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Huang Y, Liu H, Qi W, Du L, Li M, Zeng X, Guo X, Zhao J, Zhang S. Sex Differences in Clinical Characteristics and Prognosis in Primary Thrombotic Antiphospholipid Syndrome. Front Cardiovasc Med 2022; 9:895098. [PMID: 35859586 PMCID: PMC9289156 DOI: 10.3389/fcvm.2022.895098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives This study aimed to investigate whether there are sex differences in clinical characteristics and prognosis in patients with primary thrombotic antiphospholipid syndrome (ptAPS). Methods From January 2013 to July 2021, 154 consecutive patients diagnosed with ptAPS were prospectively recruited. Multivariable Cox regression was used to evaluate the association between gender and the composite endpoint including thromboembolic recurrence or all-cause death during follow-up. Results Totally, 80 (52%) male and 74 (48%) female patients with ptAPS were included, and men had a higher percentage of smokers/ex-smokers [50 (62%) vs. 6 (8%), p < 0.001] and hyperhomocysteinemia [26 (32%) vs. 9 (12%), p = 0.003]. The baseline thromboembolic events were similar in two genders, except for limb ischemia [15 (19%) in men vs. 1 (1%) in women, p < 0.001]. During a median follow-up of 42 months, the composite endpoint occurred in 30 (38%) male and 15 (20%) female patients (p = 0.019). Male gender [HR 2.499, 95% CI (1.316, 4.743), p = 0.005] and warfarin administration [HR 0.482, 95% CI (0.257, 0.905), p = 0.023] remained independent risk factors for the composite endpoint. Male gender [HR 3.699, 95% CI (1.699, 8.246), p = 0.001] and isolated lupus anticoagulant positivity [HR 2.236, 95% CI (1.039, 4.811), p = 0.040] were independent risk factors for thromboembolic recurrence. Conclusion There are sex disparities in the clinical characteristics in patients with ptAPS and the male gender is an independent risk factor for the poor prognosis. Male patients with isolated lupus anticoagulant (LA) positivity have the highest risk of thromboembolic recurrence.
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Affiliation(s)
- Yongfa Huang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Huazhen Liu
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Wanting Qi
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Le Du
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoxiao Guo
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Xiaoxiao Guo,
| | - Jiuliang Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
- Jiuliang Zhao,
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
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Benagiano M, Borghi MO, Romagnoli J, Mahler M, Bella CD, Grassi A, Capitani N, Emmi G, Troilo A, Silvestri E, Emmi L, Alnwaisri H, Bitetti J, Tapinassi S, Prisco D, Baldari CT, Meroni PL, D'Elios MM. Interleukin-17/Interleukin-21 and Interferon-γ producing T cells specific for β2 Glycoprotein I in atherosclerosis inflammation of systemic lupus erythematosus patients with antiphospholipid syndrome. Haematologica 2019; 104:2519-2527. [PMID: 30872365 PMCID: PMC6959190 DOI: 10.3324/haematol.2018.209536] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 03/06/2019] [Indexed: 12/24/2022] Open
Abstract
Systemic lupus erythematosus is frequently associated with antiphospholipid
syndrome. Patients with lupus-antiphospholipid syndrome are characterized by
recurrent arterial/venous thrombosis, miscarriages, and persistent presence of
autoantibodies against phospholipid-binding proteins, such as
β2-Glycoprotein I. We investigated the cytokine production induced by
β2-Glycoprotein I in activated T cells that infiltrate in
vivo atherosclerotic lesions of lupus-antiphospholipid syndrome
patients. We examined the helper function of β2-Glycoprotein I-specific
T cells for tissue factor production, as well as their cytolytic potential and
their helper function for antibody production. Lupus-antiphospholipid syndrome
patients harbor in vivo activated CD4+ T cells that
recognize β2-Glycoprotein I in atherosclerotic lesions.
