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Wang Q, Han G, Sha Y, Tang M, Pan Z, Zhu Y, Zhou L, Ni J. Current status and value of testing antiphospholipid antibody in patients with acute ischemic stroke: a retrospective single-center study in China. Neurol Sci 2024; 45:1121-1128. [PMID: 37707604 DOI: 10.1007/s10072-023-07054-7] [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: 05/06/2023] [Accepted: 09/01/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND AND PURPOSE Testing for antiphospholipid antibodies (aPL) is useful to determine the cause of ischemic stroke in young and female patients. However, the clinical relevance of aPL in older patients with ischemic stroke remains unclear. We aimed to explore the status and diagnostic value of initial aPL testing in all patients with acute ischemic stroke. METHODS We retrospectively analyzed patients with acute ischemic stroke who were consecutively hospitalized in our hospital between June 2012 and January 2022 and investigated the factors associated with performing aPL screening in real-world clinical practice. Furthermore, factors associated with initial aPL positivity were evaluated by comparing the demographic, etiological, and therapeutic characteristics. RESULTS Of 1209 patients, 287 (23.7%) were tested for aPL and 58 (20.2%) tested positive. Physicians tended to conduct aPL testing on female patients (P<0.001), younger patients (P<0.001), patients with fewer vascular risk factors (P<0.001), and multiple infarctions in the multivascular blood supply area (P<0.001). Multivariate logistic regression analysis showed that only stroke of other determined etiology type was a significant influencing factor for positive aPL results (OR 2.97, 95% CI 1.137, 7.774, P=0.026), adjusting for sex, age, and causes of stroke, etc. CONCLUSION: Approximately one-quarter of the patients with acute ischemic stroke were tested for aPL. Age, sex, number of vascular risk factors, and neuroimaging features affected the discretion in performing aPL testing. aPL testing may be appropriate in older patients with no identified cause of ischemic stroke and may provide additional diagnostic opportunities for acute ischemic stroke.
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Affiliation(s)
- Qiqi Wang
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Guangsong Han
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Yuhui Sha
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Mingyu Tang
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Ziang Pan
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Yicheng Zhu
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Lixin Zhou
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| | - Jun Ni
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
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Hubben A, McCrae KR. How to diagnose and manage antiphospholipid syndrome. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:606-613. [PMID: 38066904 PMCID: PMC10727028 DOI: 10.1182/hematology.2023000493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Antiphospholipid antibodies (aPL) are autoimmune antibodies directed toward phospholipids or phospholipid-protein complexes, particularly those containing β2-glycoprotein I (β2GPI). Persistently positive aPL accompanied by arterial or venous thrombosis, or recurrent pregnancy loss, constitutes the antiphospholipid syndrome (APS). Several types of aPL with different specificities have been defined and may be detected in the clinical lab, including lupus anticoagulants (detected using clotting assays) and anticardiolipin, anti-β2GPI and anti-prothrombin/phosphatidylserine antibodies (detected by ELISA); each of the last 3 aPL may be either IgG, IgM, or IgA, though IgA antibodies are not included in criteria for APS. Due to the relative rarity of APS and the heterogeneity of aPL, thrombosis risk stratification is challenging, and randomized clinical trials for thrombosis treatment and prevention have been limited. This lack of high-quality data has made the clinical management of APS difficult, and existing guidelines are few and could not possibly cover many of the scenarios encountered in managing patients with APS. In this review, we present 3 patients with aPL and/or APS who highlight treatment dilemmas, and we discuss background information that may help guide clinical judgment in developing individualized treatment plans for patients with these enigmatic antibodies.
