruit antibody-dependent cellular cytotoxicity (ADCC) of NK cells, with special emphasis on the differences in the effects of aPL containing anti-β2GPI domain 1 (anti-β2GPI-D1) antibodies (aPL+/D1+) and those that do not (aPL+/D1-). Our findings revealed a differential distribution of NK subsets in the presence of different aPL. Namely, aPL+/D1- IgGs increased CD56dim/CD16dim cells, while aPL+/D1 + IgGs increased the number of CD56bright/CD16dim cells. ADCC NK cell cytotoxicity was found to be higher in the presence of aPL+/D1- IgGs, as defined by an increased target cell death, degranulation and increased expression of CD11b, CD69 and NKG2D. Overall, our evidence showed that aPL are able to recruit ADCC, suggesting NK cells as candidate cells for APS-related obstetric complications.
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Affiliation(s)
- Gayane Manukyan
- Laboratory of Molecular and Cellular Immunology, Institute of Molecular Biology NAS RA, Yerevan, Armenia; Department of Immunology, Faculty of Medicine and Dentistry, Palacký University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic.
| | - Eva Kriegova
- Department of Immunology, Faculty of Medicine and Dentistry, Palacký University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Ludek Slavik
- Department of Hemato-oncology, Faculty of Medicine and Dentistry, Palacký University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Zuzana Mikulkova
- Department of Immunology, Faculty of Medicine and Dentistry, Palacký University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Jana Ulehlova
- Department of Hemato-oncology, Faculty of Medicine and Dentistry, Palacký University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Anush Martirosyan
- Laboratory of Molecular and Cellular Immunology, Institute of Molecular Biology NAS RA, Yerevan, Armenia
| | - Tomas Papajik
- Department of Hemato-oncology, Faculty of Medicine and Dentistry, Palacký University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
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11
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Huang Z, Tang Z, Guan H, Leung W, Wang L, Xia H, Zhang W. Inactivation of Yes-Associated Protein Mediates Trophoblast Dysfunction: A New Mechanism of Pregnancy Loss Associated with Anti-Phospholipid Antibodies? Biomedicines 2022; 10:biomedicines10123296. [PMID: 36552052 PMCID: PMC9776042 DOI: 10.3390/biomedicines10123296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/11/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Pregnancy morbidity induced by anti-phospholipid antibodies (aPL+/PM+) is mainly thought to arise from placental abnormalities. We attempted to investigate the effect of aPL on the activity of Yes-associated protein (YAP) in the trophoblast and how YAP regulated human trophoblasts function. Thus, HTR-8 cells were treated with IgG purified from aPL+/PM+ women or normal controls. We found that aPL+/PM+ IgG impacted YAP activity via abrogating YAP expression. Further investigation of the anti-β2GPI-IgG/β2GPI complex showed an inhibition of nuclear YAP level and translocation in a dose-dependent manner, which might be rescued by progesterone in HTR-8 cells. YAP overexpression or knockdown HTR-8 cells were established for the evaluation of cell function and related gene expression in vitro. Loss of YAP arrested cell cycles in the G2/M phase, accelerated cell apoptosis by increasing the ratio of Bax/Bcl2, and disrupted MMP2/9-mediated cell migration and angiogenesis tube formation by VEGF. These findings support a new mechanism of PM associated with aPL through which YAP inactivation induced by aPL perturbs the trophoblast cell cycle, apoptosis, migration, and angiogenesis, finally developing into pregnancy failure.
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Affiliation(s)
- Zengshu Huang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
| | - Zhijing Tang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
| | - Haiyun Guan
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
| | - Wingting Leung
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
| | - Lu Wang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
| | - Hexia Xia
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
| | - Wei Zhang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
- Correspondence:
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12
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Khizroeva J, Bitsadze V, Tincani A, Makatsariya A, Arslanbekova M, Babaeva N, Tsibizova V, Shkoda A, Makatsariya N, Tretyakova M, Solopova A, Gadaeva Z, Vorobev A, Khamani I, Aslanova Z, Nakaidze I, Mischenko A, Grigoreva K, Kunesko N, Egorova E, Mashkova T. Hydroxychloroquine in obstetric antiphospholipid syndrome: rationale and results of an observational study of refractory cases. J Matern Fetal Neonatal Med 2022; 35:6157-6164. [PMID: 34044735 DOI: 10.1080/14767058.2021.1908992] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The current recommended therapy of obstetric antiphospholipid syndrome (APS) is a long-term anticoagulant therapy that affects the final event, namely, when the thrombosis has already occurred. Unfortunately, this schedule is not always effective and fails despite the correct risk stratification and an adequate adjusted dose. MATERIALS AND METHODS From 2013 to 2020 we observed 217 women with antiphospholipid antibodies and obstetric morbidities who were treated with conventional treatment protocol (aspirin low doses ± LMWH). Among them 150 (69.1%) successfully completed pregnancy with delivery and live birth on the background of LMWH and aspirin therapy and in 67 (30.9%) women despite a traditional therapy regimen, obstetric complications were noted. Later, 56 of these 67 women became pregnant again and were offered traditional therapy plus hydroxychloroquine. Fifteen women refused HCQ treatment due to possible potential side effects. The final cohort consisted of 41 women with positive antiphospholipid antibodies and obstetric and thrombotic complications who received LMWH, aspirin low doses and HCQ at a dose of 200-400mg per day from the beginning of pregnancy. RESULTS Forty-one aPL women treated with HCQ after failed previous anticoagulant therapy had live births in 32 cases (78%). Adding of HCQ to the combination of LMWH and LDA showed good overall obstetric results and increased the number of live births in another 32 women. So, a total of 182 (83.8%) of initial 217 aPL-women ended their pregnancies with live birth after adding the HCQ to the traditional therapy with LMWH and low doses of aspirin. CONCLUSION In 20-30% of cases the live birth despite anticoagulation cannot be achieved. Perhaps APS is not just anticoagulation. The study of pathophysiological mechanisms suggests that some patients will benefit from other therapy (in addition to anticoagulant). Therapy that affects the early effects of aPL on target cells (monocytes, endothelial cells, etc.) or before binding to receptors-this therapy will be preferable and potentially less harmful than the officially accepted one to date. From this point of view, HCQ looks promising and can be used as an alternative candidate for women with refractory obstetric antiphospholipid syndrome. Adding HCQ should be considered in some selected patients with failed pregnancy after treatment with anticoagulants.
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Affiliation(s)
- Jamilya Khizroeva
- The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Victoria Bitsadze
- The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Angela Tincani
- The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russia
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alexander Makatsariya
- The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Madina Arslanbekova
- The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Nigar Babaeva
- The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Valentina Tsibizova
- Almazov National Medical Research Centre, Saint Petersburg, Health Ministry of Russian Federation, Saint Petersburg, Russia
| | | | - Natalya Makatsariya
- The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Maria Tretyakova
- The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Antonina Solopova
- The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Zumrad Gadaeva
- The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Alexander Vorobev
- The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Inessa Khamani
- The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Zamilya Aslanova
- The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Inga Nakaidze
- The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Alexander Mischenko
- The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Kristina Grigoreva
- The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Nart Kunesko
- Moscow's Department of Health, Center for family planning and reproduction (CPSIR), Moscow, Russia
| | - Elena Egorova
- The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Tamara Mashkova
- The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russia
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Zhang Y, Song Y, Xia X, Wang J, Qian Y, Yuan C, Mao Y, Diao F, Liu J, Ma X. A retrospective study on IVF/ICSI outcomes in patients with persisted positive of anticardiolipin antibody: Effects of low-dose aspirin plus low molecular weight heparin adjuvant treatment. J Reprod Immunol 2022; 153:103674. [PMID: 35882076 DOI: 10.1016/j.jri.2022.103674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/08/2022] [Accepted: 07/16/2022] [Indexed: 11/17/2022]
Abstract
Antiphospholipid (aPL) antibodies are more frequently detected among infertile women, but the association between aPL and in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) outcomes and whether need to get routine treatment are still controversial. The present study aims to find out whether infertile population with persistent aPL positive need treatment and which therapy is more effective. This retrospective study included 181 persistent aPL positive women, including 149 cases receiving anticoagulant treatment, either low-dose aspirin, low molecular weight heparin (LMWH) or aspirin plus LMWH adjuvant treatment (treated group), and 32 cases not receiving any treatment (untreated group). The treated group were further divided by combination therapy group (using both aspirin and LMWH,52 cases) and monotherapy group (only using aspirin,76 cases). The live birth rate and other clinical outcomes, including pregnancy rate, implantation rate, ongoing pregnancy rate and miscarriage rate were compared. The results show anticoagulant therapy can significantly improve live birth rate (59.06 % VS 34.48 %, P = 0.019), implantation rate (59.64 % VS 46.15 %, P<0.001), ongoing pregnancy rate (59.73 % VS 34.38 %, P = 0.016), as well as reduce miscarriage rate (8.25 % VS 31.25 %, P<0.001). Combination treatment of aspirin and LMWH exerts a higher live birth rate than monotherapy (75.00 % VS 53.95 %, P = 0.026). Infertile women with aPL positive might be classified as high-risk and low-risk aPL profiles. Those high-risk aPL positive infertile populations should be identified during IVF/ICSI and given corresponding thromboprophylaxis, and aspirin plus LMWH adjuvant treatment might be recommended.
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Affiliation(s)
- Yuan Zhang
- State Key Laboratory of Reproductive Medicine, the Center for Clinical Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yunjie Song
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xinru Xia
- State Key Laboratory of Reproductive Medicine, the Center for Clinical Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jing Wang
- State Key Laboratory of Reproductive Medicine, the Center for Clinical Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yi Qian
- State Key Laboratory of Reproductive Medicine, the Center for Clinical Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Chun Yuan
- State Key Laboratory of Reproductive Medicine, the Center for Clinical Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yundong Mao
- State Key Laboratory of Reproductive Medicine, the Center for Clinical Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Feiyang Diao
- State Key Laboratory of Reproductive Medicine, the Center for Clinical Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jiayin Liu
- State Key Laboratory of Reproductive Medicine, the Center for Clinical Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xiang Ma
- State Key Laboratory of Reproductive Medicine, the Center for Clinical Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
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14
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Liu J, Zhang L, Tian Y, Wan S, Hu M, Song S, Zhang M, Zhou Q, Xia Y, Wang X. Protection by hydroxychloroquine prevents placental injury in obstetric antiphospholipid syndrome. J Cell Mol Med 2022; 26:4357-4370. [PMID: 35770338 PMCID: PMC9344817 DOI: 10.1111/jcmm.17459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 12/15/2022] Open
Abstract
Obstetric antiphospholipid syndrome (OAPS) is mediated by antiphospholipid antibodies (aPLs, and anti‐β2 glycoprotein I antibody is the main pathogenic antibody), and recurrent abortion, preeclampsia, foetal growth restriction and other placental diseases are the main clinical characteristics of placental pathological pregnancy. It is a disease that seriously threatens the health of pregnant women. Hydroxychloroquine (HCQ) was originally used as an anti‐malaria drug and has now shown benefit in refractory OAPS where conventional treatment has failed, with the expectation of providing protective clinical benefits for both the mother and foetus. However, its efficacy and mechanism of action are still unclear. After clinical data were collected to determine the therapeutic effect, human trophoblast cells in early pregnancy were prepared and treated with aPL. After the addition of HCQ, the proliferation, invasion, migration and tubule formation of the trophoblast cells were observed so that the therapeutic mechanism of HCQ on trophoblast cells could be determined. By establishing an obstetric APS mouse model similar to the clinical situation, we were able to detect the therapeutic effect of HCQ on pathological pregnancy. The normal function of trophoblast cells is affected by aPL. Antibodies reduce the ability of trophoblast cells to invade and migrate and can impair tubule formation, which are closely related to placental insufficiency. HCQ can partially reverse these side effects. In the OAPS mouse model, we found that HCQ prevented foetal death and reduced the incidence of pathological pregnancy. Therefore, HCQ can improve pregnancy outcomes and reverse the aPL inhibition of trophoblast disease. In OAPS, the use of HCQ needs to be seriously considered.
