Obstetric Anti-phospholipid Syndrome: State of the Art

Gerardi, Maria Chiara; Fernandes, Melissa; Tincani, Anǵela; Andréoli, Laura

doi:10.1007/s11926-018-0772-y

Cited by 11 publications

(4 citation statements)

References 119 publications

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“…Eculizumab inhibits terminal complement activation and is apparently effective and safe in the treatment of thrombotic microangiopathy (CAPS) and in the prevention of thrombotic events during pregnancy, both in the mother and newborn. Eculizumab could be a tool to be used in selected cases of refractory OAPS [206,207]. Finally, and has been previously commented, rituximab has been used in CAPS induced by or complicated pregnancy with success and no adverse effects.…”

Section: Other Drugs Tested In the Treatment Of Oapsmentioning

confidence: 97%

Pathogenesis, Diagnosis and Management of Obstetric Antiphospholipid Syndrome: A Comprehensive Review

Alijotas‐Reig

Esteve-Valverde

Anunciación-Llunell

et al. 2022

JCM

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Antiphospholipid syndrome is an autoimmune disorder characterized by vascular thrombosis and/or pregnancy morbidity associated with persistent antiphospholipid antibody positivity. Cases fulfilling the Sydney criteria for obstetric morbidity with no previous thrombosis are known as obstetric antiphospholipid syndrome (OAPS). OAPS is the most identified cause of recurrent pregnancy loss and late-pregnancy morbidity related to placental injury. Cases with incomplete clinical or laboratory data are classified as obstetric morbidity APS (OMAPS) and non-criteria OAPS (NC-OAPS), respectively. Inflammatory and thrombotic mechanisms are involved in the pathophysiology of OAPS. Trophoblasts, endothelium, platelets and innate immune cells are key cellular players. Complement activation plays a crucial pathogenic role. Secondary placental thrombosis appears by clot formation in response to tissue factor activation. New risk assessment tools could improve the prediction of obstetric complication recurrences or thromboses. The standard-of-care treatment consists of low-dose aspirin and prophylactic low molecular weight heparin. In refractory cases, the addition of hydroxychloroquine, low-dose prednisone or IVIG improve pregnancy outcomes. Statins and eculizumab are currently being tested for treating selected OAPS women. Finally, we revisited recent insights and concerns about the pathophysiology, diagnosis and management of OAPS.

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Section: Other Drugs Tested In the Treatment Of Oapsmentioning

confidence: 97%

Pathogenesis, Diagnosis and Management of Obstetric Antiphospholipid Syndrome: A Comprehensive Review

Alijotas‐Reig

Esteve-Valverde

Anunciación-Llunell

et al. 2022

JCM

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“…Firstly, phospholipid function is adhesive molecules during the formation of syncytiotrophoblast (2) . It has been proposed that antiphospholipid antibodies (APAs) may have some relationship with infertility and ICSI outcome (3) . Secondly, the attachment of Antiphospholipid antibodies (APAs) to surface phospholipids on trophoblast may result in direct cellular injury and indirect damage of intravascular thrombosis (4) .…”

Section: Introductionmentioning

confidence: 99%

“…The presence of Antiphospholipid antibodies (APAs) in women who experienced recurrent pregnancy loss (RPL) unexplained infertility allow the diagnosis of RPL (5) . The prevalence of Antiphospholipid antibodies (APAs) was higher in infertile women than fertile, and presence of APAs appear to be associated with intracytoplasmic sperm injection ICSI failure (3) . APAs positively were associated statistically significant lower pregnancy rate and higher abortion rate after ICSI (6) .…”

Section: Introductionmentioning

confidence: 99%

Impact of Antiphospholipid Antibodies on Intracytoplasmic Sperm Injection Outcome