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Affiliation(s)
- Anne Hubben
- Taussig Cancer and Lerner Research Institutes, Cleveland Clinic, Cleveland, OH
| | - Keith R McCrae
- Taussig Cancer and Lerner Research Institutes, Cleveland Clinic, Cleveland, OH
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3
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García-Grimshaw M, Posadas-Pinto DR, Jiménez-Ruiz A, Valdés-Ferrer SI, Cadena-Fernández A, Torres-Ruiz JJ, Barrientos-Guerra JD, Amancha-Gabela M, Chiquete E, Flores-Silva FD, Cantú-Brito C. Antiphospholipid syndrome-mediated acute cerebrovascular diseases and long-term outcomes. Lupus 2022; 31:228-237. [PMID: 35042376 DOI: 10.1177/09612033221074178] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The antiphospholipid syndrome (APS) is an autoimmune disease associated with thrombotic and non-thrombotic neurologic manifestations. APS is classified as primary (PAPS) or secondary (SAPS) when it co-exists with another autoimmune disease. We aim to describe the spectrum of acute cerebrovascular disease among patients with APS, their differences between stroke subtypes, and long-term functional outcomes. METHODS Retrospective cohort study including adult (≥18 years) patients with APS followed in the stroke clinic of a tertiary-care reference center for autoimmune diseases in Mexico from 2009 to 2019. RESULTS We studied 120 cases; 99 (82.5%) women; median age 43 years (interquartile range 35-52); 63.3% with SAPS. Demographics, comorbidities, and antiphospholipid antibodies (aPL) positivity were similar between APS type and stroke subtypes. Amongst index events, we observed 84 (70%) acute ischemic strokes (AIS), 19 (15.8%) cerebral venous thromboses (CVT), 11 (9.2%) intracerebral hemorrhages (ICH), and six (5%) subarachnoid hemorrhages (SAH). Sixty-seven (55.8%) were known patients with APS; the median time from APS diagnosis to index stroke was 46 months (interquartile range 12-96); 64.7% of intracranial hemorrhages (ICH or SAH) occurred ≥4 years after APS was diagnosed (23.5% anticoagulation-related); 63.2% of CVT cases developed before APS was diagnosed or simultaneously. Recurrences occurred in 26 (22.8%) patients, AIS, in 18 (69.2%); intracranial hemorrhage, in eight (30.8%). Long-term functional outcomes were good (modified Rankin Scale ≤2) in 63.2% of cases, during follow-up, the all-cause mortality rate was 19.2%. CONCLUSION We found no differences between stroke subtypes and APS types. aPL profiles were not associated with any of the acute cerebrovascular diseases described in this cohort. CVT may be an initial thrombotic manifestation of APS with low mortality and good long-term functional outcome.
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Affiliation(s)
- Miguel García-Grimshaw
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Diego Rubén Posadas-Pinto
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Amado Jiménez-Ruiz
- Stroke, Dementia & Heart Disease Laboratory, 6221Western University, London, ON, Canada
| | - Sergio Iván Valdés-Ferrer
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,88982Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Arturo Cadena-Fernández
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José Jiram Torres-Ruiz
- Department of Immunology and Rheumatology, 42559Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José Domingo Barrientos-Guerra
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Margarita Amancha-Gabela
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Erwin Chiquete
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Fernando Daniel Flores-Silva
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos Cantú-Brito
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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4
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Neuropsychiatric Manifestations of Antiphospholipid Syndrome—A Narrative Review. Brain Sci 2022; 12:brainsci12010091. [PMID: 35053834 PMCID: PMC8773877 DOI: 10.3390/brainsci12010091] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 12/24/2022] Open
Abstract
Antiphospholipid syndrome (APS) is a common autoimmune pro-thrombotic condition characterised by thrombosis and pregnancy morbidity. There are a broad range of neuropsychiatric manifestations associated with APS, from focal symptoms to more global dysfunction. Patients commonly present with transient ischaemic attacks and ischaemic strokes, with identifiable lesions on brain imaging. However, the underlying pathogenesis remains uncertain in other manifestations, such as cognitive dysfunction, seizures, headache and chorea. The aim is to provide a comprehensive review of the various neuropsychiatric manifestations associated with APS. A detailed literature search was applied to PubMed, including citations from 1983 to December 2021.