β2-Glycoprotein I induces T-cell proliferation and expression of both
Interleukin-17/Interleukin-21 and Interferon-γ in plaque-derived T-cell
clones. β2-Glycoprotein I-specific T cells display strong help for
monocyte tissue factor production, and promote antibody production in autologous
B cells. Moreover, plaque-derived β2-Glycoprotein I-specific
CD4+ T lymphocytes express both perforin-mediated and
Fas/FasLigand-mediated-cytotoxicity. Altogether, our results indicate that
β2-Glycoprotein I is able to elicit a local
Interleukin-17/Interleukin-21 and Interferon-γ inflammation in
lupus-antiphospholipid syndrome patients that might lead, if unabated, to plaque
instability and subsequent arterial thrombosis, suggesting that the T helper
17/T helper 1 pathway may represent a novel target for the prevention and
treatment of the disease.
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Affiliation(s)
- Marisa Benagiano
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria Orietta Borghi
- IRCCS, Istituto Auxologico Italiano, Laboratory of Immunorheumatology, Cusano Milanino, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | | | - Chiara Della Bella
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessia Grassi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Nagaja Capitani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Internal Interdisciplinary Medicine, Lupus Clinic, AOU Careggi, Florence, Italy
| | - Arianna Troilo
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Elena Silvestri
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lorenzo Emmi
- Internal Interdisciplinary Medicine, Lupus Clinic, AOU Careggi, Florence, Italy
| | - Heba Alnwaisri
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Jacopo Bitetti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Simona Tapinassi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Internal Interdisciplinary Medicine, Lupus Clinic, AOU Careggi, Florence, Italy
| | | | - Pier Luigi Meroni
- IRCCS, Istituto Auxologico Italiano, Laboratory of Immunorheumatology, Cusano Milanino, Italy
| | - Mario Milco D'Elios
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy .,Internal Interdisciplinary Medicine, Lupus Clinic, AOU Careggi, Florence, Italy
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3
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Harifi G, Nour-Eldine W, Noureldine MHA, Berjaoui MB, Kallas R, Khoury R, Uthman I, Al-Saleh J, Khamashta MA. Arterial stenosis in antiphospholipid syndrome: Update on the unrevealed mechanisms of an endothelial disease. Autoimmun Rev 2018; 17:256-266. [PMID: 29339317 DOI: 10.1016/j.autrev.2017.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 10/29/2017] [Indexed: 12/20/2022]
Abstract
First described in 1983, antiphospholipid syndrome (APS) is an autoimmune condition characterized by the occurrence of recurrent arterial and/or venous thrombosis, and/or pregnancy morbidity, in the setting of persistent presence of antiphospholipid antibodies (aPL). While thrombosis is the most well-known pathogenic mechanism in this disorder, the relevance of some other mechanisms such as arterial stenosis is being increasingly recognized. Arterial stenosis has been first described in the renal arteries in patients with APS, however intracranial and coeliac arteries can also be involved with various and treatable clinical manifestations. The underlying pathophysiology of this stenotic arterial vasculopathy is not fully understood but some recent studies revealed new insights into the molecular mechanism behind this endothelial cell activation in APS. In this review, we discuss these newly discovered mechanisms and highlight the diagnostic and therapeutic modalities of the APS related arterial stenosis.
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Affiliation(s)
- Ghita Harifi
- Dr Humeira Badsha Rheumatology Center, Dubai, United Arab Emirates.