Mohamed

Khafagy

Mahmoud

et al. 2022

SJMS

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Introduction and Aim: The effect of antiphospholipid syndrome on pregnancy is extensively discussed but the debate is still ongoing. This debate increased when the association was examined after assisted reproductive techniques for infertility. The current work aimed to evaluate the influence of Antiphospholipid antibodies in patient undergo first cycle of intracytoplasmic sperm injection. Subjects and Methods: The study comprised 130 of infertile females, who were scheduled for the first ICSI cycle. Before protocol selection, basal hormonal assay was performed and included FSH, LH, E2, prolactin and AMH. Plasma concentration of anti-phospholipids (APAs) was measured. Then, females were categorized into groups according to APAs (positive and negative groups). After ICSI, the clinical pregnancy was confirmed by presence the gestational sac or sac with positive pulsation. Ongoing pregnancy was recognized if the pregnancy continued after 12 weeks of the gestation and clinical miscarriage if pregnancy terminated before 12 weeks of gestation. Results: All females were in their reproductive age (18- 40 years). Their fertility duration ranged between 1 and 7 years, and it was of primary type among 96 women. The long agonist protocol was used for 72 women and the antagonist protocol done for 58 women. The Antiphospholipid antibodies were positive among 27 females (20.8%), and there was no significant difference between APL positive and negative groups regarding pregnancy results (either chemical, clinical, incidence of abortion or ongoing pregnancy after 12 weeks) for all females. However, in women with positive clinical pregnancy, the rate of abortion was significantly increased in patients with APL- positive than negative females (66.7% vs 26.7%). Conclusion: The presence of APA was associated with higher significant abortion rate after the first cycle of ICSI. Thus, screening for APA in women with infertility scheduled for assisted reproduction is recommended.

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“…The syndrome can be diagnosed as "primary" when there is no evidence of any underlying autoimmune processes, or "secondary" if accompanied by other autoimmune diseases, with systemic lupus erythematosus (SLE) being the most common coexisting condition [6]. APS commonly affects women in childbearing age [7], causing significant maternal morbidity and mortality in pregnant women, including recurrent miscarriages, stillbirth or premature birth, preeclampsia, eclampsia, and placental insufficiency [8].…”

Section: Introductionmentioning

confidence: 99%

17β-Estradiol Promotes Proinflammatory and Procoagulatory Phenotype of Innate Immune Cells in the Presence of Antiphospholipid Antibodies

et al. 2020

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Antiphospholipid syndrome (APS) is the most common cause of acquired thrombophilia and recurrent spontaneous miscarriages associated with extended persistence of antiphospholipid antibodies (aPL). How circulating aPL and high-17β-estradiol (E2) environment contribute to the pregnancy complications in APS is poorly defined. Therefore, we aimed to analyse whether E2 could be responsible for the immune cell hyperactivation in aPL- positive (lupus anticoagulant, anti-cardiolipin, anti-β2-glycoprotein) in women. For this, peripheral blood mononuclear cells (PBMCs) from 14 aPL- positive and 13 aPL- negative women were cultured in the presence or absence of E2, LPS or E2+LPS and cell immunophenotype and cytokine release were analysed. In the aPL+ group, E2 presence markedly increased the percentage of NK cells positive for CD69 (p < 0.05), monocytes positive for tissue factor (TF, CD142) (p < 0.05), and B cells expressing PD-L1 (p < 0.05), as well as the elevated production of IL-1β comparing to aPL- women (p < 0.01). Regardless of aPL positivity, E2 augmented the procoagulatory response elicited by LPS in monocytes. Our findings show the ability of E2 to promote proinflammatory and procoagulatory phenotype of innate immune cells in individuals with aPL positivity. Our data highlights the significant impact of female hormones on the activation of immune cells in the presence of aPL.

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Obstetric Anti-phospholipid Syndrome: State of the Art

Cited by 11 publications

References 119 publications

Pathogenesis, Diagnosis and Management of Obstetric Antiphospholipid Syndrome: A Comprehensive Review

Pathogenesis, Diagnosis and Management of Obstetric Antiphospholipid Syndrome: A Comprehensive Review

Impact of Antiphospholipid Antibodies on Intracytoplasmic Sperm Injection Outcome

17β-Estradiol Promotes Proinflammatory and Procoagulatory Phenotype of Innate Immune Cells in the Presence of Antiphospholipid Antibodies

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