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Affiliation(s)
- Jing Liu
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Liting Zhang
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Yijia Tian
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Shuting Wan
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Min Hu
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Shasha Song
- Maternal and Child Health Care Hospital of Shandong Province, Jinan, China
| | - Meihua Zhang
- The Laboratory of Placenta-Related Diseases, Key Laboratory of Birth Regulation and Control Technology of National Health and Family Planning Commission of China, Jinan, China
| | - Qian Zhou
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Yu Xia
- Central Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xietong Wang
- Department of Obstetrics and Gynaecology, Shandong Provincial Hospital, Shandong University, Jinan, China.,Maternal and Child Health Care Hospital of Shandong Province, Jinan, China.,The Laboratory of Placenta-Related Diseases, Key Laboratory of Birth Regulation and Control Technology of National Health and Family Planning Commission of China, Jinan, China
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15
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Hoxha A, Tormene D, Campello E, Simioni P. Treatment of Refractory/High-Risk Pregnancies With Antiphospholipid Syndrome: A Systematic Review of the Literature. Front Pharmacol 2022; 13:849692. [PMID: 35662738 PMCID: PMC9160870 DOI: 10.3389/fphar.2022.849692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
Different treatment protocols have been employed to manage heparin/low-dose aspirin refractory or high-risk pregnancies in antiphospholipid antibody syndrome (APS) pregnancies. A systematic review of the literature on additional treatments used in refractory and/or high-risk APS pregnancies was conducted. Records from February 2006 to October 2021 were retrieved from PubMed, Web of Science, Cochrane, and the www.clinicaltrials.gov platform. Twenty-one studies met our eligibility criteria. Live birth rate is this study’s primary endpoint, while pregnancy complications and adverse events are secondary endpoints. A total of 434 pregnancies, 162 (37.3%) refractory and 272 (62.7%) high-risk/refractory pregnancies, were included. Both IVIG <2 gr/kg/monthly/HCQ/LDS and PEX/IA ± LDS led to 100% viable infants in refractory APS. Furthermore, HCQ 200–400 mg showed a higher live birth rate than HCQ + LDS (88.6% vs. 82.7%). Following treatment protocol with HCQ 200–400 mg and IVIG <2 gr/kg/monthly/HCQ/LDS, pregnancy complications rates of 16.7 and 83.3% were registered, respectively. Pravastatin 20 mg, IA weekly + IVIG 2 gr/monthly, and PEX weekly + IVIg 2 gr/kg/monthly showed higher live birth rates in high-risk APS pregnancies of 100, 100 and 92%, respectively, whereas the lower severe pregnancy complications were reported in pregnancies treated with PEX weekly + IVIg 2 gr/kg/monthly (11.1%). One (0.6%) case of dermatitis during treatment with HCQ was observed. The results of this study showed that HCQ 200–400 mg and PEX weekly + IVIG 2 gr/kg/monthly achieved a higher live birth rate in refractory APS and high-risk/refractory APS, respectively. The results presented provide clinicians with up-to-date knowledge in the management of APS pregnancies according to risk stratification.
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Affiliation(s)
- Ariela Hoxha
- Internal Medicine Unit, Department of Medicine, San Bortolo Hospital, Vicenza, Italy
- General Internal Medicine and Thrombotic and Hemorrhagic Unit, University of Padua, Padua, Italy
- *Correspondence: Ariela Hoxha,
| | - Daniela Tormene
- General Internal Medicine and Thrombotic and Hemorrhagic Unit, University of Padua, Padua, Italy
| | - Elena Campello
- General Internal Medicine and Thrombotic and Hemorrhagic Unit, University of Padua, Padua, Italy
| | - Paolo Simioni
- General Internal Medicine and Thrombotic and Hemorrhagic Unit, University of Padua, Padua, Italy
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16
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Hamadi GM, Lafta SF. Immunological parameters of recurrent miscarriages among women in Thi-Qar province. J Med Life 2022; 15:635-639. [PMID: 35815084 PMCID: PMC9262261 DOI: 10.25122/jml-2021-0388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/02/2022] [Indexed: 11/17/2022] Open
Abstract
Recurrent miscarriage (RM) is defined as the loss of pregnancy three or more consecutive times in the first and second trimester, which in some cases occurs due to immune abnormalities. This study aimed to assess some immunological parameters in women with recurrent miscarriages, including the level of antiphospholipid antibody (APA), anticardiolipin (ACA), antinuclear antibody (ANA), complement C3 and C4, and interleukine-3 (IL-3). We included 100 patients together with 100 healthy women as a control. ELIZA was used to measure some types of autoantibodies. APA and ACA significantly increased (P≤0.05) in patients compared to control. In addition, 29% of the patients were positive for antinuclear antibodies (ANA), while the control subjects had negative results for these autoantibodies. Regarding the complement, the serum levels of C3 and C4 were significantly elevated in the serum level of patients when compared to the control group, but in treated patients (heparin and low-dose aspirin), the levels of the complement (C3 and C4) showed a significant decrease in patients compared to total controls. Cytokine level (IL-3) significantly decreased in untreated patients 302.78 pg/ml compared to treated patients (741.57 pg/ml). Antiphospholipid antibodies are more prevalent among women with recurrent miscarriages and are also believed to be the result of abnormal autoimmune activation.
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Affiliation(s)
- Ghaneemah Malik Hamadi
- Department of Community Health, Nasiriyah Technical Institute, Southern Technical University, Thi-Qar, Iraq,Corresponding Author: Ghaneemah Malik Hamadi, Department of Community Health, Nasiriyah Technical Institute, Southern Technical University, Thi-Qar, Iraq. E-mail:
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17
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Tong M, Kayani T, Jones DM, Salmon JE, Whirledge S, Chamley LW, Abrahams VM. Antiphospholipid antibodies increase endometrial stromal cell decidualization, senescence and inflammation via TLR4, ROS and p38 MAP kinase signaling. Arthritis Rheumatol 2022; 74:1001-1012. [PMID: 35044724 DOI: 10.1002/art.42068] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/23/2021] [Accepted: 01/12/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Miscarriage affects one in seven pregnancies and antiphospholipid autoantibodies (aPL) are one of the biggest risk factors for recurrent pregnancy loss. While aPL target the endometrial stroma, little is known about their impact. Endometrial stromal cells (EnSCs) undergo decidualization each menstrual cycle, priming the uterus to receive implanting embryos. Thus, appropriate decidualization and EnSC function is key for establishment of a successful pregnancy. METHODS EnSCs under decidualizing conditions were exposed to aPL or control IgG alone or in the presence of either a Toll-like receptor 4 (TLR4) antagonist, a p38 MAPK inhibitor, a reactive oxygen species (ROS) inhibitor, low-molecular weight heparin (LMWH), or acetyl salicylic acid (ASA). Secretion of decidualization markers and inflammatory interleukin (IL)-8 were quantified by ELISA, and senescence-associated β-galactosidase activity was evaluated. In a mouse model of decidualization, aPL or control IgG was administered and uterine expression of decidualization and inflammatory markers quantified by RT-qPCR. RESULTS aPL increased human EnSC decidualization, senescence and inflammation. This phenotype was recapitulated in the mouse model. The decidualization and inflammatory responses were partially mediated by TLR4 and p38 MAP kinase, while the decidualization and senescence responses were ROS-dependent. LMWH, commonly used to treat aPL-positive women at risk for obstetric complications, reduced the ability of aPL to increase EnSC decidualization and inflammation. CONCLUSION These findings shed new light on the pathogenesis of pregnancy complications in women with aPL and underscore the benefit of heparin for preventing pregnancy loss in this high-risk population.
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Affiliation(s)
- Mancy Tong
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Teimur Kayani
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Deidre M Jones
- Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
| | - Jane E Salmon
- Department of Medicine, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Shannon Whirledge
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Lawrence W Chamley
- Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
| | - Vikki M Abrahams
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
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18
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DeSpenza RA, Jones DM, Chamley LW, Abrahams VM. Antiphospholipid antibody-induced trophoblast responses are differentially modulated by viral dsRNA and viral ssRNA. Am J Reprod Immunol 2021; 87:e13516. [PMID: 34904767 DOI: 10.1111/aji.13516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/08/2021] [Indexed: 11/28/2022] Open
Abstract
PROBLEM Women with antiphospholipid antibodies (aPL) are at increased risk for pregnancy loss and preeclampsia. aPL target the trophoblast and induce a pro-inflammatory, anti-angiogenic and anti-migratory profile. Since infection during pregnancy can increase the risk for preeclampsia, a viral infection could further increase this in women with aPL. The goal of this study was to characterize the effect of viral components on trophoblast responses to aPL. METHOD OF STUDY A human first trimester trophoblast cell line was treated with or without aPL or control IgG in the presence of media, viral dsRNA or viral ssRNA. Supernatants were measured for inflammatory IL-1β and IL-8; inflammasome-associated uric acid and caspase-1 activity; and anti-angiogenic sFlt-1. Trophoblast migration was measured using a two-chamber assay. RESULTS Viral dsRNA augmented aPL-induced trophoblast caspase-1 activity, and IL-1β and IL-8 secretion in an additive manner. Viral ssRNA inhibited aPL-induced uric acid, IL-1β and sFlt-1 secretion, and further exacerbated aPL-inhibition of trophoblast migration. CONCLUSION While viral ssRNA may have some protective effects on aPL-induced inflammation and anti-angiogenic responses, viral dsRNA exacerbated aPL-mediated inflammation and viral ssRNA further limited cell migration, which could prove detrimental to placentation. Thus, viral infections may contribute to adverse pregnancy outcomes in women with aPL.
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Affiliation(s)
- Rachel A DeSpenza
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University, New Haven, Connecticut, USA
| | - Deidre M Jones
- Department of Obstetrics & Gynecology, University of Auckland, Auckland, New Zealand
| | - Lawrence W Chamley
- Department of Obstetrics & Gynecology, University of Auckland, Auckland, New Zealand
| | - Vikki M Abrahams
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University, New Haven, Connecticut, USA
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19
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Intersection of regulatory pathways controlling hemostasis and hemochorial placentation. Proc Natl Acad Sci U S A 2021; 118:2111267118. [PMID: 34876522 DOI: 10.1073/pnas.2111267118] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 11/18/2022] Open
Abstract
Hemochorial placentation is characterized by the development of trophoblast cells specialized to interact with the uterine vascular bed. We utilized trophoblast stem (TS) cell and mutant rat models to investigate regulatory mechanisms controlling trophoblast cell development. TS cell differentiation was characterized by acquisition of transcript signatures indicative of an endothelial cell-like phenotype, which was highlighted by the expression of anticoagulation factors including tissue factor pathway inhibitor (TFPI). TFPI localized to invasive endovascular trophoblast cells of the rat placentation site. Disruption of TFPI in rat TS cells interfered with development of the endothelial cell-like endovascular trophoblast cell phenotype. Similarly, TFPI was expressed in human invasive/extravillous trophoblast (EVT) cells situated within first-trimester human placental tissues and following differentiation of human TS cells. TFPI was required for human TS cell differentiation to EVT cells. We next investigated the physiological relevance of TFPI at the placentation site. Genome-edited global TFPI loss-of-function rat models revealed critical roles for TFPI in embryonic development, resulting in homogeneous midgestation lethality prohibiting analysis of the role of TFPI as a regulator of the late-gestation wave of intrauterine trophoblast cell invasion. In vivo trophoblast-specific TFPI knockdown was compatible with pregnancy but had profound effects at the uterine-placental interface, including restriction of the depth of intrauterine trophoblast cell invasion while leading to the accumulation of natural killer cells and increased fibrin deposition. Collectively, the experimentation implicates TFPI as a conserved regulator of invasive/EVT cell development, uterine spiral artery remodeling, and hemostasis at the maternal-fetal interface.
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20
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Gao R, Zeng R, Qing P, Meng C, Cheng K, Zhang S, Chen H, Jin X, Qin L, Li T. Antiphospholipid antibodies and pregnancy outcome of assisted reproductive treatment: A systematic review and meta-analysis. Am J Reprod Immunol 2021; 86:e13470. [PMID: 34018271 DOI: 10.1111/aji.13470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/13/2021] [Accepted: 05/18/2021] [Indexed: 02/05/2023] Open
Abstract
PROBLEM Antiphospholipid antibodies (aPLs) are a group of autoantibodies associated with a variety of pregnancy complications, but the impact of aPL on the outcomes of assisted fertility treatment (ART) is controversial. This systematic review and meta-analysis were designed to explore the association between aPL and ART outcomes and to explore in which stages does aPL play a role. METHOD OF STUDY PubMed and Cochrane database were systematically retrieved, and odds ratios (ORs) or risk ratios (RRs) with 95% confidence intervals (CIs) were calculated in a random-effect model or fixed-effect model according to the heterogenicity assessed by the Cochran Q and I2 statistic test. Of 246 records identified by the search, 10 case-control studies and 13 cohort studies that explored the association between aPL and in vitro fertilization (IVF) and/or intracytoplasmic sperm injection (ICSI) were analyzed. RESULTS The results showed that aPL positive rate was higher in females who failed in IVF/ICSI than those who succeeded in IVF/ICSI (OR: 3.62, 95% CI: 1.95-6.74). This study also indicated that females positive for aPL have a higher miscarriage rate (RR: 1.68, 95% CI: 1.24-2.28) than those negative for aPL, but live birth rate, biochemical pregnancy rate, and clinical pregnancy rate were similar between two groups (RR: 1.01, 95% CI: 0.91-1.12; RR: 1.18, 95% CI: 0.57-2.43 and RR: 0.95, 95% CI: 0.80-1.13). CONCLUSIONS There was higher aPL prevalence in females with adverse IVF/ICSI outcomes. It seems that aPL mainly affects the miscarriage rate, but has little effect on live birth rate, biochemical pregnancy rate, and clinical pregnancy rate. Routine detection of aPL before IVF/ICSI treatment is meaningful.
