Preeclampsia (PE) constitutes one of the principal reasons for maternal and perinatal morbidity and mortality worldwide. The circumstance typically implicates formerly healthful normotensive women, after 20 weeks of gestation, typically withinside the third trimester, without regarded threat elements or past deliveries. PE can be further complicated with hemolysis and thrombocytopenia, leading to the emergence of HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low platelets). Both conditions are classified as hypertensive diseases of pregnancy (HDP), and their pathogenesis has been linked to an excessive maternal inflammatory response, accompanied by enhanced endothelial activation. Several studies have found that in pregnancies affected by PE/HELLP, von Willebrand factor (vWF) antigen levels (vWF:Ag) are significantly elevated, while its cleaving protease (ADAMTS-13, A Disintegrin-like and Metalloprotease with Thrombospondin type 1 motif, member 13) activity is normal to decreased. Furthermore, the higher urine excretion of the terminal complement complex C5b-9, as well as its greater deposition in the placental surface in preeclamptic women, imply that the utero-placental unit’s distinctive deficits are intimately tied to disproportionate complement activation. The goal of this updated evaluation is to provide the most up-to-date molecular advances in the pathophysiology of PE/HELLP syndromes. Recent medical data on vWF:Ag levels in patients with PE, ADAMTS-13, and dysregulation of the complement system, are highlighted and evaluated. Furthermore, we discuss the relationship between those entities and the progression of the disease, as well as their significance in the diagnostic process. Finally, considering the difficulties in analyzing and controlling those symptoms in pregnant women, we can provide a current diagnostic and therapeutic algorithm.

Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are essential weapons to control the spread of the coronavirus disease-19 (COVID-19) pandemic and protect immunocompromised patients. With a greater susceptibility to infection, sickle cell disease (SCD) patients are considered as “high risk” patients during the current COVID-19 pandemic. In our study, we try to determine the immune response of adult SCD patients monitored at our center after the first and second dose of the qualified mRNA vaccines available and correlate them to several disease-specific markers, as well as complement activation. The results demonstrate that the levels of neutralizing antibodies (nAbs) against SARS-CoV-2 were adequate for most patients studied after the second dose and there seemed to be a certain association with complement activation. Further studies are critical to determine the durability of this immune response and the potential benefit of a third dose.

Complement dysregulation has been documented in adults with COVID-19 and implicated in relevant pediatric inflammatory responses against SARS-CoV-2. We propose that signatures of complement missense coding SNPs associated with dysregulation could also be identified in children with multisystem inflammatory syndrome (MIS-C). We investigated 71 pediatric patients with RT-PCR validated SARS-CoV-2 hospitalized in pediatric COVID-19 care units (November 2020–March 2021) in three major groups. Seven (7) patients suffered from MIS-C (MIS-C group), 32 suffered from COVID-19 and were hospitalized (admitted group), whereas 32 suffered from COVID-19, but were sent home. All patients survived and were genotyped for variations in the C3, C5, CFB, CFD, CFH, CFHR1, CFI, CD46, CD55, MASP1, MASP2, MBL2, COLEC11, FCN1, and FCN3 genes. Upon evaluation of the missense coding SNP distribution patterns along the three study groups, we noticed similarities, but also considerably increased frequencies of the alternative pathway (AP) associated with SNPs rs12614 CFB, rs1061170, and rs1065489 CFH in the MIS-C patients. Our analysis suggests that the corresponding substitutions potentially reduce the C3b-inactivation efficiency and promote slower and weaker AP C3bBb pre-convertase assembly on virions. Under these circumstances, the complement AP opsonization capacity may be impaired, leading to compromised immune clearance and systemic inflammation in the MIS-C syndrome.

