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Wu YY, V. Nguyen A, Wu XX, Loh M, Vu M, Zou Y, Liu Q, Guo P, Wang Y, Montgomery LL, Orlofsky A, Rand JH, Lin EY. Antiphospholipid Antibodies Promote Tissue Factor–Dependent Angiogenic Switch and Tumor Progression. THE AMERICAN JOURNAL OF PATHOLOGY 2014; 184:3359-75. [DOI: 10.1016/j.ajpath.2014.07.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 07/22/2014] [Accepted: 07/29/2014] [Indexed: 12/30/2022]
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Velayuthaprabhu S, Archunan G, Balakrishnan K. Placental thrombosis in experimental anticardiolipin antibodies-mediated intrauterine fetal death. Am J Reprod Immunol 2007; 57:270-6. [PMID: 17362388 DOI: 10.1111/j.1600-0897.2007.00474.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PROBLEM Anticardiolipin (aCL) antibodies are associated with stillbirths, recurrent miscarriages and recurrent in vitro fertilization implantation failure in women. Previous animal studies have demonstrated that these antibodies can cause early fetal demise and implantation failure in mice, but most previous studies have not allowed the immunized mice to proceed to the full term of gestation. METHOD OF STUDY Mice were immunized with either cardiolipin alone or cardiolipin in combination with beta2-glycoprotein I (beta2GPI) and have studied the effects of these antibodies on pregnancies which were allowed to progress to term. RESULTS Immunization with cardiolipin alone induced significant levels of anticardiolipin antibodies in mice, but immunization with a combination of cardiolipin and beta2GPI produced even higher levels of antibodies. Mice with elevated levels of anticardiolipin antibodies had poor pregnancy outcomes. This study confirms previous results that anticardiolipin antibodies cause early pregnancy losses and also demonstrates that these antibodies cause stillbirth-like late fetal demise. This study further demonstrated that very high levels of anticardiolipin antibodies cause intrauterine death by facilitating the thrombotic episode in placenta. CONCLUSIONS The present study concludes that the possible mechanism involves in stillbirth of aCL is possibly because of the thrombotic events of placenta.
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Quenby S, Mountfield S, Cartwright JE, Whitley GS, Chamley L, Vince G. Antiphospholipid antibodies prevent extravillous trophoblast differentiation. Fertil Steril 2005; 83:691-8. [PMID: 15749499 DOI: 10.1016/j.fertnstert.2004.07.978] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2004] [Revised: 07/26/2004] [Accepted: 07/26/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We investigated the hypothesis that antiphospholipid antibodies (aPL) have a detrimental effect on human extravillous trophoblast (EVT) differentiation into giant multinucleated cells "in vitro." DESIGN The EVT were isolated from the placental chorion using enzymatic digestion and Percoll gradient centrifugation. After 24, 36, and 48 hours in culture, giant multinuclear cells (GMC) were identified by immunohistochemistry using antibodies to cytokeratin 7 and counted. SETTING An academic research laboratory. PATIENT(S) Placentas were donated by women having an elective cesarean section for a normal pregnancy at term. MAIN OUTCOME MEASURE(S) This model was then used to investigate the effect of two different monoclonal aPL to beta2-glycoprotein 1 (IIC5 and ID2), and control mouse IgG antibody on EVT differentiation. RESULT(S) Freshly isolated EVT were nonproliferative but moved together losing their intervening cell walls and differentiated into GMC. Maximal numbers of GMC were detected after 48 hours of culture. The aPL, IIC5, and ID2 significantly inhibited GMC formation, whereas the mouse IgG control had no effect. CONCLUSION(S) Antiphospholipid antibodies can inhibit EVT differentiation and GMC formation "in vitro" suggesting that a failure of trophoblast differentiation and subsequent uteroplacental development may be an underlying pathology in antiphospholipid syndrome-associated pregnancy loss.
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Affiliation(s)
- Siobhan Quenby
- Department of Obstetrics and Gynaecology, Liverpool Women's Hospital, University of Liverpool, Liverpool, United Kingdom.
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Matalon ST, Shoenfeld Y, Blank M, Yacobi S, von Landenberg P, Ornoy A. Antiphosphatidylserine Antibodies Affect Rat Yolk Sacs in Culture: a Mechanism for Fetal Loss in Antiphospholipid Syndrome. Am J Reprod Immunol 2004; 51:144-51. [PMID: 14748841 DOI: 10.1046/j.8755-8920.2003.00140.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PROBLEM A variety of reproductive impairments have been reported in the context of the antiphospholipid syndrome (APS). APS is associated with the presence of antibodies to negatively charged phospholipids that may affect the outcome of pregnancy. METHOD OF STUDY Rat embryos were cultured within their yolk sacs. The effects of two antiphosphatidylserine monoclonal aPS antibodies (HL5B, RR7F) regarding their influence on growth and apoptotic events of the yolk sacs, as well as on growth and the morphology of the embryos, were studied. RESULTS Exposure of rat embryos and their yolk sacs to aPS inhibited yolk sac growth. Moreover, increased number of apoptotic events of giant cells in the aPS-exposed ectoplacental cone was found in comparison with control IgG-exposed giant cells (P < 0.05). No significant damage was observed in the embryos. CONCLUSIONS The results suggest that aPS affect growth and apoptosis of rat ectoplacental cone.