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Affiliation(s)
- Rui Gao
- The Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Rujun Zeng
- The Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Pingying Qing
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Cheng Meng
- Key Laboratory of Birth Defects and Related of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.,Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Kemin Cheng
- Department of Outpatients, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Sirui Zhang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Hanxiao Chen
- The Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiaolei Jin
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Lang Qin
- The Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Tao Li
- Key Laboratory of Birth Defects and Related of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.,Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
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21
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Zhang Y, Lin M, Hao X, Ping M, Zhang H, Zheng J. Imbalance of circulating CTLA4 + follicular helper and follicular regulatory T cells in obstetric antiphospholipid syndrome. Clin Exp Med 2021; 22:27-36. [PMID: 34002285 DOI: 10.1007/s10238-021-00720-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/05/2021] [Indexed: 11/26/2022]
Abstract
Obstetric antiphospholipid syndrome (OAPS) is a systemic autoimmune disease that is characterized clinically by a variety of obstetric manifestations (fetal death and recurrent abortions) and serologically by the presence of antiphospholipid antibodies (aPLs). Whether dysregulation of Follicular helper T (Tfh) and Follicular regulatory T (Tfr) cells contribute to the immunopathogenesis in OAPS is still unknown. We analyzed phenotypic characterizations of circulating Tfh cells and Tfr cells in OAPS patients and healthy individuals. CTLA4(Cytotoxic T lymphocyte antigen 4)+ Tfh cells and CTLA4+ Tfr cells were declined and CTLA4+ Tfr/Tfh ratio and IL-21 were increased in OAPS patients compared with healthy controls. Percentages of CTLA4+ Tfh cells and CTLA4+ Tfr cells were the lowest in OAPS patients whose antiphospholipid antibodies (aPL) were triple positive. Increased CTLA4+ Tfr/Tfh ratio was positively correlated with anti-β2 glycoprotein I (anti-β2GPI) IgM, Complement 4(C4) or IL-21 in OAPS. Increased Th17 subtype and decreased Th1, Th2 subtypes in Tfh cells and Tfr cells, increased effector memory subtype and decreased central memory subtype of Tfh cells and Tfr cells were also observed in OAPS compared with healthy individuals. Our data demonstrated that an imbalance of circulating CTLA4+ Tfh cells, and Tfr cells correlates with the immunopathogenesis of OAPS.
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Affiliation(s)
- Yinmei Zhang
- Department of Laboratory Medicine, Peking University Third Hospital, Haidian District, No. 49 North Garden Road, Beijing, 100191, People's Republic of China
| | - Mingmei Lin
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Haidian District, No. 49 North Garden Road, Beijing, 100191, People's Republic of China
| | - Xinjie Hao
- Department of Laboratory Medicine, Peking University Third Hospital, Haidian District, No. 49 North Garden Road, Beijing, 100191, People's Republic of China
| | - Muye Ping
- Department of Laboratory Medicine, Peking University Third Hospital, Haidian District, No. 49 North Garden Road, Beijing, 100191, People's Republic of China
| | - Han Zhang
- Department of Laboratory Medicine, Peking University Third Hospital, Haidian District, No. 49 North Garden Road, Beijing, 100191, People's Republic of China
| | - Jiajia Zheng
- Department of Laboratory Medicine, Peking University Third Hospital, Haidian District, No. 49 North Garden Road, Beijing, 100191, People's Republic of China.
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22
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Alecsandru D, Klimczak AM, Garcia Velasco JA, Pirtea P, Franasiak JM. Immunologic causes and thrombophilia in recurrent pregnancy loss. Fertil Steril 2021; 115:561-566. [PMID: 33610320 DOI: 10.1016/j.fertnstert.2021.01.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 12/16/2022]
Abstract
Certain miscarriages result from immunologic factors, but there is no clear identification of the precise causes of recurrent pregnancy loss (RPL). Miscarriages and RPL can arise from a disruption of maternal-fetal immune homeostasis. Remodeling of the maternal uterine spiral arteries is one of the key steps for normal growth and development of the fetus. An adequate oxygen supply is necessary for correct placentation, and it is accomplished by proper vascular changes. The development of fetal tissues creates a potential immunologic problem since the fetus can express paternal antigens and, in some cases, antigens of a gamete donor. The maternal immune system actively responds to fetal antigens, and dysregulation of this crosstalk could partly explain pregnancy complications such as miscarriages and RPL. RPL resulting from thrombophilia is primarily due to acquired thrombophilia, and therefore screening and treatment should be focused on antiphospholipid antibody syndrome.
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Affiliation(s)
- Diana Alecsandru
- Department of Immunology, IVI RMA Madrid, Spain; Rey Juan Carlos University, Madrid, Spain
| | | | - Juan A Garcia Velasco
- Rey Juan Carlos University, Madrid, Spain; Department of Reproductive Endocrinology and Infertility, IVI RMA Madrid; IVI Foundation, Health Research Institute La Fe, Valencia, Spain
| | - Paul Pirtea
- Department of Obstetrics and Gynecology, Hospital Foch, Paris, France.
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23
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Magawa S, Nii M, Ishida M, Takase S, Nakayama R, Enomoto N, Tanaka H, Kondo E, Sakuma H, Ikeda T. Evaluation of placental oxygenation index using blood oxygen level-dependent magnetic resonance imaging (BOLD-MRI) during normal late pregnancy. J Matern Fetal Neonatal Med 2021; 35:5274-5281. [PMID: 33491514 DOI: 10.1080/14767058.2021.1878140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM Noninvasive blood oxygen level-dependent magnetic resonance imaging (BOLD-MRI) has recently been used to evaluate placental oxygenation. However, this method still has unresolved problems, such as long testing times and lack of normal values set. In the present study, we used a shorter protocol in BOLD-MRI and established normal values for placental oxygenation in late pregnancy. METHODS We recruited 18 healthy singleton pregnant women (>32 weeks of gestation) who had a normal body size before pregnancy and a normal course of pregnancy. They underwent BOLD-MRI with three consecutive 4-min periods of different oxygenation: normoxia (21% O2), hyperoxia (10 L O2/min), and then normoxia. Placental time-activity curves were presented as signal intensity change relative to baseline (ΔR2*). The time from starting maternal oxygen administration to peak ΔR2*. To assess the relationship between peak ΔR2* values and placenta-related parameters and fetal development, the correlation between peak ΔR2*, placental weight, and neonatal birth weight was evaluated using Spearman's rank correlation test. RESULTS In all cases, the BOLD signal was elevated by maternal oxygen administration, with the peak resolving within 4 min after the end of oxygen administration. Peak ΔR2* and time to peak ΔR2* during oxygenation were 7.99 ± 2.58, and 458.1 ± 73.9 s, respectively. There was a significant correlation between peak ΔR2* and neonatal birth weight (percentile) (r = 0.537, p = .022), and between placental weight and neonatal birth weight (r = 0.769, p < .01). CONCLUSIONS In all cases, the BOLD signal increased with maternal hyperoxia using this protocol. So, 4 min observation following maternal oxygen administration is sufficient for peak ΔR2* evaluation. These reference values set in this study may be one of the indicators of BOLD signal changes in normal pregnancies after 32 weeks of gestation.
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Affiliation(s)
- Shoichi Magawa
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Mie, Japan
| | - Masafumi Nii
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Mie, Japan
| | - Masaki Ishida
- Department of Radiology, Mie University Faculty Medicine, Mie, Japan
| | - Shinichi Takase
- Department of Radiology, Mie University Faculty Medicine, Mie, Japan
| | - Ryohei Nakayama
- Department of Electronic and Computer Engineering, Ritsumeikan University, Kyoto, Japan
| | - Naosuke Enomoto
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Mie, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Mie, Japan
| | - Eiji Kondo
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Mie, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Faculty Medicine, Mie, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Faculty Medicine, Mie, Japan
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24
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Tong M, Tsai BW, Chamley LW. Antiphospholipid antibodies and extracellular vesicles in pregnancy. Am J Reprod Immunol 2020; 85:e13312. [PMID: 32715546 DOI: 10.1111/aji.13312] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 07/20/2020] [Indexed: 12/28/2022] Open
Abstract
Antiphospholipid antibodies (aPL) are autoantibodies that target phospholipid-binding proteins, such as β2 glycoprotein I (β2GPI), and can induce thrombosis systemically, as well as increase the risk of obstetric complications such as recurrent miscarriage and preeclampsia. Due to the expression of β2GPI by placental trophoblasts, aPL readily target the maternal-fetal interface during pregnancy and many studies have investigated the deleterious effects of aPL on placental trophoblast function. This review will focus on studies that have examined the effects of aPL on the production and modification of extracellular vesicles (EVs) from trophoblasts, as EVs are a key mode of feto-maternal communication in both normal and pathological pregnancy. A more comprehensive understanding of the effects of aPL on the quantity and cargo of EVs extruded by the human placenta may contribute to our current knowledge of how aPL induce both systemic and obstetric disease.
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Affiliation(s)
- Mancy Tong
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Bridget W Tsai
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, NZ, USA
| | - Lawrence W Chamley
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, NZ, USA
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25
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Antiapolipoprotein A-1 Autoantibody Positivity Is Associated with Threatened Abortion. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9309121. [PMID: 32219148 PMCID: PMC7081016 DOI: 10.1155/2020/9309121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/08/2020] [Indexed: 11/17/2022]
Abstract
Background Autoantibodies against apolipoprotein A-1 (anti-ApoA-1 IgG) were demonstrated to be associated with cardiovascular outcomes in several inflammatory diseases. As balanced inflammation is critical for uncomplicated pregnancy, we aimed to investigate the prevalence of anti-ApoA-1 IgG and anti-c-terminal ApoA-1 autoantibodies (Ac-terAA1 IgG) in a cohort of pregnant women and their potential relationship with threatened abortion (TA). Methods Between 2012 and 2014, 371 consecutive outpatient pregnant women were included in this study and followed until delivery. Anti-ApoA-1 and anti-Ac-terAA1 IgG were measured by ELISA technique on serum samples collected between the 24th and 26th week of pregnancy. Associations with TA were tested using linear regression analysis and C-statistics. Results Median age was 34 with a prevalence of the Caucasian ethnicity (90.5%). TA occurred in 10 women (2.7%). C-statistics indicated that anti-ApoA-1 and anti-Ac-terAA1 IgG levels upon study inclusion were predictive of TA (0.73, 95% confidence interval [CI] 0.69-0.78, p < 0.001 and 0.76, 95% CI 0.71-0.80, p < 0.001 and 0.76, 95% CI 0.71-0.80, p < 0.001 and 0.76, 95% CI 0.71-0.80, p < 0.001 and 0.76, 95% CI 0.71-0.80, Conclusion Anti-ApoA-1 and anti-Ac-terAA1 IgG are independently associated with TA during pregnancy with an appealing NPV. The causal biological mechanisms underlying this association as well as the possible clinical relevance of these findings require further investigations.
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26
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D'Ippolito S, Ticconi C, Tersigni C, Garofalo S, Martino C, Lanzone A, Scambia G, Di Simone N. The pathogenic role of autoantibodies in recurrent pregnancy loss. Am J Reprod Immunol 2019; 83:e13200. [PMID: 31633847 DOI: 10.1111/aji.13200] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 12/20/2022] Open
Abstract
In the present manuscript, we review the recent research investigating the pathogenic association between most studied autoantibodies and recurrent pregnancy loss. Pregnancy loss represents a common obstetric complication occurring in about 15%-25% of all clinically recognized pregnancies. The recurrence of pregnancy loss identifies a distinct clinical entity, that is recurrent pregnancy loss (RPL), affecting about 2%-4% of couples. Several factors, including age, chromosomal abnormalities, uterine anomalies, thrombophilic disorders, endocrinopathies, hormonal and metabolic disorders, infections, sperm quality, and lifestyle issues, are involved in RPL. The role of autoantibodies in RPL is only partially determined. In some cases (antiphospholipid antibodies [aPL]), their involvement is well established. In other cases (anti-thyroid autoantibodies, antinuclear, anti-transglutaminase, and anti-endomysial antibodies), it is still debated, despite multiple, although not fully conclusive, evidences strongly suggest a possible involvement in RPL. Further extensive research is needed to definitively confirm or exclude their actual role.