Background:Background: Healthcare systems around the world are still under considerable pressure from the constant threat of the coronavirus disease-19 (COVID-19) pandemic. Although adult sickle cell disease (SCD) patients were vaccinated as a high-risk group, due to their coexisting immunosuppression and possible development of acute thoracic syndrome, there are no data on the following immune response. Aims:Aims: We investigated the immune response of our SCD patients to COVID-19 vaccination. Methods:Methods: We prospectively studied adult SCD patients monitored at our Center who received at least one dose of COVID-19 vaccination until August 2021. We detected neutralizing antibodies (nAbs) against SARS-CoV-2 in patients' sera (ELISA, cPass™ SARS-CoV-2 nAbs Detection Kit; GenScript, Piscataway, NJ, USA), 21 days after each vaccination dose. Levels ≥30% are considered as positive, while levels ≥50% are considered highly protective against severe disease. We investigated possible predictive factors, including age, usage of anticoagulants, pulmonary hypertension, previous episodes of vascular strokes, hydroxycarbamide administration, regular transfusions, renal damage and complement activation. Complement activation was detected in patient's sera by measuring soluble C5b-9 with a commercially available enzyme-linked immunosorbent assay (ELISA) kit (Quidel, upper normal limit: 245 ng/ml), before vaccination and 21 days after the second dose. Results:Results: Among 53 adult SCD patients monitored at our Center, 27 were studied after their first dose (24 received BNT162b2, 2 mRNA-1273, and 1 patient JNJ-78436735). Their median age was 40 years. Sixteen were female and 23 had the S/β genotype. NAbs ≥30% were detected in 14/27 patients, 11 of whom (84%) had already increased complement activation. On the contrary, among the 13 patients who did not develop nAbs after the first dose, only 5 (38.4%) were found with increased levels of soluble C5b-9 (p=0.042). The patient that received the single-shot JNJ vaccine did not develop adequate nAbs, despite increased C5b-9 baseline levels. Interestingly, 2/27 patients who had suffered from a vascular stroke in the past, also did not develop adequate nAbs (p=0.002). No other significant associations between nAbs and studied parameters were found. Clinically important SARS-CoV-2 inhibition and protection against severe disease indicated by nAbs ≥50% was detected only in 11/27 patients (40.7%) after the first dose.Twenty-one days after the second dose we were able to study 22 patients. NAbs significantly increased in all patients (p<0.001) at levels ≥50%, even though 12 patients had levels of <30% after the first dose. Similarly, a significant increase of C5b-9 levels was also detected after the second dose (p=0.009). This increase was above the upper normal limit in the majority of patients (16/22), although 13/22 had normal baseline levels. No complications of COVID-19 vaccinations were reported.

Sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) detected in the liver has been considered a severe complication of hematopoietic stem cell transplantation (HSCT). SOS/VOD is characterized by hepatomegaly, right upper quadrant pain, jaundice, and ascites. The severe forms of the disease may result in multi-organ dysfunction (MOD) with a high mortality rate (>80%). The development of SOS/VOD can be rapid and unpredictable. Therefore, early identification and severity assessment is crucial in facilitating prompt diagnosis and timely treatment. Effective treatment and potential prophylaxis with defibrotide highlight the need for characterizing a sub-group of patients at high risk for SOS/VOD. Moreover, antibodies that are conjugated with calicheamicin, gemtuzumab, and inotuzumab ozogamicin, have led to renewed interest in this syndrome. Evaluation and management of serious adverse events associated with gemtuzumab and inotuzumab ozogamicin are recommended. We review hepatic-, transplant- and patient-related risk factors, criteria for diagnosis and grading classification, and SOS/VOD potential biomarkers. Furthermore, we examine pathogenesis, clinical presentation, diagnostic criteria, risk factors, prophylaxis, and treatment of SOS/VOD occurring post HSCT. Moreover, we aim to provide an up-to-date summary of molecular advances in the diagnosis and management of SOS/VOD. We performed a comprehensive review of the literature and examined the recently available data, mostly using the PubMed and Medline search engines for original articles published over the last decade. In the era of precision medicine, our review provides up-to-date knowledge of genetic or sera markers for SOS/VOD with the goal of identifying a subset of high-risk patients.