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Naranjo L, Ostos F, Gil-Etayo FJ, Hernández-Gallego J, Cabrera-Marante Ó, Pleguezuelo DE, Díaz-Simón R, Cerro M, Lora D, Martínez-Salio A, Serrano A. Presence of Extra-Criteria Antiphospholipid Antibodies Is an Independent Risk Factor for Ischemic Stroke. Front Cardiovasc Med 2021; 8:665741. [PMID: 34012984 PMCID: PMC8126615 DOI: 10.3389/fcvm.2021.665741] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/01/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Ischemic stroke is the most common and severe arterial thrombotic event in Antiphospholipid syndrome (APS). APS is an autoimmune disease characterized by the presence of thrombosis and antiphospholipid antibodies (aPL), which provide a pro-coagulant state. The aPL included in the classification criteria are lupus anticoagulant, anti-cardiolipin (aCL) and anti-β2-glycoprotein-I antibodies (aB2GPI) of IgG and IgM isotypes. Extra-criteria aPL, especially IgA aB2GPI and IgG/IgM anti-phosphatidylserine/prothrombin antibodies (aPS/PT), have been strongly associated with thrombosis. However, their role in the general population suffering from stroke is unknown. We aim (1) to evaluate the aPL prevalence in ischemic stroke patients, (2) to determine the role of aPL as a risk factor for stroke, and (3) to create an easy-to-use tool to stratify the risk of ischemic stroke occurrence considering the presence of aPL and other risk factors. Materials and Methods: A cohort of 245 consecutive ischemic stroke patients was evaluated in the first 24 h after the acute event for the presence of classic aPL, extra-criteria aPL (IgA aB2GPI, IgG, and IgM aPS/PT) and conventional cardiovascular risk factors. These patients were followed-up for 2-years. A group of 121 healthy volunteers of the same age range and representative of the general population was used as reference population. The study was approved by the Ethics Committee for Clinical Research (Reference numbers CEIC-14/354 and CEIC-18/182). Results: The overall aPL prevalence in stroke patients was 28% and IgA aB2GPI were the most prevalent (20%). In the multivariant analysis, the presence of IgA aB2GPI (OR 2.40, 95% CI: 1.03–5.53), dyslipidemia (OR 1.70, 95% CI: 1.01–2.84), arterial hypertension (OR 1.82, 95% CI: 1.03–3.22), atrial fibrillation (OR 4.31, 95% CI: 1.90–9.78), and active smoking (OR 3.47, 95% CI: 1.72–6.99) were identified as independent risk factors for ischemic stroke. A risk stratification tool for stroke was created based on these factors (AUC: 0.75). Conclusions: IgA aB2GPI are an important independent risk factor for ischemic stroke. Evaluation of aPL (including extra-criteria) in cardiovascular risk factor assessment for stroke can potentially increase the identification of patients at risk of thrombotic event, facilitating a decision on preventive treatments.
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Affiliation(s)
- Laura Naranjo
- Healthcare Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain.,Immunology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Fernando Ostos
- Healthcare Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain.,Neurology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Francisco Javier Gil-Etayo
- Healthcare Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain.,Immunology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jesús Hernández-Gallego
- Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Neurology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Óscar Cabrera-Marante
- Healthcare Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain.,Immunology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Daniel Enrique Pleguezuelo
- Healthcare Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain.,Immunology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Raquel Díaz-Simón
- Healthcare Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain.,Internal Medicine Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Mercedes Cerro
- Healthcare Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain.,Department of Nursing, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - David Lora
- Healthcare Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain.,Epidemiology Department, Healthcare Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain.,Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Faculty of Statistical Studies, Universidad Complutense de Madrid, Madrid, Spain
| | - Antonio Martínez-Salio
- Healthcare Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain.,Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Neurology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Antonio Serrano
- Healthcare Research Institute, Hospital Universitario 12 de Octubre, Madrid, Spain.,Immunology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
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6
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Weiss R, Bushi D, Mindel E, Bitton A, Diesendruck Y, Gera O, Drori T, Zmira O, Aharoni SA, Agmon-Levin N, Kashi O, Benhar I, Golderman V, Orion D, Chapman J, Shavit-Stein E. Autoantibodies to Annexin A2 and cerebral thrombosis: Insights from a mouse model. Lupus 2021; 30:775-784. [PMID: 33554716 PMCID: PMC8020307 DOI: 10.1177/0961203321992117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Antiphospholipid syndrome (APS) is an autoimmune disorder manifested by
thromboembolic events, recurrent spontaneous abortions and elevated titers
of circulating antiphospholipid antibodies. In addition, the presence of
antiphospholipid antibodies seems to confer a fivefold higher risk for
stroke or transient ischemic attack. Although the major antigen of APS is
β2 glycoprotein I, it is now well established that
antiphospholipid antibodies are heterogeneous and bind to various targets.