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Affiliation(s)
- Silvia D'Ippolito
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, U.O.C. di Ostetricia e Patologia Ostetrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Ticconi
- Section of Gynecology and Obstetrics, Department of Surgical Sciences, University Tor Vergata, Rome, Italy
| | - Chiara Tersigni
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, U.O.C. di Ostetricia e Patologia Ostetrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Serafina Garofalo
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, U.O.C. di Ostetricia e Patologia Ostetrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carmelinda Martino
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, U.O.C. di Ostetricia e Patologia Ostetrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Lanzone
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, U.O.C. di Ostetricia e Patologia Ostetrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, U.O.C. di Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicoletta Di Simone
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, U.O.C. di Ostetricia e Patologia Ostetrica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
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27
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Elshafay A, Omran ES, Abdelkhalek M, El-Badry MO, Eisa HG, Fala SY, Dang T, Ghanem MAT, Elbadawy M, Elhady MT, Vuong NL, Hirayama K, Huy NT. Reporting quality in systematic reviews of in vitro studies: a systematic review. Curr Med Res Opin 2019; 35:1631-1641. [PMID: 30977685 DOI: 10.1080/03007995.2019.1607270] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Systematic reviews (SRs) and/or meta-analyses of in vitro research have an important role in establishing the foundation for clinical studies. In this study, we aimed to evaluate the reporting quality of SRs of in vitro studies using the PRISMA checklist.Method: Four databases were searched including PubMed, Virtual Health Library (VHL), Web of Science (ISI) and Scopus. The search was limited from 2006 to 2016 to include all SRs and/or meta-analyses (MAs) of pure in vitro studies. The evaluation of reporting quality was done using the PRISMA checklist.Results: Out of 7702 search results, 65 SRs were included and evaluated with the PRISMA checklist. Overall, the mean overall quality score of reported items of the PRISMA checklist was 68%. We have noticed an increasing pattern in the numbers of published SRs of in vitro studies over the last 10 years. In contrast, the reporting quality was not significantly improved over the same period (p = .363). There was a positive but not significant correlation between the overall quality score and the journal impact factor of the included studies.Conclusions: The adherence of SRs of in vitro studies to the PRISMA guidelines was poor. Therefore, we believe that using reporting guidelines and journals paying attention to this fact will improve the quality of SRs of in vitro studies.
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Affiliation(s)
- Abdelrahman Elshafay
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Online Research Club (http://www.onlineresearchclub.org/)
| | - Esraa Salah Omran
- Online Research Club (http://www.onlineresearchclub.org/)
- Kasralainy School of Medicine, Cairo University, Cairo, Egypt
| | - Mariam Abdelkhalek
- Online Research Club (http://www.onlineresearchclub.org/)
- Microbiology and Immunology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed Omar El-Badry
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Online Research Club (http://www.onlineresearchclub.org/)
| | - Heba Gamal Eisa
- Online Research Club (http://www.onlineresearchclub.org/)
- Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Salma Y Fala
- Online Research Club (http://www.onlineresearchclub.org/)
- Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Thao Dang
- Online Research Club (http://www.onlineresearchclub.org/)
- Surgery Department School of Medicine, Tan Tao University, Tan Duc Ecity, Vietnam
| | - Mohammad A T Ghanem
- Online Research Club (http://www.onlineresearchclub.org/)
- Department of Vascular Surgery, Uniklinik Magdeburg, Magdeburg, Germany
| | - Maha Elbadawy
- Online Research Club (http://www.onlineresearchclub.org/)
- Ministry of Health, Cairo, Egypt
| | - Mohamed Tamer Elhady
- Online Research Club (http://www.onlineresearchclub.org/)
- Department of Pediatrics, Zagazig University Hospitals, Faculty of Medicine, Sharkia, Egypt
| | - Nguyen Lam Vuong
- Online Research Club (http://www.onlineresearchclub.org/)
- Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Kenji Hirayama
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Nguyen Tien Huy
- Evidence Based Medicine Research Group & Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam
- Department of Clinical Product Development, Institute of Tropical Medicine (NEKKEN), School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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28
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Wu CH, Lee TH, Yang SF, Tsao HM, Chang YJ, Chou CH, Lee MS. Interleukin-3 Polymorphism is Associated with Miscarriage of Fresh in Vitro Fertilization Cycles. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16060995. [PMID: 30893922 PMCID: PMC6466610 DOI: 10.3390/ijerph16060995] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/05/2019] [Accepted: 03/17/2019] [Indexed: 11/21/2022]
Abstract
The aim of this study was to examine the association between interleukin (IL) genes polymorphisms and in vitro fertilization (IVF) outcome. A prospective cohort analysis was performed at a Women’s Hospital IVF centre of 1015 female patients undergoing fresh non-donor IVF cycles. The effects of the following six single nucleotide polymorphisms (SNPs) in five IL genes on IVF outcomes were explored: IL-1α (rs1800587 C/T), IL-3 (rs40401 C/T), IL-6 (rs1800795 C/G), IL-15 (rs3806798 A/T), IL-18 (rs187238 C/G) and IL-18 (rs1946518 G/T). The main outcome measures included clinical pregnancy, embryo implantation, abortion and live birth rates. There were no statistically significant differences in clinical pregnancy, embryo implantation and live birth rates in the analysis of 1015 patients attempting their first cycle of IVF. Infertile women with IL-3 homozygous major genotype had a higher abortion rate than those with heterozygous and homozygous minor genotype (16.5% vs. 7.9%, P = 0.025). In conclusion, our results indicated that the IL-3 rs40401 polymorphism is associated with increased risk of abortion of IVF patients. Future studies with inclusion of other ethnic populations must be conducted to confirm the findings of this study.
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Affiliation(s)
- Cheng-Hsuan Wu
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan.
- Women's Health Research Laboratory, Changhua Christian Hospital, Changhua 50006, Taiwan.
- School of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
| | - Tsung-Hsien Lee
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan.
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan.
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan.
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan.
| | - Hui-Mei Tsao
- Division of Infertility Clinic, Lee Womens' Hospital, Taichung 406, Taiwan.
| | - Yu-Jun Chang
- Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua 50006, Taiwan.
| | - Chia-Hsuan Chou
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan.
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan.
| | - Maw-Sheng Lee
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan.
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan.
- Division of Infertility Clinic, Lee Womens' Hospital, Taichung 406, Taiwan.
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Alijotas-Reig J, Esteve-Valverde E, Llurba E, Gris JM. Treatment of refractory poor aPL-related obstetric outcomes with TNF-alpha blockers: Maternal-fetal outcomes in a series of 18 cases. Semin Arthritis Rheum 2019; 49:314-318. [PMID: 30824278 DOI: 10.1016/j.semarthrit.2019.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/08/2019] [Accepted: 02/04/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND No absolute data on the treatment of antiphospholipid antibodies (aPL) related to refractory obstetric complications exist to date. TNF-α play a major role in this disorder. OBJECTIVE To assess the effectiveness of TNF-α blockers in 18 aPL-positive women with recurrent infertility after therapy with low-molecular-weight heparin (LMWH) plus aspirin (LDA) plus hydroxychloroquine (HCQ). METHODS Prospective case-series of 12 women fulfilling Sydney criteria for obstetric antiphospholipid syndrome (OAPS) and 6 with incomplete forms (OMAPS). All women tested positive for aPL at least twice. Non-criteria aPL were tested in 15/18. Complement, TNF-α and IL-10 were also evaluated. Women were closely monitored for fetal well-being and possible malformations throughout gestation and the postpartum period. RESULTS Sixteen patients were started on adalimumab and 2 on certolizumab. Twelve women completed gestation: 9 at term and 3 pre-term. Differences in laboratory categories and outcomes were observed when OAPS and OMAPS were compared. First trimester miscarriage or implantation failure recurred in 6 cases, all of the OAPS group. Malformations were not seen in the newborns. CONCLUSIONS Overall, good obstetric results were obtained in 70% of previous LMWH-LDA+HCQ refractory cases. TNF-α blockers were well tolerated without adverse effects. The combination of LMWH plus LDA plus TNF-α blockers appears to be a promising treatment for refractory obstetric complaints related to aPL; nevertheless, outcome differences between OAPS and OMAPS do exist.
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Affiliation(s)
- Jaume Alijotas-Reig
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine-1, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Department of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | | | - Elisa Llurba
- Obstetric and Ginecology Department, Sant Pau University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep Mª Gris
- Reproductive Medicine Unit, Obstetric Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
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30
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Mulla MJ, Pasternak MC, Salmon JE, Chamley LW, Abrahams VM. Role of NOD2 in antiphospholipid antibody-induced and bacterial MDP amplification of trophoblast inflammation. J Autoimmun 2018; 98:103-112. [PMID: 30594350 DOI: 10.1016/j.jaut.2018.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/14/2018] [Accepted: 12/16/2018] [Indexed: 10/27/2022]
Abstract
Women with antiphospholipid antibodies (aPL) are at high risk for pregnancy complications, such as preeclampsia. We previously demonstrated that aPL recognizing β2GPI promote an extravillous trophoblast pro-inflammatory, anti-migratory and anti-angiogenic profile similar to that seen in preeclampsia. Since preeclampsia in the absence of aPL may have an underlying infectious element, women with aPL may be at increased risk for preeclampsia or other adverse outcomes if an infection is present. Our objective was to determine the impact the common bacterial component, muramyl dipeptide (MDP), has on trophoblast responses to aPL. Herein, we report that bacterial MDP amplifies trophoblast IL-1β expression, processing, and secretion in the presence of aPL through activation of NOD2. In the absence of MDP, NOD2 also mediates anti- β2GPI antibody-induced trophoblast IL-1β and VEGF secretion. Additionally, we report a role for extravillous trophoblast vimentin as a novel danger signal that contributes to the aPL-induced trophoblast IL-1β production. Together our data indicate that NOD2 mediates trophoblast inflammatory and angiogenic responses to aPL alone, and mediates trophoblast inflammation in the presence of bacterial MDP. These findings suggest that a bacterial infection at the maternal-fetal interface may exacerbate the impact aPL have on trophoblast inflammation and, thus, on pregnancy outcome.
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Affiliation(s)
- Melissa J Mulla
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University, New Haven, CT, USA
| | - Monica C Pasternak
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University, New Haven, CT, USA
| | - Jane E Salmon
- Department of Medicine, Hospital for Special Surgery, New York, NY, USA
| | - Lawrence W Chamley
- Department of Obstetrics & Gynecology, University of Auckland, Auckland, New Zealand
| | - Vikki M Abrahams
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University, New Haven, CT, USA.
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31
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Velásquez M, Rojas M, Abrahams VM, Escudero C, Cadavid ÁP. Mechanisms of Endothelial Dysfunction in Antiphospholipid Syndrome: Association With Clinical Manifestations. Front Physiol 2018; 9:1840. [PMID: 30627104 PMCID: PMC6309735 DOI: 10.3389/fphys.2018.01840] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/06/2018] [Indexed: 12/13/2022] Open
Abstract
The endothelium is a monolayer of cells that covers the inner surface of blood vessels and its integrity is essential for the maintenance of vascular health. Endothelial dysfunction is a key pathological component of antiphospholipid syndrome (APS). Its systemic complications include thrombotic endocarditis, valvular dysfunction, cerebrovascular occlusions, proliferative nephritis, deep vein thrombosis, and pulmonary embolism. In women, APS is also associated with pregnancy complications (obstetric APS). The conventional treatment regimens for APS are ineffective when the clinical symptoms are severe. Therefore, a better understanding of alterations in the endothelium caused by antiphospholipid antibodies (aPL) may lead to more effective therapies in patients with elevated aPL titers and severe clinical symptoms. Currently, while in vivo analyses of endothelial dysfunction in patients with APS have been reported, most research has been performed using in vitro models with endothelial cells exposed to either patient serum/plasma, monoclonal aPL, or IgGs isolated from patients with APS. These studies have described a reduction in endothelial cell nitric oxide synthesis, the induction of inflammatory and procoagulant phenotypes, an increase in endothelial proliferation, and impairments in vascular remodeling and angiogenesis. Despite these lines of evidence, further research is required to better understand the pathophysiology of endothelial dysfunction in patients with APS. In this review, we have compared the current understanding about the mechanisms of endothelial dysfunction induced by patient-derived aPL under the two main clinical manifestations of APS: thrombosis and gestational complications, either alone or in combination. We also discuss gaps in our current knowledge regarding aPL-induced endothelial dysfunction.
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Affiliation(s)
- Manuela Velásquez
- Grupo Reproducción, Departamento de Microbiología y Parasitología, Escuela de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Mauricio Rojas
- Grupo de Inmunología Celular e Inmunogenética, Facultad de Medicina, Coordinador Unidad de Citometría de Flujo, Sede de Investigación Universitaria, Universidad de Antioquia, Medellín, Colombia
| | - Vikki M Abrahams
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States
| | - Carlos Escudero
- Vascular Physiology Laboratory, Group of Investigation in Tumor Angiogenesis (GIANT), Department of Basic Sciences, Universidad del Bío-Bío, Chillán, Chile.,Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillan, Chile.,Red Iberoamericana de Alteraciones Vasculares Asociadas a Transtornos del Embarazo, Chillan, Chile
| | - Ángela P Cadavid
- Grupo Reproducción, Departamento de Microbiología y Parasitología, Escuela de Medicina, Universidad de Antioquia, Medellín, Colombia.,Red Iberoamericana de Alteraciones Vasculares Asociadas a Transtornos del Embarazo, Chillan, Chile
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Yang X, Zhang C, Chen G, Sun C, Li J. Antibodies: The major participants in maternal-fetal interaction. J Obstet Gynaecol Res 2018; 45:39-46. [PMID: 30338894 DOI: 10.1111/jog.13839] [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] [Received: 07/12/2018] [Accepted: 09/20/2018] [Indexed: 01/24/2023]
Abstract
The aim of this study is to improve our understanding of the mechanisms involved in maternal-fetal immune tolerance. We searched the related literatures and overviewed the major antibodies associated with pregnancy and described in details their possible roles in mediating maternal-fetal interactions. Antibodies classified into different types based on their functional or structural characteristics were summarized, including immunoglobulin G, blocking antibody, nonprecipitating asymmetric antibody, antiphospholipid antibody, antitrophoblast antibody and antipaternal antibody. The presence and levels of various circulating antibodies in pregnancy may play a crucial role in the occurrence, development and termination of pregnancy.