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Affiliation(s)
- Shelly Tartakover Matalon
- Department of Anatomy and Cell Biology, Laboratory of Teratology, Hebrew University Hadassah Medical School, Jerusalem
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Born WK, Vollmer M, Reardon C, Matsuura E, Voelker DR, Giclas PC, O'Brien RL. Hybridomas expressing gammadelta T-cell receptors respond to cardiolipin and beta2-glycoprotein 1 (apolipoprotein H). Scand J Immunol 2003; 58:374-81. [PMID: 12950685 DOI: 10.1046/j.1365-3083.2003.01315.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hybridomas expressing murine gammadelta T-cell receptors were found to produce cytokines in response to cardiolipin (CL) and structurally related anionic phospholipids. This response required serum at concentrations related to the amount of CL in cultures. The purified serum factor, beta2-glycoprotein 1 (beta2-GP1) (apolipoprotein H), supported the CL response alone, whereas several other serum proteins and ovalbumin did not. beta2-GP1 is known to form complexes with anionic phospholipids, particularly CL, which are often recognized by pathological autoantibodies. We speculate that gammadelta T cells also recognize such complexes and that the hybridoma response reported here reflects this specificity.
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Affiliation(s)
- W K Born
- Department of Immunology at National Jewish Medical and Research Center, Denver, CO 80206, USA.
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Abstract
High-risk pregnancy is the most common clinical association with antiphospholipid antibodies; the principal manifestations are pregnancy loss and early preeclampsia. Membership in this family of antibodies is continually growing and includes antibodies against a variety of phospholipids, phospholipid-protein complexes, and phospholipid-binding proteins. The current information in the literature is inadequate to clearly implicate a subgroup of antiphospholipid antibodies or a particular pathophysiologic mechanism as being responsible for poor pregnancy outcomes. It is clear, however, that prevalent diagnostic tests for LA and aCL are extremely useful to identify many of these patients, but are inadequate for diagnosis of all patients with autoimmune pregnancy loss or to elucidate the pathophysiology. Many patients who present clinically with autoimmune-like pregnancy complications currently are negative in tests for LA or aCL, but have antibodies against annexin V, phosphatidylserine, or other relevant antigens. The greatest risk for a complicated pregnancy is conveyed by a subgroup of antibodies that affect the normal function of placental trophoblast. As clinical laboratory tests designed to detect more members of the antiphospholipid antibody family become available, understanding of this complicated disease (APS) will increase.
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Affiliation(s)
- Neal S Rote
- Department of Reproductive Biology, Case Western Reserve University School of Medicine, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.
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Placental Pathology, Antiphospholipid Antibodies, and Pregnancy Outcome in Recurrent Miscarriage Patients. Obstet Gynecol 2003. [DOI: 10.1097/00006250-200302000-00011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Salmon JE, Girardi G, Holers VM. Complement activation as a mediator of antiphospholipid antibody induced pregnancy loss and thrombosis. Ann Rheum Dis 2002; 61 Suppl 2:ii46-50. [PMID: 12379621 PMCID: PMC1766708 DOI: 10.1136/ard.61.suppl_2.ii46] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- J E Salmon
- Department of Medicine, Hospital for Special Surgery-Weill Medical College, Cornell University, New York 10021, USA.