Recently, antibodies to Annexin A2 (ANXA2) have been reported in APS. This
is of special interest since data indicated ANXA2 as a key player in
fibrinolysis. Therefore, in the present study we assessed whether anti-ANXA2
antibodies play a pathological role in thrombosis associated disease. Materials and Methods Mice were induced to produce anti-ANXA2 antibodies by immunization with ANXA2
(iANXA2) and control mice were immunized with adjuvant only. A middle
cerebral artery occlusion stroke model was applied to the mice. The outcome
of stroke severity was assessed and compared between the two groups. Results Our results indicate that antibodies to ANXA2 lead to a more severe stroke as
demonstrated by a significant larger stroke infarct volume (iANXA2
133.9 ± 3.3 mm3 and control 113.7 ± 7.4 mm3;
p = 0.017) and a more severe neurological outcome (iANXA2 2.2 ± 0.2, and
control 1.5 ± 0.18; p = 0.03). Conclusions This study supports the hypothesis that auto-antibodies to ANXA2 are an
independent risk factor for cerebral thrombosis. Consequently, we propose
screening for anti-ANXA2 antibodies should be more widely used and patients
that exhibit the manifestations of APS should be closely monitored by
physicians.
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Affiliation(s)
- Ronen Weiss
- Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Doron Bushi
- Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Neurology, Comprehensive Stroke Center, Sheba Medical Center, Sackler Faculty of Medicine, Ramat Gan, Israel
| | - Ekaterina Mindel
- Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Almog Bitton
- Department of Molecular Microbiology and Biotechnology, School of Molecular Cell Biology and Biotechnology, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Diesendruck
- Department of Molecular Microbiology and Biotechnology, School of Molecular Cell Biology and Biotechnology, Tel-Aviv University, Tel-Aviv, Israel
| | - Orna Gera
- Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tali Drori
- Department of Neurology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Ofir Zmira
- Department of Neurology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Shay Anat Aharoni
- Department of Neurology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Nancy Agmon-Levin
- Angioedema and Allergy Department, Sheba Medical Center, Ramat Gan, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oren Kashi
- Robert and Martha Harden Chair in Mental and Neurological Diseases, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itai Benhar
- Department of Molecular Microbiology and Biotechnology, School of Molecular Cell Biology and Biotechnology, Tel-Aviv University, Tel-Aviv, Israel
| | - Valery Golderman
- Department of Neurology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - David Orion
- Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Neurology, Comprehensive Stroke Center, Sheba Medical Center, Sackler Faculty of Medicine, Ramat Gan, Israel
| | - Joab Chapman
- Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Department of Neurology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel.,Robert and Martha Harden Chair in Mental and Neurological Diseases, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Shavit-Stein
- Department of Neurology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
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7
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Comparison of patients with transient and sustained increments of antiphospholipid antibodies after acute ischemic stroke. J Neurol 2021; 268:2541-2549. [PMID: 33547954 DOI: 10.1007/s00415-021-10432-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE Antiphospholipid syndrome (APS) is one of the uncommon causes of ischemic stroke, and is associated with young and female patients. However, the significance of antiphospholipid antibody (aPL) in older ischemic stroke patients is uncertain. We aimed to examine the significance of aPLs in ischemic stroke in these older patients. MATERIALS AND METHODS A total of 739 patients with acute ischemic stroke within 7 days of initial symptoms were collected consecutively. Clinical and laboratory data were obtained from medical records. aPLs (lupus anticoagulant, anti-cardiolipin antibody, anti-β2glycoprotein-I antibody) were measured the day after admission and the presence of at least one antibody was regarded as positive aPL. Patients with positive aPL were rechecked after at least 12 weeks for confirmation of APS. RESULT Of the 739 patients, 103 (13.9%) had at least one aPL initially. These patients were older, had more atrial fibrillation and higher levels of inflammatory markers. Among the 103 aPL positive patients, 41 remained positive at 3 months, 23 showed negative conversion, and 39 were not available for follow-up. Patients diagnosed with APS had higher numbers of aPL and had specifically anti-β2glycoprotein-I IgG antibody. The patients with aPLs did not differ significantly from the others in terms of stroke subtype. CONCLUSION aPL was rather common in ischemic stroke patients regardless of age. Although the influence of transient positive aPL on ischemic stroke remains uncertain, two or more aPLs and the presence of anti-β2glycoprotein-I IgG may predict a diagnosis of APS.