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Affiliation(s)
- Xin Yang
- Department of Clinical Lab, Yantai Yuhuangding Hospital, Yantai, China
| | - Caiji Zhang
- Department of Clinical Lab, Yantai Yuhuangding Hospital, Yantai, China
| | - Guozhen Chen
- Department of Clinical Lab, Yantai Yuhuangding Hospital, Yantai, China
| | - Chengming Sun
- Department of Clinical Lab, Yantai Yuhuangding Hospital, Yantai, China
| | - Jinming Li
- National Center for Clinical Laboratories, Beijing Hospital, Beijing, China
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33
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Belizna C, Pregnolato F, Abad S, Alijotas-Reig J, Amital H, Amoura Z, Andreoli L, Andres E, Aouba A, Apras Bilgen S, Arnaud L, Bienvenu B, Bitsadze V, Blanco P, Blank M, Borghi MO, Caligaro A, Candrea E, Canti V, Chiche L, Chretien JM, Cohen Tervaert JW, Damian L, Delross T, Dernis E, Devreese K, Djokovic A, Esteve-Valverde E, Favaro M, Fassot C, Ferrer-Oliveras R, Godon A, Hamidou M, Hasan M, Henrion D, Imbert B, Jeandel PY, Jeannin P, Jego P, Jourde-Chiche N, Khizroeva J, Lambotte O, Landron C, Latino JO, Lazaro E, de Leeuw K, Le Gallou T, Kiliç L, Limper M, Loufrani L, Lubin R, Magy-Bertrand N, Mahe G, Makatsariya A, Martin T, Muchardt C, Nagy G, Omarjee L, Van Paasen P, Pernod G, Perrinet F, Pïres Rosa G, Pistorius MA, Ruffatti A, Said F, Saulnier P, Sene D, Sentilhes L, Shovman O, Sibilia J, Sinescu C, Stanisavljevic N, Stojanovich L, Tam LS, Tincani A, Tollis F, Udry S, Ungeheuer MN, Versini M, Cervera R, Meroni PL. HIBISCUS: Hydroxychloroquine for the secondary prevention of thrombotic and obstetrical events in primary antiphospholipid syndrome. Autoimmun Rev 2018; 17:1153-1168. [PMID: 30316994 DOI: 10.1016/j.autrev.2018.05.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 05/25/2018] [Indexed: 02/09/2023]
Abstract
The relapse rate in antiphospholipid syndrome (APS) remains high, i.e. around 20%-21% at 5 years in thrombotic APS and 20-28% in obstetrical APS [2, 3]. Hydroxychloroquine (HCQ) appears as an additional therapy, as it possesses immunomodulatory and anti-thrombotic various effects [4-16]. Our group recently obtained the orphan designation of HCQ in antiphospholipid syndrome by the European Medicine Agency. Furthermore, the leaders of the project made the proposal of an international project, HIBISCUS, about the use of Hydroxychloroquine in secondary prevention of obstetrical and thrombotic events in primary APS. This study has been launched in several countries and at now, 53 centers from 16 countries participate to this international trial. This trial consists in two parts: a retrospective and a prospective study. The French part of the trial in thrombosis has been granted by the French Minister of Health in December 2015 (the academic trial independent of the pharmaceutical industry PHRC N PAPIRUS) and is coordinated by one of the members of the leading consortium of HIBISCUS.
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Affiliation(s)
- Cristina Belizna
- Vascular and Coagulation Department, University Hospital Angers, Angers, France; MITOVASC institute and CARFI facility, UMR CNRS 6015, INSERM U1083, University of Angers, Angers, France.
| | - Francesca Pregnolato
- Istituto Auxologico Italiano, IRCCS, Laboratory of Immunorheumatology, Milan, Italy
| | - Sebastien Abad
- Department of Internal Medicine, Hospital Avicenne, Publique - Hôpitaux de Paris, University Paris 13, Bobigny, France
| | - Jaume Alijotas-Reig
- Systemic Autoimmune Disease Unit, Department of Internal Medicine, Vall d'Hebron University Hospital, Barcelona, Spain; Department of Medicine, Universitat Autonòma, Barcelona, Spain
| | - Howard Amital
- The Zabludowicz Center for Autoimmune Diseases, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Zahir Amoura
- Internal Medicine Department 2, Pitié-Salpêtrière Hospital, French National Centre for Rare Systemic Diseases, AP-HP, Paris, France; Paris VI University, UPMC, Sorbonne Universities, Paris, France
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, University of Brescia, Brescia, Italy
| | - Emmanuel Andres
- Internal Medicine Department, University Hospital Strasbourg, Strasbourg, France
| | - Achile Aouba
- Department of Internal Medicine, Caen University Hospital, Caen, France; University of Normandy, Caen, France
| | | | - Laurent Arnaud
- Rheumatology Department, University Hospital Strasbourg, Strasbourg, France
| | - Boris Bienvenu
- Department of Internal Medicine, Saint Joseph Hospital, Marseille, France
| | - Viktoria Bitsadze
- Department of Obstetrics and Gynecology, I.M. Sechenow First Moscow State Medical University, Moscow, Russia
| | - Patrick Blanco
- ImmunoConcEpT, CNRS-UMR 5164, University Bordeaux, Bordeaux, France; FHU ACRONIM, Bordeaux University Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Miri Blank
- The Zabludowicz Center for Autoimmune Diseases, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Maria Orietta Borghi
- Istituto Auxologico Italiano, IRCCS, Laboratory of Immunorheumatology, Milan, Italy
| | - Antonia Caligaro
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Elisabeta Candrea
- Department of Dermatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Valentina Canti
- Immunology, Rheumatology, Allergology and Rare Disease-IRCCS San Raffaele Hospital, Laboratory of Autoimmunity and vascular inflammation San Raffaele, Milan, Italy
| | - Laurent Chiche
- Department of Internal Medicine and Infectious Disease, Hôpital européen Marseille, Marseille, France
| | | | - Jan Willem Cohen Tervaert
- Nephrology Department, Maastricht University, Maastricht, the Netherlands; Rheumatology Department, Kaye Edmonton Clinic University of Alberta, Edmonton, Canada
| | - Laura Damian
- Department of Rheumatology, County Emergency Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Teresa Delross
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | | | - Katrien Devreese
- Coagulation Laboratory, Department of Clinical Biology, Immunology and Microbiology, Ghent University Hospital, Ghent, Belgium
| | - Aleksandra Djokovic
- Scientific Research Department, Internal Medicine-Rheumatology Bezhanijska Kosa, University Medical Center, Belgrade University, Belgrade, Serbia
| | | | - Maria Favaro
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Céline Fassot
- MITOVASC institute and CARFI facility, UMR CNRS 6015, INSERM U1083, University of Angers, Angers, France
| | - Raquel Ferrer-Oliveras
- Systemic Autoimmune Disease Unit, Department of Internal Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alban Godon
- Departement of hematology et immunology, University Hospital Angers, Angers, France
| | - Mohamed Hamidou
- Department of Internal Medicine, University Hospital Nantes, Nantes, France
| | - Milena Hasan
- Cytometry and Biomarkers Unit of Technology and Service, Center for Translational Science, Institut Pasteur, 28, Rue Doct Roux, 75015 Paris, France
| | - Daniel Henrion
- MITOVASC institute and CARFI facility, UMR CNRS 6015, INSERM U1083, University of Angers, Angers, France
| | - Bernard Imbert
- Vascular Medicine Department, Grenoble University Hospital, Grenoble, France
| | - Pierre Yves Jeandel
- Department of Internal Medicine, Archet-1 Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint Antoine de Ginestière, 06202 Nice, France
| | - Pascale Jeannin
- Departement of hematology et immunology, University Hospital Angers, Angers, France
| | - Patrick Jego
- Department of Internal Medicine, University Hospital Rennes, Rennes, France
| | - Noemie Jourde-Chiche
- INSERM, UMR-S 1076, VRCM, Aix-Marseille University, Marseille, France; Centre de Néphrologie et Transplantation Rénale, AP-HM, Marseille, France
| | - Jamilya Khizroeva
- Department of Obstetrics and Gynecology, I.M. Sechenow First Moscow State Medical University, Moscow, Russia
| | - Olivier Lambotte
- Publique - Hôpitaux de Paris, Hôpital Bicêtre, Service de Médecine Interne et Immunologie clinique, F-94275 Le Kremlin-Bicêtre, France; UMR 1184, Université Paris Sud, F-94276 Le Kremlin-Bicêtre, France; INSERM, U1184, Immunology of Viral Infections and Autoimmune Diseases, F-94276 Le Kremlin-Bicêtre, France; CEA, DSV/iMETI, IDMIT, F-92265 Fontenay-aux-Roses, France
| | - Cédric Landron
- Department of Internal Medicine, University Hospital Poitiers, Poitiers, France
| | - Jose Omar Latino
- Autoimmune and thrombophilic disorders Department, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - Estibaliz Lazaro
- Department of Internal Medicine, Haut-Lévêque Hospital, 33604 Pessac, France
| | - Karina de Leeuw
- Department of Internal Medicine, Division of Clinical Immunology, University Hospital Groningen, Groningen, the Netherlands
| | - Thomas Le Gallou
- Department of Internal Medicine, University Hospital Rennes, Rennes, France
| | - Levent Kiliç
- Internal Medicine Department, Hacettepe University, Ankara, Turkey
| | - Maarten Limper
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Laurent Loufrani
- MITOVASC institute and CARFI facility, UMR CNRS 6015, INSERM U1083, University of Angers, Angers, France
| | - Romain Lubin
- MITOVASC institute and CARFI facility, UMR CNRS 6015, INSERM U1083, University of Angers, Angers, France
| | - Nadine Magy-Bertrand
- Department of Internal Medicine, University Hospital Jean Minjoz, Besançon, France
| | - Guillaume Mahe
- Vascular Medicine Department, University Hospital Rennes, Rennes, France; CHU Rennes, INSERM, CIC 1414, University Rennes, F-35000 Rennes, France
| | - Alexander Makatsariya
- Department of Obstetrics and Gynecology, I.M. Sechenow First Moscow State Medical University, Moscow, Russia
| | - Thierry Martin
- Clinical Immunology Department, University Hospital Strasbourg, Strasbourg, France
| | - Christian Muchardt
- CM Unit of Epigenetic Regulation, Department of Developmental and Stem Cell Biology UMR3738 CNRS, Pasteur Institute, Paris, France
| | - Gyorgy Nagy
- Department of Genetics, Cell and Immunobiology, Semmelweis University, Budapest, Hungary; Department of Rheumatology, 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Loukman Omarjee
- Vascular Medicine Department, University Hospital Rennes, Rennes, France; CHU Rennes, INSERM, CIC 1414, University Rennes, F-35000 Rennes, France
| | - Pieter Van Paasen
- Department of Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Gilles Pernod
- InnoVTE: French Investigation Network on Venous Thromboembolique Disease, Grenoble-Alps University, France; Informatique, Mathématiques et Applications (IMAG) Unité Mixte de Recherche (UMR), 5525/Themas, Centre National de Recherche Scientifique (CNRS)/Techniques de l'Ingénieurie Médicale et de la Complexité (TIMC), Grenoble, France
| | | | - Gilberto Pïres Rosa
- Internal Medicine Sao Joao Hospital, Alameda Prof Hernani Monteiro Vila Nova de Gaia, 4200-319 Porto, Portugal
| | | | - Amelia Ruffatti
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Fatma Said
- Internal Medicine Department, University Hospital La Rabta, Tunis, Tunisia
| | - Patrick Saulnier
- Research Department Unit, University Hospital Angers, Angers, France
| | - Damien Sene
- Department of Internal Medicine, Lariboisière Hospital, Paris Diderot University, Paris, France
| | - Loic Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Ova Shovman
- The Zabludowicz Center for Autoimmune Diseases, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Jean Sibilia
- Rheumatology Department, University Hospital Strasbourg, Strasbourg, France
| | - Crina Sinescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Natasa Stanisavljevic
- Scientific Research Department, Internal Medicine-Rheumatology Bezhanijska Kosa, University Medical Center, Belgrade University, Belgrade, Serbia
| | - Ljudmila Stojanovich
- Scientific Research Department, Internal Medicine-Rheumatology Bezhanijska Kosa, University Medical Center, Belgrade University, Belgrade, Serbia
| | - Lai Shan Tam
- Department of Medicine and Therapeutics, and Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, University of Brescia, Brescia, Italy
| | | | - Sebastian Udry
- Autoimmune and thrombophilic disorders Department, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - Marie Noelle Ungeheuer
- Clinical Investigation and Acces to Bioresources Department, Institut Pasteur, 28, Rue Doct Roux, 75015 Paris, France
| | | | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Pier Luigi Meroni
- Istituto Auxologico Italiano, IRCCS, Laboratory of Immunorheumatology, Milan, Italy
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Yockey LJ, Iwasaki A. Interferons and Proinflammatory Cytokines in Pregnancy and Fetal Development. Immunity 2018; 49:397-412. [PMID: 30231982 PMCID: PMC6152841 DOI: 10.1016/j.immuni.2018.07.017] [Citation(s) in RCA: 296] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 05/13/2018] [Accepted: 07/26/2018] [Indexed: 12/15/2022]
Abstract
Successful pregnancy requires carefully-coordinated communications between the mother and fetus. Immune cells and cytokine signaling pathways participate as mediators of these communications to promote healthy pregnancy. At the same time, certain infections or inflammatory conditions in pregnant mothers cause severe disease and have detrimental impacts on the developing fetus. In this review, we examine evidence for the role of maternal and fetal immune responses affecting pregnancy and fetal development, both under homeostasis and following infection. We discuss immune responses that are necessary to promote healthy pregnancy and those that lead to congenital disorders and pregnancy complications, with a particular emphasis on the role of interferons and cytokines. Understanding the contributions of the immune system in pregnancy and fetal development provides important insights into the pathogenesis underlying maternal and fetal diseases and sheds insights on possible targets for therapy.