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Donohoe S, Quenby S, Mackie I, Panal G, Farquharson R, Malia R, Kingdom J, Machin S. Fluctuations in levels of antiphospholipid antibodies and increased coagulation activation markers in normal and heparin-treated antiphospholipid syndrome pregnancies. Lupus 2002; 11:11-20. [PMID: 11898913 DOI: 10.1191/0961203302lu132oa] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Antiphospholipid antibodies (aPL) are associated with an increased risk of thrombosis and recurrent miscarriage. We assessed levels of coagulation activation markers and aPL during normal pregnancy and in women with the antiphospholipid syndrome (aPS). Fluctuations in aPL levels were observed in all patients with aPS. No particular pattern of antibody positivity, or fluctuation in aPL level, was associated with poor pregnancy outcome. A significant increase was observed in levels of factor Xlla (FXIIa; P < 0.001), factor VIIa (FVIIa, P < 0.001), thrombin antithrombin complexes (TAT; P < 0.001), prothrombin fragment F1.2 (F1.2; P < 0.001) and D-dimer (DD; P < 0.05) during normal pregnancy. Factor VIIa, TAT, F1.2 and DD increased significantly before 20 weeks gestation, while a statistically significant increase in FXIIa levels was first detected between weeks 20 and 30 of gestation. In pregnant women with aPS, increases in FXIIa were similar to those in normal pregnancy, but increased FVIIa levels were not observed until after 30 weeks gestation. Similar to normal pregnancy, increased levels of TAT and F1.2 were detected in aPS pregnancies before 20 weeks gestation, but increased DD were not observed until after week 20. Surprisingly, women with aPS receiving low molecular weight heparin prophylaxis had significantly higher (P = 0.02) levels of TAT (median 8.6; interquartile range (IQR) 6.5-20.8) between weeks 20 and 30 of gestation compared to the normal pregnant population (median 5.9; IQR 4.7-7.9), thus indicating increased thrombin generation in women with aPS in mid-pregnancy.
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Affiliation(s)
- S Donohoe
- Department of Haematology, University College London Medical School, UK
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Holers VM, Girardi G, Mo L, Guthridge JM, Molina H, Pierangeli SS, Espinola R, Xiaowei LE, Mao D, Vialpando CG, Salmon JE. Complement C3 activation is required for antiphospholipid antibody-induced fetal loss. J Exp Med 2002; 195:211-20. [PMID: 11805148 PMCID: PMC2193604 DOI: 10.1084/jem.200116116] [Citation(s) in RCA: 395] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2001] [Revised: 11/06/2001] [Accepted: 11/28/2001] [Indexed: 01/13/2023] Open
Abstract
The antiphospholipid syndrome (APS) is characterized by recurrent fetal loss, vascular thrombosis, and thrombocytopenia occurring in the presence of antiphospholipid (aPL) antibodies. The pathogenesis of fetal loss and tissue injury in APS is incompletely understood, but is thought to involve platelet and endothelial cell activation as well as procoagulant effects of aPL antibodies acting directly on clotting pathway components. Recent studies have shown that uncontrolled complement activation in the placenta leads to fetal death in utero. We hypothesized that aPL antibodies activate complement in the placenta, generating split products that mediate placental injury and lead to fetal loss and growth retardation. To test this hypothesis, we used a murine model of APS in which pregnant mice are injected with human IgG containing aPL antibodies. We found that inhibition of the complement cascade in vivo, using the C3 convertase inhibitor complement receptor 1-related gene/protein y (Crry)-Ig, blocks fetal loss and growth retardation. Furthermore, mice deficient in complement C3 were resistant to fetal injury induced by aPL antibodies. While antigenic epitopes recognized by aPL antibodies are important in the pathogenesis of APS, our data show that in vivo complement activation is required for aPL antibody-induced fetal loss and growth retardation.
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Affiliation(s)
- V Michael Holers
- Department of Medicine, University of Colorado Health Sciences Center, Denver, CO 80262, USA
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Jacob-Meisel M, Römer T, Straube W, Meisel P. Anticardiolipin antibodies in ectopic pregnancies. Eur J Obstet Gynecol Reprod Biol 2001; 99:97-101. [PMID: 11604194 DOI: 10.1016/s0301-2115(01)00360-8] [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: 11/20/2022]
Abstract
BACKGROUND Anticardiolipin auto-antibodies are known to be inflicted in recurrent pregnancy losses and other adverse outcomes of pregnancy. However, their role in extrauterine pregnancies is unknown. OBJECTIVE To clarify the association between anticardiolipin antibodies and extrauterine pregnancies. PATIENTS AND METHODS About 30 patients with ectopic pregnancies confirmed histologically and 40 control subjects with intrauterine pregnancies were studied. Mean duration of pregnancy was 38 and 39 days, respectively. Serum levels of IgG, IgA, and IgM antibodies against cardiolipin were measured. In addition, measurements of human chorionic gonadotropin (beta hCG) and progesterone were made. RESULTS Mean levels of IgA and IgM but not IgG antibodies were significantly higher in patients with ectopic pregnancies than in normal pregnant women. Distribution frequency histograms revealed that a subgroup of ectopic pregnancies exhibit antibody titers corresponding to that of intrauterine pregnancies, and others showing elevated levels. Markedly elevated antibody levels were observed in patients having low levels of beta hCG and/or progesterone. CONCLUSION In view of the inflammatory events associated with some cases of ectopic pregnancies, elevated levels of anticardiolipin auto-antibodies may give clues to pathogenesis. Determination of IgM antibodies may help discriminate ectopic pregnancies with auto-immune pathogenesis from those caused by other factors.