| | - Wared Nour-Eldine
- Institut National de la Santé et de la Recherche Médicale (Inserm), Unit 970, Paris-Cardiovascular Research Center, Paris, France; Université Paris-Descartes, Paris, France
| | | | - Mohammad Baker Berjaoui
- Department of Internal Medicine, Lebanese American University Medical Center, Beirut, Lebanon
| | - Romy Kallas
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Rita Khoury
- Department of Internal Medicine, Lebanese American University Medical Center, Beirut, Lebanon
| | - Imad Uthman
- Division of Rheumatology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Jamal Al-Saleh
- Division of Rheumatology, Department of Internal Medicine, Dubai Hospital, United Arab Emirates
| | - Munther A Khamashta
- Division of Rheumatology, Department of Internal Medicine, Dubai Hospital, United Arab Emirates
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4
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Benagiano M, Gerosa M, Romagnoli J, Mahler M, Borghi MO, Grassi A, Della Bella C, Emmi G, Amedei A, Silvestri E, Emmi L, Prisco D, Meroni PL, D'Elios MM. β2 Glycoprotein I Recognition Drives Th1 Inflammation in Atherosclerotic Plaques of Patients with Primary Antiphospholipid Syndrome. THE JOURNAL OF IMMUNOLOGY 2017; 198:2640-2648. [PMID: 28193831 DOI: 10.4049/jimmunol.1600305] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 01/24/2017] [Indexed: 01/08/2023]
Abstract
Antiphospholipid syndrome (APS) is characterized by recurrent arterial/venous thrombosis and miscarriages in the persistent presence of autoantibodies against phospholipid-binding proteins (aPLs), such as β2 glycoprotein I (β2GPI). In addition to the aPL thrombophilic effect, arterial thrombosis was related to accelerated atherosclerosis in animal models; however, contrasting findings were reported in primary APS patients with regard to the increased number of plaques or abnormal arterial wall thickness. We investigated the cytokine production induced by β2GPI in activated T cells that infiltrate in vivo atherosclerotic lesions of primary APS patients with atherothrombosis. We also examined the helper function of β2GPI-specific T cells for monocyte matrix metalloproteinase-9 and tissue factor production, as well as their cytolytic potential and their helper function for Ab production. APS patients with atherothrombosis harbor in vivo-activated CD4+ T cells that recognize β2GPI in atherothrombotic lesions. β2GPI induces T cell proliferation and IFN-γ expression in plaque-derived T cell clones. β2GPI-specific T cells display helper function for monocyte matrix metalloproteinase-9 and tissue factor production and promote Ig production in autologous B cells. Moreover, plaque-derived β2GPI-specific CD4+ T lymphocytes express perforin-mediated and Fas/Fas ligand-mediated cytotoxicity. β2GPI, and especially the DI domain, drive a local Th1 inflammatory response, with subsequent plaque instability that eventually favors atherothrombosis. This finding may explain the association between aPLs and arterial thrombosis, despite the lack of evidence of surrogate markers for atherosclerosis in primary APS.
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Affiliation(s)
- Marisa Benagiano
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Maria Gerosa
- Department of Clinical Sciences and Community Health, Lupus Clinic, Institute Gaetano Pini, University of Milan, 20122 Milan, Italy
| | - Jacopo Romagnoli
- Department of Surgery, Catholic University of Rome, 00136 Rome, Italy
| | | | - Maria O Borghi
- Department of Clinical Sciences and Community Health, Lupus Clinic, Institute Gaetano Pini, University of Milan, 20122 Milan, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico Istituto Auxologico Italiano, 20095 Cusano Milanino, Italy; and
| | - Alessia Grassi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Chiara Della Bella
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy.,Internal Interdisciplinary Medicine, Lupus Clinic, Florence Careggi Hospital, 50134 Florence, Italy
| | - Elena Silvestri
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Lorenzo Emmi
- Internal Interdisciplinary Medicine, Lupus Clinic, Florence Careggi Hospital, 50134 Florence, Italy
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy.,Internal Interdisciplinary Medicine, Lupus Clinic, Florence Careggi Hospital, 50134 Florence, Italy
| | - Pier Luigi Meroni
- Department of Clinical Sciences and Community Health, Lupus Clinic, Institute Gaetano Pini, University of Milan, 20122 Milan, Italy; .,Istituto di Ricovero e Cura a Carattere Scientifico Istituto Auxologico Italiano, 20095 Cusano Milanino, Italy; and
| | - Mario M D'Elios
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; .,Internal Interdisciplinary Medicine, Lupus Clinic, Florence Careggi Hospital, 50134 Florence, Italy
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