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Affiliation(s)
- Laura J Yockey
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Akiko Iwasaki
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06520, USA; Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA.
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Schenkein HA, Thomas RR. Anticardiolipin (aCL) in sera from periodontitis subjects activate Toll-like receptor 4 (TLR4). PLoS One 2018; 13:e0203494. [PMID: 30192824 PMCID: PMC6128564 DOI: 10.1371/journal.pone.0203494] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/19/2018] [Indexed: 11/21/2022] Open
Abstract
Anticardiolipin antibodies (aCL) have been reported to be present in 15–20% of sera from subjects with periodontitis at concentrations exceeding those found in 95% of the healthy adult population. These antibodies, albeit at concentrations exceeding those generally found in periodontitis subjects, are typically present in patients with the antiphospholipid syndrome (APS), an autoimmune disease characterized by thrombosis and recurrent pregnancy loss. aCL from APS patients are proinflammatory and can activate trophoblasts, macrophages, and platelets via cell-surface interactions with their target antigen beta-2-glycoprotein-I (β2GPI). β2GPI is an anionic phospholipid-binding serum protein that can associate with toll-like receptors (TLR’s) on the cell-surface, leading to cell activation following interaction with autoimmune aCL. We examined an expanded series of 629 sera from clinically characterized subjects for aCL content, and observed that 14–19% of these sera contained elevated (>95th %-tile) levels of aCL. We purified IgG from 16 subjects with elevated or normal levels of aCL and examined their ability to activate TLR2- or TLR4-transfected human embryonic kidney (HEK) cells, and observed that IgG from periodontitis patients with elevated aCL activated HEK-TLR4 cells, but not HEK-TLR2 cells. Prior removal of aCL by immunoabsorption significantly reduced the ability of IgG preparations from these sera to activate TLR4. Further experiments using a human first trimester trophoblastic cell line (HTR8 sv/neo) revealed that aCL from periodontitis patients stimulated IL-8 production, which was profoundly decreased if aCL was removed by immunoabsorption or if HTR8 sv/neo were pretreated with blocking anti-TLR4 antibodies. Thus, it appears that aCL from periodontitis patients can be proinflammatory, activating cells via TLR4. Since these antibodies are likely produced via molecular mimicry due to similarities between oral bacterial antigens and β2GPI, the data indicate that circulating serum aCL may induce or influence inflammatory responses at sites distant from the oral cavity.
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Affiliation(s)
- Harvey A. Schenkein
- Department of Periodontics, Virginia Commonwealth University School of Dentistry, Richmond, Virginia, United States of America
- * E-mail:
| | - Ravindar R. Thomas
- Department of Periodontics, Virginia Commonwealth University School of Dentistry, Richmond, Virginia, United States of America
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Canti V, Del Rosso S, Tonello M, Lucianò R, Hoxha A, Coletto LA, Vaglio Tessitore I, Rosa S, Manfredi AA, Castiglioni MT, Ruffatti A, Rovere-Querini P. Antiphosphatidylserine/prothrombin Antibodies in Antiphospholipid Syndrome with Intrauterine Growth Restriction and Preeclampsia. J Rheumatol 2018; 45:1263-1272. [PMID: 30008452 DOI: 10.3899/jrheum.170751] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Antibodies that recognize the phosphatidylserine/prothrombin complex (antiphosphatidylserine/prothrombin antibodies; aPS/PT) might reveal enhanced thrombotic risk in patients with systemic lupus erythematosus. Little is known about their association with pregnancy complications in the antiphospholipid syndrome (APS). METHODS We enrolled 55 patients with APS who were seeking pregnancy in 2 Italian hospitals. Antiphospholipid antibodies (aPL), including anticardiolipin antibodies, anti-β2-glycoprotein I antibodies, lupus-like anticoagulant, and aPS/PT antibodies were assessed, and the patients were prospectively followed for 24 months. RESULTS There were 65% (36/55) of the APS patients who had aPS/PT antibodies. Forty-seven pregnancies were followed, including 33 of aPS/PT+ patients. Forty-one of the 47 patients (87%) who initiated a pregnancy eventually gave birth to a child. The pregnancy duration and the mean newborn weight at delivery were significantly lower in aPS/PT+ than in aPS/PT- patients (33.1 ± 4.7 vs 36.2 ± 3.4 wks of gestation, respectively, and 2058 ± 964 g vs 2784 ± 746 g, respectively, p < 0.05). Late pregnancy complications, including intrauterine fetal death, preterm delivery, preeclampsia, and intrauterine growth restriction (IUGR), were more frequent in aPS/PT+ patients, independent of the therapy. Titers of aPS/PT IgG were significantly inversely correlated with the neonatal weight at delivery. Vascular injury, as reflected by thrombosis, fibrinoid necrosis, ischemic and hemorrhagic areas, and presence of chorangiomas characterized the IUGR placentas in the presence of aPS/PT. CONCLUSION The aPS/PT antibodies might represent markers of aPL-related pregnancy complications, IUGR/preeclampsia in particular, and could help identify beforehand patients who may require additional treatment.
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Affiliation(s)
- Valentina Canti
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Stefania Del Rosso
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Marta Tonello
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Roberta Lucianò
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Ariela Hoxha
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Lavinia A Coletto
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Isadora Vaglio Tessitore
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Susanna Rosa
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Angelo A Manfredi
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Maria Teresa Castiglioni
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Amelia Ruffatti
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy.,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University
| | - Patrizia Rovere-Querini
- From the Istituto Scientifico Ospedale San Raffaele; Vita-Salute San Raffaele University, Milan; Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua, Padua, Italy. .,V. Canti, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Del Rosso, MD, Istituto Scientifico Ospedale San Raffaele; M. Tonello, BSc, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; R. Lucianò, MD, Istituto Scientifico Ospedale San Raffaele; A. Hoxha, MD, PhD, Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; L.A. Coletto, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; I. Vaglio Tessitore, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; S. Rosa, MD, Istituto Scientifico Ospedale San Raffaele; A.A. Manfredi, MD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University; M.T. Castiglioni, MD, Istituto Scientifico Ospedale San Raffaele; A. Ruffatti, MD, PhD Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Padua; P. Rovere-Querini, MD, PhD, Istituto Scientifico Ospedale San Raffaele, and Vita-Salute San Raffaele University.
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Mulla MJ, Weel IC, Potter JA, Gysler SM, Salmon JE, Peraçoli MTS, Rothlin CV, Chamley LW, Abrahams VM. Antiphospholipid Antibodies Inhibit Trophoblast Toll-Like Receptor and Inflammasome Negative Regulators. Arthritis Rheumatol 2018; 70:891-902. [PMID: 29342502 DOI: 10.1002/art.40416] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 01/09/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Women with antiphospholipid antibodies (aPL) are at risk for pregnancy complications associated with poor placentation and placental inflammation. Although these antibodies are heterogeneous, some anti-β2 -glycoprotein I (anti-β2 GPI) antibodies can activate Toll-like receptor 4 (TLR-4) and NLRP3 in human first-trimester trophoblasts. The objective of this study was to determine the role of negative regulators of TLR and inflammasome function in aPL-induced trophoblast inflammation. METHODS Human trophoblasts were not treated or were treated with anti-β2 GPI aPL or control IgG in the presence or absence of the common TAM (TYRO3, AXL, and Mer tyrosine kinase [MERTK]) receptor ligand growth arrest-specific protein 6 (GAS6) or the autophagy-inducer rapamycin. The expression and function of the TAM receptor pathway and autophagy were measured by quantitative reverse transcription-polymerase chain reaction (qRT-PCR), Western blotting, and enzyme-linked immunosorbent assay (ELISA). Antiphospholipid antibody-induced trophoblast inflammation was measured by qRT-PCR, activity assays, and ELISA. RESULTS Anti-β2 GPI aPL inhibited trophoblast TAM receptor function by reducing cellular expression of the receptor tyrosine kinases AXL and MERTK and the ligand GAS6. The addition of GAS6 blocked the effects of aPL on the TLR-4-mediated interleukin-8 (IL-8) response. However, the NLRP3 inflammasome-mediated IL-1β response was not affected by GAS6, suggesting that another regulatory pathway was involved. Indeed, anti-β2 GPI aPL inhibited basal trophoblast autophagy, and reversing this with rapamycin inhibited aPL-induced inflammasome function and IL-1β secretion. CONCLUSION Basal TAM receptor function and autophagy may serve to inhibit trophoblast TLR and inflammasome function, respectively. Impairment of TAM receptor signaling and autophagy by anti-β2 GPI aPL may allow subsequent TLR and inflammasome activity, leading to a robust inflammatory response.
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Affiliation(s)
| | - Ingrid C Weel
- Yale University, New Haven, Connecticut, and São Paulo State University, São Paulo, Brazil
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Ruffatti A, Hoxha A, Favaro M, Tonello M, Colpo A, Cucchini U, Banzato A, Pengo V. Additional Treatments for High-Risk Obstetric Antiphospholipid Syndrome: a Comprehensive Review. Clin Rev Allergy Immunol 2018; 53:28-39. [PMID: 27342460 DOI: 10.1007/s12016-016-8571-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Most investigators currently advocate prophylactic-dose heparin plus low-dose aspirin as the preferred treatment of otherwise healthy women with obstetric antiphospholipid syndrome, whilst women with a history of vascular thrombosis alone or associated with pregnancy morbidity are usually treated with therapeutic heparin doses in association with low-dose aspirin in an attempt to prevent both thrombosis and pregnancy morbidity. However, the protocols outlined above fail in about 20 % of pregnant women with antiphospholipid syndrome. Identifying risk factors associated with pregnancy failure when conventional therapies are utilized is an important step in establishing guidelines to manage these high-risk patients. Some clinical and laboratory risk factors have been found to be related to maternal-foetal complications in pregnant women on conventional therapy. However, the most efficacious treatments to administer to high-risk antiphospholipid syndrome women in addition to conventional therapy in order to avoid pregnancy complications are as yet unestablished. This is a comprehensive review on this topic and an invitation to participate in a multicentre study in order to identify the best additional treatments to be used in this subset of antiphospholipid syndrome patients.
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Affiliation(s)
- Amelia Ruffatti
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy.
