Primary anti-phospholipid syndrome: any role for serum complement levels in predicting pregnancy complications?

Reggia, Rossella; Ziglioli, Tamara; Andréoli, Laura; Bellisai, Francesca; Iuliano, Annamaria; Gerosa, Maria; Ramoni, Vèronique; Tani, Chiara; Brucato, Antonio; Galeazzi, Mauro; Mosca, Marta; Caporali, Roberto; Meroni, Pier Luigi; Tincani, Anǵela

doi:10.1093/rheumatology/kes225

Cited by 38 publications

(27 citation statements)

References 12 publications

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“…Previous studies have demonstrated that the activation of complement components C3, C4, and C5 increases the risk of injury or death in animal models injected with aPL ( 16 , 17 ). Our group has also investigated this relationship in a multicenter study ( 18 ). Utilizing pregnancy C3 and C4 normality ranges (in each trimester), we did not show an association between hypocomplementemia and obstetric complications in primary APS.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Adverse Maternal and Fetal Outcomes in Women With Confirmed aPL Positivity: Results From a Multicenter Study of 283 Pregnancies

et al. 2018

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ObjectiveAntiphospholipid antibodies positivity (aPL) is considered as a risk factor for adverse pregnancy outcome (APO). The aim of this study was to determine the risk factors for APO in patients with confirmed aPL positivity, isolated (aPL carriers) or associated with a definite primary antiphospholipid syndrome (PAPS).MethodsThe clinical and laboratory features of 283 pregnancies occurring between 2000 and 2014 in 200 women were collected in three institutions.ResultsThe rate of live birth was 87.9% and APO was observed in 50 cases (17.7%). Multivariate analysis showed that the independent variables related to APO were the concomitant diagnosis of an organ-specific autoimmune disease (p = 0.012, odds ratio (OR) 3.29, confidence interval (CI) 95% 1.29–8.38) and the presence of low complement levels during the first trimester (p = 0.02, OR 2.3, CI 95% 1.17–9.15). No statistical differences were found in APO occurrence among patients treated with low-dose aspirin (LDA) versus those treated with LDA plus heparin (LMWH), but LDA + LMWH was more frequently administered in patients with triple aPL positivity (p = 0.001, OR 3.21, CI 95% 1.48–7.11) and with PAPS (p < 0.001, OR 8.08, CI 95% 4.3–15.4). Based on clinical history, the patients were divided into four groups: obstetric, thrombotic, non-criteria antiphospholipid syndrome (clinical non-criteria), and aPL carriers. APOs were more frequent in the thrombotic group (24%). Seven patients had a thrombotic event during pregnancy or puerperium (2.4%).ConclusionMaternal and fetal complications were observed in some aPL-positive patients despite their efficient management according to the current recommendations. A higher risk of APO was observed in patients with a previous thrombosis and/or more complex autoimmune phenotype.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Adverse Maternal and Fetal Outcomes in Women With Confirmed aPL Positivity: Results From a Multicenter Study of 283 Pregnancies

et al. 2018

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“…Even if our study was performed in few patients, higher CD8+DR+ T-cell percentages were an independent risk factor for development of complications. Poor pregnancy outcomes have been described among primary APS pregnancies with hypocomplementemia [19]. The percentage of circulating CD8+DR+ T-cells has been suggested as a biological marker which accurately reflects disease activity in SLE patients [20].…”

Section: Discussionmentioning

confidence: 99%

CD8+DR+ T-Cells and C3 Complement Serum Concentration as Potential Biomarkers in Thrombotic Antiphospholipid Syndrome

Sarmiento

Dale

Arraya

et al. 2014

Autoimmune Diseases

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Purpose. To assess complement factors and T lymphocyte activation subset abnormalities in patients with thrombotic antiphospholipid syndrome (APS) as potential biomarkers for development of clinical complications. Methods. We assessed C3, C4, factor B concentrations (nephelometry), complement haemolytic functional activity (CH100, radial immune diffusion), and the activation status of CD4+ and CD8+ T-cells (three-colour flow cytometry) in patients with thrombotic APS. Antiphospholipid (aPL) positive patients without APS-related clinical criteria, systemic lupus erythematosus (SLE) patients, and healthy individuals were evaluated as controls. A clinical followup was performed to assess the potential relationship between the immunological parameters and development of APS-related complications. Results. Lower concentrations of C3 and higher levels of CD8+DR+ cells were risk factors for development of APS-related complications during followup, including rethrombosis and neuropsychiatric symptoms. Patients with diagnosed thrombotic APS had significantly lower levels of C3, C4, and CH100 as well as higher percentages of activated CD4+DR+ and of CD8+DR+ T-cells than healthy controls but similar to that observed in autoimmune disease controls. Conclusion. Lower C3 and C4 complement levels and higher percentages of CD8+DR+ T-cells were observed in thrombotic APS patients. The potential role of these abnormalities as biomarkers of clinical outcome warrants further evaluation in a multicenter study.

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“…However, a subsequent study failed to report any association between hypocomplementemia and obstetric complications [47]. Conventional treatment of patients with APS during pregnancy can significantly improve live birth rates, so reaching more than 70 % of live birth rate [48], but other complications remain high despite treatment.…”

Section: Authors (Reference) Year Clinical Reports Treatment Protocolmentioning

confidence: 99%

Additional Treatments for High-Risk Obstetric Antiphospholipid Syndrome: a Comprehensive Review

Ruffatti

Hoxha

Favarò

et al. 2016

Clinic Rev Allerg Immunol

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Most investigators currently advocate prophylactic-dose heparin plus low-dose aspirin as the preferred treatment of otherwise healthy women with obstetric antiphospholipid syndrome, whilst women with a history of vascular thrombosis alone or associated with pregnancy morbidity are usually treated with therapeutic heparin doses in association with low-dose aspirin in an attempt to prevent both thrombosis and pregnancy morbidity. However, the protocols outlined above fail in about 20 % of pregnant women with antiphospholipid syndrome. Identifying risk factors associated with pregnancy failure when conventional therapies are utilized is an important step in establishing guidelines to manage these high-risk patients. Some clinical and laboratory risk factors have been found to be related to maternal-foetal complications in pregnant women on conventional therapy. However, the most efficacious treatments to administer to high-risk antiphospholipid syndrome women in addition to conventional therapy in order to avoid pregnancy complications are as yet unestablished. This is a comprehensive review on this topic and an invitation to participate in a multicentre study in order to identify the best additional treatments to be used in this subset of antiphospholipid syndrome patients.

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Primary anti-phospholipid syndrome: any role for serum complement levels in predicting pregnancy complications?

Cited by 38 publications

References 12 publications

Risk Factors for Adverse Maternal and Fetal Outcomes in Women With Confirmed aPL Positivity: Results From a Multicenter Study of 283 Pregnancies

Risk Factors for Adverse Maternal and Fetal Outcomes in Women With Confirmed aPL Positivity: Results From a Multicenter Study of 283 Pregnancies

CD8+DR+ T-Cells and C3 Complement Serum Concentration as Potential Biomarkers in Thrombotic Antiphospholipid Syndrome

Additional Treatments for High-Risk Obstetric Antiphospholipid Syndrome: a Comprehensive Review

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