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Cheng C, Cheng GY, Denas G, Pengo V. Arterial thrombosis in antiphospholipid syndrome (APS): Clinical approach and treatment. A systematic review. Blood Rev 2020; 48:100788. [PMID: 33341301 DOI: 10.1016/j.blre.2020.100788] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/17/2020] [Accepted: 12/08/2020] [Indexed: 12/17/2022]
Abstract
Thrombotic Antiphospholipid Syndrome (APS) is a condition affecting young individuals in whom a thromboembolic event occurs in the presence of circulating antiphospholipid antibodies (aPL). An extensive body of literature has covered the most common clinical presentation of the syndrome, venous thromboembolism. Arterial thrombosis in APS, a lesser clinical expression, is less studied. This review will concentrate on the body of literature concerning pathogenesis, clinical presentation and management of arterial thrombosis in APS.
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Affiliation(s)
- Chunyan Cheng
- Thrombosis Research Laboratory, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Gang-Yi Cheng
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Gentian Denas
- Thrombosis Research Laboratory, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Vittorio Pengo
- Thrombosis Research Laboratory, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padua, Italy; Arianna Foundation on Anticoagulation, Bologna, Italy.
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9
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Antiphospholipid antibodies predict post-stroke depression after acute ischemic stroke. J Affect Disord 2019; 257:160-165. [PMID: 31301618 DOI: 10.1016/j.jad.2019.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/24/2019] [Accepted: 07/04/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Antiphospholipid activity was reported to be increased in depressive patients, while the impact of antiphospholipid antibodies (aPLs) on post-stroke depression (PSD) is unclear. We aimed to investigate the associations of aPLs, including antiphosphatidylserine (aPS) and anticardiolipin (aCL) antibodies with depression after acute ischemic stroke. METHODS aPS and aCL were measured in 497 ischemic stroke patients recruited from 7 of 26 participating hospitals of China Antihypertensive Trial in Acute Ischemic Stroke. 24-item Hamilton Depression Rating Scale was used to evaluate PSD status at 3 months after stroke. RESULTS Compared with aPS-negative or aCL-negative, the adjusted odds ratios (ORs) [95% confidence intervals (CIs)] associated with aPS-positive or aCL-positive were 1.77 (1.07-2.92) or 2.06 (1.11-3.80) for risk of PSD. On continuous analyses, per 1-SD increment of aPS and aCL were associated with 29% (OR 1.29, 95% CI 1.06-1.58) and 30% (OR 1.30, 95% CI 1.06-1.60) increased risks for PSD, respectively. Adding aPLs to conventional risk factors models significantly improved risk reclassification for PSD (net reclassification improvement index = 21.87%, P = 0.016 for aPS; net reclassification improvement index = 32.24%, P = 0.0004 for aCL). LIMITATIONS aPLs levels were tested only at baseline without serial measurements, and we were unable to detect the association between aPLs changes and PSD. CONCLUSIONS Higher aPS and aCL levels in the acute phase of ischemic stroke were associated with increased risk of 3-month PSD, suggesting that aPLs may play an important role in post-stroke depression prediction.
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10
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Zha C, Zhang W, Gao F, Xu J, Jia R, Cai J, Liu Y. Anti-β 2GPI/β 2GPI induces neutrophil extracellular traps formation to promote thrombogenesis via the TLR4/MyD88/MAPKs axis activation. Neuropharmacology 2018; 138:140-150. [PMID: 29883691 DOI: 10.1016/j.neuropharm.2018.06.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 12/12/2022]
Abstract
Antiphospholipid antibodies (aPLs) are a large group of heterogeneous antibodies that bind to anionic phospholipids alone or in combination with phospholipid binding proteins. Increasing evidence has converged to indicate that aPLs especially anti-β2 glycoprotein I antibody (anti-β2GPI) correlate with stroke severity and outcome. Though studies have shown that aPLs promote thrombus formation in a neutrophil-dependent way, the underlying mechanisms remain largely unknown. In the present study, we investigated the effect of anti-β2GPI in complex with β2GPI (anti-β2GPI/β2GPI) on neutrophil extracellular traps (NETs) formation and thrombus generation in vitro and in vivo. We found that anti-β2GPI/β2GPI immune complex induced NETs formation in a time- and concentration-dependent manner. This effect was mediated by its interaction with TLR4 and the production of ROS. We demonstrated that MyD88-IRAKs-MAPKs, an intracellular signaling pathway, was involved in anti-β2GPI/β2GPI-induced NETs formation. We also presented evidence that tissue factor was expressed on anti-β2GPI/β2GPI-induced NETs, and NETs could promote platelet aggregation in vitro. In addition, we identified that anti-β2GPI/β2GPI-induced NETs enhanced thrombus formation in vivo, and this effect was counteracted by using DNase I. Our data suggest that anti-β2GPI/β2GPI induces NETs formation to promote thrombogenesis via the TLR4/MyD88/MAPKs axis activation, and could be a potentially novel target for aPLs related ischemic stroke.