- Reumatologia, Policlinico Universitario, Via Giustiniani, 2-35128, Padova, Italy.
| | - Ariela Hoxha
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Maria Favaro
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Marta Tonello
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Anna Colpo
- Blood Transfusion Unit, University-Hospital of Padua, Padua, Italy
| | - Umberto Cucchini
- Cardiology Unit, Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Alessandra Banzato
- Cardiology Unit, Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Vittorio Pengo
- Cardiology Unit, Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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Bolnick AD, Bolnick JM, Kohan-Ghadr HR, Kilburn BA, Pasalodos OJ, Singhal PK, Dai J, Diamond MP, Armant DR, Drewlo S. Enhancement of trophoblast differentiation and survival by low molecular weight heparin requires heparin-binding EGF-like growth factor. Hum Reprod 2018; 32:1218-1229. [PMID: 28402449 DOI: 10.1093/humrep/dex069] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 02/09/2017] [Indexed: 02/07/2023] Open
Abstract
STUDY QUESTION Does low molecular weight heparin (LMWH) require heparin-binding epidermal growth factor (EGF)-like growth factor (HBEGF) signaling to induce extravillous trophoblast differentiation and decrease apoptosis during oxidative stress? SUMMARY ANSWER LMWH increased HBEGF expression and secretion, and HBEGF signaling was required to stimulate trophoblast extravillous differentiation, increase invasion in vitro and reduce trophoblast apoptosis during oxidative stress. WHAT IS KNOWN ALREADY Abnormal trophoblast differentiation and survival contribute to placental insufficiency syndromes, including preeclampsia and intrauterine growth restriction. Preeclampsia often manifests as a pro-thrombotic state, with unsuccessful transformation of the spiral arteries that reduces oxygen supply and can produce placental infarction. LMWH improves placental function by increasing blood flow. Recent data suggest that the actions of LMWH transcend its anti-coagulative properties, but the molecular mechanism is unknown. There is evidence that LMWH alters the expression of human HBEGF in trophoblast cells, which regulates human trophoblast pathophysiology. HBEGF, itself, is capable of increasing trophoblast survival and invasiveness. STUDY DESIGN, SIZE, DURATION First-trimester placental explants and the HTR-8/SVneo cell line, established using extravillous trophoblast outgrowths from first-trimester villous explants, were treated in vitro with LMWH to examine the effects on HBEGF signaling and trophoblast function under normal physiological and pathological conditions. A highly specific antagonist of HBEGF and other inhibitors of HBEGF downstream signaling were used to determine the relationship between LMWH treatment and HBEGF. PARTICIPANTS/MATERIALS, SETTING, METHODS Placental tissues (n = 5) were obtained with IRB approval and patient consent from first-trimester terminations. Placental explants and HTR-8/SVneo cells were cultured on plastic or Matrigel™ and treated with a therapeutic dose of LMWH (Enoxaparin; 10 IU/ml), with or without CRM197, pan Erb-B2 Receptor Tyrosine Kinase (ERBB) inhibitor, anti-ERBB1 or ERBB4 blocking antibodies, or pretreatment of cells with heparitinase I. Extravillous differentiation was assessed by immunocytochemistry to determine the relative levels of integrins α6β4 and α1β1. Trophoblast invasiveness was assessed in villous explants by measuring outgrowth from villous tips cultured on Matrigel, and by invasion assays with HTR-8/SVneo cells cultured on Matrigel-coated transwell insert. Placental explants and HTR-8/SVneo cells were exposed to oxidative stress in a hypoxia-reoxygenation (H-R) model, measuring cell death by TUNEL assay, caspase 3 cleavage, and BCL-2α expression. MAIN RESULTS AND THE ROLE OF CHANCE LMWH induced extravillous differentiation, according to trophoblast invasion assays and integrin (α6β4-α1β1) switching. Treatment with LMWH rescued cytotrophoblasts and HTR-8/SVneo cells from apoptosis during exposure to reoxygenation injury, based on TUNEL, caspase 3 cleavage and BCL-2α expression. Experiments using CRM197, ERBB1 and ERBB4 blocking antibodies, pan-ERBB inhibitor and removal of cell surface heparin demonstrated that the effects of LMWH on trophoblast invasion and survival were dependent upon HBEGF signaling. LARGE SCALE DATA N/A. LIMITATIONS, REASONS FOR CAUTION The primary limitation of this study was the use of only in vitro experiments. Patient demographics from elective terminations were not available. WIDER IMPLICATIONS OF THE FINDINGS These data provide new insights into the non-coagulation-related aspects of perinatal LMWH treatment in the management of placental insufficiency disorders. STUDY FUNDING/COMPETING INTEREST(S) This research was supported by grants from the National Institutes of Health (HD071408 and HL128628), the March of Dimes, and the W. K. Kellogg Foundation. There were no conflicts or competing interests.
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Affiliation(s)
- Alan D Bolnick
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Jay M Bolnick
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | | | - Brian A Kilburn
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Omar J Pasalodos
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Pankaj K Singhal
- Department of Obstetrics and Gynecology, Good Samaritan Hospital Medical Center, West Islip, NY, USA
| | - Jing Dai
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA, USA
| | - D Randall Armant
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA.,Department of Anatomy and Cell Biology, Wayne State University, Detroit, MI, USA
| | - Sascha Drewlo
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
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Quao ZC, Tong M, Bryce E, Guller S, Chamley LW, Abrahams VM. Low molecular weight heparin and aspirin exacerbate human endometrial endothelial cell responses to antiphospholipid antibodies. Am J Reprod Immunol 2018; 79:10.1111/aji.12785. [PMID: 29135051 PMCID: PMC5728699 DOI: 10.1111/aji.12785] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 10/26/2017] [Indexed: 12/25/2022] Open
Abstract
PROBLEM Women with antiphospholipid antibodies (aPL) are at risk for pregnancy complications despite treatment with low molecular weight heparin (LMWH) or aspirin (ASA). aPL recognizing beta2 glycoprotein I can target the uterine endothelium, however, little is known about its response to aPL. This study characterized the effect of aPL on human endometrial endothelial cells (HEECs), and the influence of LMWH and ASA. METHOD OF STUDY HEECs were exposed to aPL or control IgG, with or without low-dose LMWH and ASA, alone or in combination. Chemokine and angiogenic factor secretion were measured by ELISA. A tube formation assay was used to measure angiogenesis. RESULTS aPL increased HEEC secretion of pro-angiogenic VEGF and PlGF; increased anti-angiogenic sFlt-1; inhibited basal secretion of the chemokines MCP-1, G-CSF, and GRO-α; and impaired angiogenesis. LMWH and ASA, alone and in combination, exacerbated the aPL-induced changes in the HEEC angiogenic factor and chemokine profile. There was no reversal of the aPL inhibition of HEEC angiogenesis by either single or combination therapy. CONCLUSION By aPL inhibiting HEEC chemokine secretion and promoting sFlt-1 release, the uterine endothelium may contribute to impaired placentation and vascular transformation. LMWH and ASA may further contribute to endothelium dysfunction in women with obstetric APS.
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Affiliation(s)
- Zola Chihombori Quao
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University, New Haven, CT, USA
| | - Mancy Tong
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University, New Haven, CT, USA
| | - Elena Bryce
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University, New Haven, CT, USA
- Albert Einstein College of Medicine, Bronx, NY
| | - Seth Guller
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University, New Haven, CT, USA
| | - Lawrence W Chamley
- Department of Obstetrics & Gynecology, University of Auckland, Auckland, New Zealand
| | - Vikki M Abrahams
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University, New Haven, CT, USA
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Tong M, Johansson C, Xiao F, Stone PR, James JL, Chen Q, Cree LM, Chamley LW. Antiphospholipid antibodies increase the levels of mitochondrial DNA in placental extracellular vesicles: Alarmin-g for preeclampsia. Sci Rep 2017; 7:16556. [PMID: 29185455 PMCID: PMC5707355 DOI: 10.1038/s41598-017-16448-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 11/13/2017] [Indexed: 01/13/2023] Open
Abstract
The pathogenesis of preeclampsia remains unclear but placental factors are known to play a crucial role causing maternal endothelial cell dysfunction. One potential factor is placental micro- and nano- vesicles. Antiphospholipid antibodies (aPL) increase the risk of preeclampsia ten-fold, in part by damaging the mitochondria in the syncytiotrophoblast. Since mitochondrial DNA (mtDNA) is a danger- associated molecular pattern (DAMP/alarmin) that may activate endothelial cells, the aims of the current study were to investigate whether aPL affect the number of placental vesicles extruded, their mtDNA content and their ability to activate endothelial cells. Exposure of first trimester human placental explants to aPL affected neither the number nor size of extruded micro- and nano- vesicles (n = 5), however their levels of mtDNA were increased (n = 6). These vesicles significantly activated endothelial cells (n = 5), which was prevented by blocking toll-like receptor 9 (TLR-9), a receptor for extracellular DNA. Thus, aPL may increase the risk of preeclampsia in part by increasing the amount of mtDNA associated with placental vesicles. That mitochondrial DNA is recognised as a DAMP by TLR-9 to cause endothelial cell activation, raises the possibility that placental vesicles or TLR-9 might be a target for pharmaceutical intervention to reduce the consequences of aPL in pregnancy.
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Affiliation(s)
- Mancy Tong
- Department of Obstetrics and Gynaecology, School of Medicine, The University of Auckland, Auckland, 1023, New Zealand.
| | - Caroline Johansson
- Department of Obstetrics and Gynaecology, School of Medicine, The University of Auckland, Auckland, 1023, New Zealand.,Faculty of Medicine and Health Sciences, Linköping University, Linköping, SE-581 83, Sweden
| | - Fengyi Xiao
- Department of Obstetrics and Gynaecology, School of Medicine, The University of Auckland, Auckland, 1023, New Zealand.,The Hospital of Obstetrics & Gynaecology, Fudan University, Shanghai, China
| | - Peter R Stone
- Department of Obstetrics and Gynaecology, School of Medicine, The University of Auckland, Auckland, 1023, New Zealand
| | - Joanna L James
- Department of Obstetrics and Gynaecology, School of Medicine, The University of Auckland, Auckland, 1023, New Zealand
| | - Qi Chen
- Department of Obstetrics and Gynaecology, School of Medicine, The University of Auckland, Auckland, 1023, New Zealand
| | - Lynsey M Cree
- Department of Obstetrics and Gynaecology, School of Medicine, The University of Auckland, Auckland, 1023, New Zealand
| | - Lawrence W Chamley
- Department of Obstetrics and Gynaecology, School of Medicine, The University of Auckland, Auckland, 1023, New Zealand
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Chighizola CB, Shoenfeld Y, Meroni PL. Therapy for antiphospholipid miscarriages: Throwing the baby out with the bathwater? Am J Reprod Immunol 2017; 79. [DOI: 10.1111/aji.12792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 11/07/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Cecilia Beatrice Chighizola
- Department of Clinical Science and Community Health; University of Milan; Milan Italy
- Clinical Immunology and Rheumatology Unit; Immunorheumatology Research Laboratory; Istituto Auxologico Italiano; Milan Italy
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases; Sheba Medical Center Affiliated to Tel-Aviv University; Tel-Hashomer Israel
| | - Pier Luigi Meroni
- Department of Clinical Science and Community Health; University of Milan; Milan Italy
- Clinical Immunology and Rheumatology Unit; Immunorheumatology Research Laboratory; Istituto Auxologico Italiano; Milan Italy
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43
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Immunoglobulins from sera of APS patients bind HTR-8/SVneo trophoblast cell line and reduce additional mediators of cell invasion. Reprod Biol 2017; 17:389-395. [PMID: 29102762 DOI: 10.1016/j.repbio.2017.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/18/2017] [Accepted: 10/27/2017] [Indexed: 12/20/2022]
Abstract
Immunoglobulins from sera of patients with antiphospholipid syndrome (APS) decrease trophoblast cell invasion in vitro. This study aimed to extend understanding of cellular effects of immunoglobulins from APS (aPL+) in HTR-8/SVneo cells. aPL+ IgG induced change in effector molecules important for cell invasion was investigated further. After 1h of culture 21% cells bound aPL+ IgG, as opposed to 6% in control (aPL-). This was accompanied by increase in phospho-p38 at 30min. After 24h treatment aPL+IgG decreased protein levels of integrin subunits α1 (78% of control; p<0.01), α4 (65% of control, p<0.01), α5 (76% of control; p<0.01) and β1 (80% of control; p<0.01), and secreted gal-1 (68% of control; p<0.05). ProMMP-9 was reduced to 70% of control (p<0.001). Treatment with inhibitor of p38 MAPK signaling SB202190 reversed inhibition in integrin β1 and secreted gal-1. Involvement of p38 MAPK signaling and decrease in integrin subunit α4, proMMP-9, and secreted gal-1 in HTR-8/SVneo cells are novel and extend the list of mediators of trophoblast invasion affected by aPL.
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Abstract
Recurrent pregnancy loss (RPL), commonly defined as 3 consecutive losses <10 weeks gestation, affects up to 5% of couples. Well-accepted causes include uterine malformation, antiphospholipid syndrome, and parental chromosomal abnormalities; however, the majority of RPL cases are idiopathic (up to 75%). This chapter covers these accepted causes of RPL and provides diagnosis and management strategies for patients falling within the above categories.