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Affiliation(s)
- M Jacob-Meisel
- Department of Obstetrics and Gynaecology, Ernst Moritz Arndt University Greifswald, Wollweberstrasse 1, D-17487 Greifswald, Germany.
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Abstract
Antiphospholipid antibodies are the marker for antiphospholipid syndrome. There is evidence that these autoantibodies lead to both thrombotic diathesis and obstetrical manifestations. Besides the known interaction with soluble coagulation factors, in vitro and in vivo experimental models and studies in humans recently have shown the ability of antiphospholipid antibodies to modulate functions of cells involved in coagulation homeostasis. These findings support a new hypothesis to explain the paradox of the prolongation of coagulation assays in vitro and the association with thrombophilic diathesis in vivo. Obstetrical manifestations have been linked to a direct antibody effect on the trophoblast leading to defective placentation that is not necessarily associated with thrombotic phenomena. Phospholipid binding proteins such as beta 2 -glycoprotein I appear to behave as a bridge between circulating antiphospholipid antibodies and cellular targets.
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Affiliation(s)
- P L Meroni
- Allergy and Clinical Immunology Unit, IRCCS Istituto Auxologico Italiano, Department of Internal Medicine, University of Milan, Italy.
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Wright CA, Tefferi A. A single institutional experience with 43 pregnancies in essential thrombocythemia. Eur J Haematol 2001; 66:152-9. [PMID: 11350483 DOI: 10.1034/j.1600-0609.2001.00367.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES We describe the periconception circumstances and outcome of 43 consecutive pregnancies in an unselected group of young women with essential thrombocythemia (ET). PATIENTS AND METHODS We retrospectively studied 74 consecutive cases of young women with ET seen at our institution, among whom 43 pregnancies occurred in 20 patients. RESULTS Of the 43 pregnancies, 22 (51%) were successful (21 term and 1 preterm live births) and 21 (49%) ended in miscarriages (1 ectopic pregnancy, 2 elective abortions, 16 first-trimester spontaneous abortions, 1 stillbirth at 22 wk, and 1 abruptio placentae at 33 wk). Management of ET at the time of conception included either no specific therapy (16 cases) or the use of aspirin alone (24 cases), a cytoreductive agent (2 cases), or heparin (1 case). There were no significant differences with respect to platelet count or the effect of treatment with aspirin, either at the time of conception or during the first trimester, among cases of successful pregnancies (22), all miscarriages (21), or first-trimester spontaneous abortions (16). The findings were similar when the analysis was restricted to only first-time pregnancies. In patients with multiple pregnancies, the outcome of a subsequent pregnancy was not predicted by the outcome of the first. In general, in successful cases the last two trimesters were mostly uneventful, with healthy offspring being reported in all cases. CONCLUSIONS Pregnant patients with ET have an increased risk of first-trimester abortion which is not predictable by preconception platelet count or aspirin therapy. In addition, our experience does not support the use of prophylactic platelet apheresis during delivery.
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MESH Headings
- Abortion, Induced/statistics & numerical data
- Abortion, Spontaneous/epidemiology
- Abruptio Placentae/epidemiology
- Adult
- Anticoagulants/therapeutic use
- Aspirin/therapeutic use
- Busulfan/therapeutic use
- Erythromelalgia/epidemiology
- Erythromelalgia/etiology
- Female
- Fetal Death/epidemiology
- Follow-Up Studies
- Heparin/therapeutic use
- Humans
- Hydroxyurea/therapeutic use
- Migraine Disorders/epidemiology
- Migraine Disorders/etiology
- Obstetric Labor, Premature/epidemiology
- Phosphorus Radioisotopes/therapeutic use
- Platelet Aggregation Inhibitors/therapeutic use
- Platelet Count
- Plateletpheresis
- Pregnancy
- Pregnancy Complications, Hematologic/drug therapy
- Pregnancy Complications, Hematologic/epidemiology
- Pregnancy Complications, Hematologic/radiotherapy
- Pregnancy Complications, Hematologic/therapy
- Pregnancy Outcome
- Pregnancy Trimester, First
- Pregnancy, Ectopic/epidemiology
- Pregnancy, High-Risk
- Quinazolines/therapeutic use
- Retrospective Studies
- Risk
- Thrombocythemia, Essential/drug therapy
- Thrombocythemia, Essential/epidemiology
- Thrombocythemia, Essential/radiotherapy
- Thrombocythemia, Essential/therapy
- Uterine Hemorrhage/epidemiology
- Uterine Hemorrhage/etiology
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Affiliation(s)
- C A Wright
- Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
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