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Affiliation(s)
- Caijun Zha
- Department of Laboratory Diagnosis, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Wenjing Zhang
- Department of Laboratory Diagnosis, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Fei Gao
- Department of Laboratory Diagnosis, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Jiali Xu
- Laboratory of Endocrinology and Metabolism Department, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Ruichun Jia
- Department of Blood Transfusion, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Jinquan Cai
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China.
| | - Yanhong Liu
- Department of Laboratory Diagnosis, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China.
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Novel Treatment Strategies Using TiO 2 -Nanowired Delivery of Histaminergic Drugs and Antibodies to Tau With Cerebrolysin for Superior Neuroprotection in the Pathophysiology of Alzheimer's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 137:123-165. [DOI: 10.1016/bs.irn.2017.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Bu X, Peng H, Zhong C, Xu T, Xu T, Peng Y, Chen CS, Wang J, Ju Z, Li Q, Geng D, Sun Y, Zhang D, Zhang J, Chen J, Zhang Y, He J. Antiphosphatidylserine Antibodies and Clinical Outcomes in Patients With Acute Ischemic Stroke. Stroke 2016; 47:2742-2748. [DOI: 10.1161/strokeaha.116.013827] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 09/16/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Antiphosphatidylserine antibodies (aPS) have been associated with the risk of ischemic stroke. However, it remains unclear whether aPS will influence clinical outcomes in patients with acute ischemic stroke.
Methods—
A total of 3013 patients with acute ischemic stroke recruited from 26 hospitals across China from August 2009 to May 2013 were included in the study The primary outcome was a combination of death and major disability (modified Rankin Scale score ≥3) at 3 months after stroke. Secondary outcomes included death, major disability, recurrent stroke, and vascular events.
Results—
Composite outcome of death and major disability rates were 29.1% versus 23.9% in aPS-positive and aPS-negative groups. Compared with aPS-negative, adjusted odds ratios or hazard ratios (95% confidence interval) associated with aPS-positive were 1.35 (1.07–1.71), 1.63 (0.99–2.69), and 1.25 (0.98–1.59) for composite outcome of death or major disability, death, and major disability, respectively. For 1 interquartile range increase of aPS, the adjusted odds ratios or hazard ratios were 1.10 (1.01–1.20), 1.19 (1.05–1.35), and 1.05 (0.96–1.14), respectively. Adding aPS status to a model containing conventional risk factors improved risk prediction for composite outcome of death or major disability (net reclassification improvement index=11.3%,
P
=0.006; integrated discrimination improvement=0.2%,
P
=0.04). There was no significant association between aPS and risks of recurrent stroke and vascular events.
Conclusions—
We found that positive aPS increased risks of death or major disability at 3 months after an acute ischemic stroke, suggesting that aPS might be a prognostic marker for ischemic stroke.