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Santos TDS, Ieque AL, de Carvalho HC, Sell AM, Lonardoni MVC, Demarchi IG, de Lima Neto QA, Teixeira JJV. Antiphospholipid syndrome and recurrent miscarriage: A systematic review and meta-analysis. J Reprod Immunol 2017; 123:78-87. [PMID: 28985591 DOI: 10.1016/j.jri.2017.09.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
Abstract
Antiphospholipid syndrome (APS) is an autoimmune condition that is associated with thrombosis and morbidity in pregnancy. The exact mechanisms by which these associations occur appear to be heterogeneous and are not yet well understood. The aim of this study was to identify and analyze publications in recent years to better understand the diagnosis and its contribution to monitoring APS among women with recurrent miscarriage (RM). This systematic review and meta-analysis was conducted using the PubMed and Web of Knowledge databases, with articles published between 2010 and 2014, according to the PRISMA statement. Of the 85 identified studies, nine were selected. Most of the studies reported an association between recurrent miscarriage and specific antiphospholipid antibodies, as anticardiolipin antibodies (aCL), lupus anticoagulant (LA), anti-β2-glycoprotein I antibodies (aβ2GPI) and antiphosphatidylserine (aPS), which showed a relationship with RM. The main result of the meta-analysis revealed association between antiphospholipid antibodies (aPLs) and/or APS compared to the patients with RM (OR: 0.279; 95% CI: 0.212-0.366) and APS cases compared to the patients with RM (OR: 0.083; 95% CI: 0.036-0.189). High heterogeneity among these studies (I2=100.0%, p <0.001) was observed. In addition, there was no significant publication bias across studies according to Begg's test (p=0.230), although Egger's test (p=0.037) suggests significant publication bias. The funnel plot was slightly asymmetrical. Systematic review and meta-analysis demonstrated a positive association between antiphospholipid antibodies and/or antiphospholipid syndrome in patients with recurrent miscarriage.
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Affiliation(s)
- Thaís da Silva Santos
- Postgraduate Program in Biosciences and Physiopathology, State University Maringa, 5790 Colombo Avenue, 87020-900, Maringa, Brazil
| | - Andressa Lorena Ieque
- Postgraduate Program in Health Sciences, State University Maringa, 5790 Colombo Avenue, 87020-900 Maringa, Brazil
| | - Hayalla Corrêa de Carvalho
- Postgraduate Program in Biosciences and Physiopathology, State University Maringa, 5790 Colombo Avenue, 87020-900, Maringa, Brazil
| | - Ana Maria Sell
- Department of Cell Biology and Genetics, Center of Biological Sciences, State University Maringa,5790 Colombo Avenue, 87020-900 Maringa, Brazil
| | | | - Izabel Galhardo Demarchi
- Department of Clinical Analyses and Biomedicine, State University Maringa, 5790 Colombo Avenue, 87020-900 Maringa, Brazil
| | - Quirino Alves de Lima Neto
- Department of Basic Health Sciences, State University Maringa,5790 Colombo Avenue, 87020-900 Maringa, Brazil
| | - Jorge Juarez Vieira Teixeira
- Postgraduate Program in Biosciences and Physiopathology, Department of Clinical Analyses and Biomedicine, State University Maringa, 5790 Colombo Avenue, 87020-900 Maringa, Brazil.
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Manfredi AA, Rovere-Querini P, D'Angelo A, Maugeri N. Low molecular weight heparins prevent the induction of autophagy of activated neutrophils and the formation of neutrophil extracellular traps. Pharmacol Res 2017; 123:146-156. [PMID: 28161237 DOI: 10.1016/j.phrs.2016.08.008] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/04/2016] [Accepted: 08/04/2016] [Indexed: 12/12/2022]
Abstract
The protection exerted by neutrophils against invading microbes is partially mediated via the generation of neutrophil extracellular traps (NETs). In sterile conditions NETs are damaging species, enriched in autoantigens and endowed with the ability to damage the vessel wall and bystander tissues, to promote thrombogenesis, and to impair wound healing. To identify and reposition agents that can be used to modulate the formation of NETs is a priority in the research agenda. Low molecular weight heparins (LMWH) are currently used, mostly on an empirical basis, in conditions in which NETs play a critical role, such as pregnancy complications associated to autoimmune disease. Here we report that LMWHs induce a profound change in the ability of human neutrophils to generate NETs and to mobilize the content of the primary granules in response to unrelated inflammatory stimuli, such as IL-8, PMA and HMGB1. Autophagy consistently accompanies NET generation in our system and autophagy inhibitors, 3-MA and wortmannin, prevent NET generation. Pretreatment with LMWH in vitro critically jeopardizes neutrophil ability to activate autophagy, a mechanism that might contribute to neutrophil unresponsiveness. Finally, we verified that treatment of healthy volunteers with a single prophylactic dose of parnaparin abrogated the ability of neutrophils to activate autophagy and to generate NETs. Together, these results support the contention that neutrophils, and NET generation in particular, might represent a preferential target of the anti-inflammatory action of LMWH.
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Affiliation(s)
- Angelo A Manfredi
- Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Scientific Institute, Milano, Italy; Vita-Salute San Raffaele University, Milano, Italy
| | - Patrizia Rovere-Querini
- Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Scientific Institute, Milano, Italy; Vita-Salute San Raffaele University, Milano, Italy
| | - Armando D'Angelo
- Coagulation Service and Thrombosis Research Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Norma Maugeri
- Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Scientific Institute, Milano, Italy.
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Sacharidou A, Shaul PW, Mineo C. New Insights in the Pathophysiology of Antiphospholipid Syndrome. Semin Thromb Hemost 2017; 44:475-482. [PMID: 28129662 DOI: 10.1055/s-0036-1597286] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The antiphospholipid syndrome (APS) is an autoimmune disorder characterized by an elevated risk for arterial and venous thrombosis and pregnancy-related morbidity. Since the discovery of the disease in 1980s, numerous studies in cell culture systems, in animal models, and in patient populations have been reported, leading to a deeper understanding of the pathogenesis of APS. These studies have determined that circulating autoantibodies, collectively called antiphospholipid antibodies (aPL), the majority of which recognize cell surface proteins attached to the plasma membrane phospholipids, play a causal role in the development of the disease. The binding of aPL to the cell surface antigens triggers interaction of the complex with transmembrane receptors to initiate intracellular signaling in critical cell types, including platelets, monocytes, endothelial cells, and trophoblasts. Subsequent alteration of various cell functions results in inflammation, thrombus formation, and pregnancy complications. Apolipoprotein E receptor 2 (apoER2), a lipoprotein receptor family member, has been implicated as a mediator for aPL actions in platelets and endothelial cells. Nitric oxide (NO) is a signaling molecule known to exert potent antithrombotic, anti-inflammatory, and anti-atherogenic effects. NO insufficiency and oxidative stress have been linked to APS pathogenesis. This review will focus on the recent findings on how apoER2 and dysregulation of NO production contribute to aPL-mediated pathologies in APS.
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Affiliation(s)
- Anastasia Sacharidou
- Department of Pediatrics, Center for Pulmonary and Vascular Biology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Philip W Shaul
- Department of Pediatrics, Center for Pulmonary and Vascular Biology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chieko Mineo
- Department of Pediatrics, Center for Pulmonary and Vascular Biology, University of Texas Southwestern Medical Center, Dallas, Texas
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48
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Review: Placental mitochondrial function and structure in gestational disorders. Placenta 2016; 54:2-9. [PMID: 28024805 DOI: 10.1016/j.placenta.2016.12.012] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 12/05/2016] [Accepted: 12/08/2016] [Indexed: 12/13/2022]
Abstract
The aetiology of many gestational disorders is still unknown. However, insufficient trans-placental nutrient and oxygen transfer due to abnormal placentation is characteristic of several pathologies, and may alter the function of placental mitochondria. Mitochondria are multifunctional organelles that respond to a wide range of stimuli - such as physiological changes in cellular energy demands or various pathologies - by reshaping via fusion or fission, increasing/decreasing in number, altering oxidative phosphorylation, and signalling cellular functions such as apoptosis. Mitochondrial function is integral to tissue functions including energy production, metabolism, and regulation of various cellular responses including response to oxidative stress. This review details the functions of placental mitochondria and investigates mitochondrial function and structure in gestational disorders including preeclampsia, intrauterine growth restriction, diabetes mellitus, and obesity. Placental mitochondrial dysfunction may be critical in a range of gestational disorders which have important implications for maternal and fetal/offspring health.
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49
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Bertolaccini ML, Contento G, Lennen R, Sanna G, Blower PJ, Ma MT, Sunassee K, Girardi G. Complement inhibition by hydroxychloroquine prevents placental and fetal brain abnormalities in antiphospholipid syndrome. J Autoimmun 2016; 75:30-38. [PMID: 27160365 PMCID: PMC6203312 DOI: 10.1016/j.jaut.2016.04.008] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/21/2016] [Accepted: 04/24/2016] [Indexed: 11/24/2022]
Abstract
Placental ischemic disease and adverse pregnancy outcomes are frequently observed in patients with antiphospholipid syndrome (APS). Despite the administration of conventional antithrombotic treatment a significant number of women continue to experience adverse pregnancy outcomes, with uncertain prevention and management. Efforts to develop effective pharmacological strategies for refractory obstetric APS cases will be of significant clinical benefit for both mothers and fetuses. Although the antimalarial drug, hydroxychloroquine (HCQ) is increasingly used to treat pregnant women with APS, little is known about its efficacy and mechanism of action of HCQ. Because complement activation plays a crucial and causative role in placental ischemia and abnormal fetal brain development in APS we hypothesised that HCQ prevents these pregnancy complications through inhibition of complement activation. Using a mouse model of obstetric APS that closely resembles the clinical condition, we found that HCQ prevented fetal death and the placental metabolic changes -measured by proton magnetic resonance spectroscopy in APS-mice. Using 111In labelled antiphospholipid antibodies (aPL) we identified the placenta and the fetal brain as the main organ targets in APS-mice. Using this same method, we found that HCQ does not inhibit aPL binding to tissues as was previously suggested from in vitro studies. While HCQ did not affect aPL binding to fetal brain it prevented fetal brain abnormal cortical development. HCQ prevented complement activation in vivo and in vitro. Complement C5a levels in serum samples from APS patients and APS-mice were lower after treatment with HCQ while the antibodies titres remained unchanged. HCQ prevented not only placental insufficiency but also abnormal fetal brain development in APS. By inhibiting complement activation, HCQ might also be an effective antithrombotic therapy.
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Affiliation(s)
| | - Gregorio Contento
- Division of Women's Health, St Thomas' Hospital, King's College London, London, SE1 7EH, UK
| | - Ross Lennen
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Giovanni Sanna
- Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, SE1 7EH, UK
| | - Philip J Blower
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, SE1 7EH, UK
| | - Michelle T Ma
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, SE1 7EH, UK
| | - Kavitha Sunassee
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, SE1 7EH, UK
| | - Guillermina Girardi
- Division of Women's Health, St Thomas' Hospital, King's College London, London, SE1 7EH, UK; MRC Centre for Inflammation Research, Queen's Medical Research Institute University of Edinburgh, Edinburgh, EH16 4TJ, UK.
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50
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Meroni PL. Prevention & treatment of obstetrical complications in APS: Is hydroxychloroquine the Holy Grail we are looking for? J Autoimmun 2016; 75:1-5. [PMID: 27496152 DOI: 10.1016/j.jaut.2016.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 07/05/2016] [Indexed: 12/30/2022]
Abstract
Pregnancy morbidity is part of the clinical spectrum of the anti-phospholipid syndrome (APS), with an important social and economical cost. Antiplatelet and anticoagulant agents are effective in preventing the clinical manifestations in the majority of the patients. However, a consistent proportion of the pregnant women present recurrences in spite of the standard therapy. Observational studies and anecdotal reports raised the issue of additional therapeutic strategies in these refractory cases. Among these, anti-malarials (AMs) and in particular hydroxychloroquine (HCQ) are becoming more and more popular in APS as well as in other systemic autoimmune rheumatic conditions. AMs display a pleiotropic activity spanning from immunomodulation effect to anti-inflammatory and anti-thrombotic activities, all of which potentially useful in APS. The well-known safety of HCQ in pregnancy encouraged its use in pregnant women with autoimmune rheumatic disorders including APS and observational reports suggested a protective effect on obstetrical recurrences. Since thrombosis does not seem to be the main pathogenic mechanism in obstetric APS, effectiveness of the treatment with HCQ should be related to other pharmacological effects rather than to the anti-platelet or anti-thrombotic activity of the molecule. Experimental models showed that HCQ may restore some defective biological functions induced by anti-phospholipid antibodies (aPL) on trophoblasts and a recent study reported a protective effect on in vivo aPL-mediated placental and foetal neurodevelopmental abnormalities. Although the rational behind the use of HCQ in obstetric APS is sound, the evidence from the real life is not conclusive and a critical appraisal through clinical trials is mandatory.
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Affiliation(s)
- Pier Luigi Meroni
- Department of Clinical Sciences and Community Health, University of Milan, Division of Rheumatology, ASST G. Pini, Pini Piazza C. Ferrari 1, 20122, Milan, Italy; IRCCS, Istituto Auxologico Italiano, Milan, Italy.
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