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Affiliation(s)
- Xiaoqing Bu
- From the Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (X.B., H.P., C.Z., Tan Xu, Tian Xu, Y.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (X.B., H.P., C.-S.C., J.C., J.H.); Department of Neurology, Affiliated Hospital of Nantong University, Jiangsu, China (Tian Xu); Department of
| | - Hao Peng
- From the Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (X.B., H.P., C.Z., Tan Xu, Tian Xu, Y.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (X.B., H.P., C.-S.C., J.C., J.H.); Department of Neurology, Affiliated Hospital of Nantong University, Jiangsu, China (Tian Xu); Department of
| | - Chongke Zhong
- From the Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (X.B., H.P., C.Z., Tan Xu, Tian Xu, Y.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (X.B., H.P., C.-S.C., J.C., J.H.); Department of Neurology, Affiliated Hospital of Nantong University, Jiangsu, China (Tian Xu); Department of
| | - Tan Xu
- From the Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (X.B., H.P., C.Z., Tan Xu, Tian Xu, Y.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (X.B., H.P., C.-S.C., J.C., J.H.); Department of Neurology, Affiliated Hospital of Nantong University, Jiangsu, China (Tian Xu); Department of
| | - Tian Xu
- From the Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (X.B., H.P., C.Z., Tan Xu, Tian Xu, Y.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (X.B., H.P., C.-S.C., J.C., J.H.); Department of Neurology, Affiliated Hospital of Nantong University, Jiangsu, China (Tian Xu); Department of
| | - Yanbo Peng
- From the Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (X.B., H.P., C.Z., Tan Xu, Tian Xu, Y.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (X.B., H.P., C.-S.C., J.C., J.H.); Department of Neurology, Affiliated Hospital of Nantong University, Jiangsu, China (Tian Xu); Department of
| | - Chung-Shiuan Chen
- From the Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (X.B., H.P., C.Z., Tan Xu, Tian Xu, Y.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (X.B., H.P., C.-S.C., J.C., J.H.); Department of Neurology, Affiliated Hospital of Nantong University, Jiangsu, China (Tian Xu); Department of
| | - Jinchao Wang
- From the Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (X.B., H.P., C.Z., Tan Xu, Tian Xu, Y.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (X.B., H.P., C.-S.C., J.C., J.H.); Department of Neurology, Affiliated Hospital of Nantong University, Jiangsu, China (Tian Xu); Department of
| | - Zhong Ju
- From the Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (X.B., H.P., C.Z., Tan Xu, Tian Xu, Y.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (X.B., H.P., C.-S.C., J.C., J.H.); Department of Neurology, Affiliated Hospital of Nantong University, Jiangsu, China (Tian Xu); Department of
| | - Qunwei Li
- From the Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (X.B., H.P., C.Z., Tan Xu, Tian Xu, Y.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (X.B., H.P., C.-S.C., J.C., J.H.); Department of Neurology, Affiliated Hospital of Nantong University, Jiangsu, China (Tian Xu); Department of
| | - Deqin Geng
- From the Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (X.B., H.P., C.Z., Tan Xu, Tian Xu, Y.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (X.B., H.P., C.-S.C., J.C., J.H.); Department of Neurology, Affiliated Hospital of Nantong University, Jiangsu, China (Tian Xu); Department of
| | - Yingxian Sun
- From the Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (X.B., H.P., C.Z., Tan Xu, Tian Xu, Y.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (X.B., H.P., C.-S.C., J.C., J.H.); Department of Neurology, Affiliated Hospital of Nantong University, Jiangsu, China (Tian Xu); Department of
| | - Dongsheng Zhang
- From the Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (X.B., H.P., C.Z., Tan Xu, Tian Xu, Y.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (X.B., H.P., C.-S.C., J.C., J.H.); Department of Neurology, Affiliated Hospital of Nantong University, Jiangsu, China (Tian Xu); Department of
| | - Jintao Zhang
- From the Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (X.B., H.P., C.Z., Tan Xu, Tian Xu, Y.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (X.B., H.P., C.-S.C., J.C., J.H.); Department of Neurology, Affiliated Hospital of Nantong University, Jiangsu, China (Tian Xu); Department of
| | - Jing Chen
- From the Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (X.B., H.P., C.Z., Tan Xu, Tian Xu, Y.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (X.B., H.P., C.-S.C., J.C., J.H.); Department of Neurology, Affiliated Hospital of Nantong University, Jiangsu, China (Tian Xu); Department of
| | - Yonghong Zhang
- From the Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (X.B., H.P., C.Z., Tan Xu, Tian Xu, Y.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (X.B., H.P., C.-S.C., J.C., J.H.); Department of Neurology, Affiliated Hospital of Nantong University, Jiangsu, China (Tian Xu); Department of
| | - Jiang He
- From the Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (X.B., H.P., C.Z., Tan Xu, Tian Xu, Y.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (X.B., H.P., C.-S.C., J.C., J.H.); Department of Neurology, Affiliated Hospital of Nantong University, Jiangsu, China (Tian Xu); Department of
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