Anti-cardiolipin antibodies (IgG and IgA) in women with recurrent fetal loss correlate to clinical and serological characteristics of SLE

Maternal and fetal outcome of lupus pregnancy: a prospective study of 29 pregnancies

The aim of this study was to analyse pregestational and pregnancy risk factors for adverse fetal and maternal outcome in lupus pregnancy. Twenty women with systemic lupus erythematosus (SLE) (29 pregnancies) were prospectively evaluated.

Mean patient age was 29.5 + 4.7 years, and mean disease duration, 6.3 + 6.5 years. Twenty-two pregnancies (75.9%) ended in live births; preterm delivery occurred in 17.4%, intrauterine growth restriction in 50%, preeclampsia in 3.7%, and gestational hypertension in 8%. Six pregnancies (20.7%) ended in spontaneous abortions. Adverse live-birth outcome was significantly associated with low pregestational serum albumin level, elevated gestational anti-dsDNA antibody, and diabetes mellitus. Spontaneous abortion was directly associated with low levels of pregestational serum albumin, positive anticardiolipin IgA, anti-β2-glycoprotein I IgM, and anti-La antibodies, and inversely associated with number of patients’ children. Postgestational lupus flare-up was noted in six pregnancies. Risk factors included high pregestational SLE Disease Activity Index (SLEDAI), lower serum albumin, elevated serum antibody to dsDNA, proteinuria, and use of prednisone and hydroxychloroquine.

We conclude that despite high rate of obstetrical complications and postpartum lupus flare-up, pregnancy poses low risk for the majority of women with SLE.

Study on antiphospholipid/anticardioliplin antibodies in women with recurrent abortion

Background

Antiphospholipid antibodies are associated with recurrent abortion but correlation between level of antibodies and gestational age of abortion and duration post abortion is not clear.

Objectives

Aim of this study was study on relation between antiphospholipid antibodies in women with recurrent abortion and their gestational age and duration post abortion.

Patients and Methods

We performed a case-control study on 197 pregnant women who had history of spontaneous recurrent abortion as case group and 50 pregnant healthy women as control group. Demographic characteristic of all participants filled in questionnaire forms. Antipospholipid and anticardiolipin antibodies were measured in their serum by Enzyme linked Immunoassay with orgenec kits. Data analyzed by SPSS software (version 13) and T statistical test. P value less than 0.05 was considered significant.

Results

Mean age of participants was 24-39 years old. The average rate of antiphospolipid antibodies in patients with normal anticardiolipin was greater than those with abnormal anticardiolipin and T-test showed significant difference between two groups.(P = 0.000) In case group the number of abortions was more, mean of antiphosopolipid antibody levels were also higher. Mean anticardiolipin and antiphospholipid antibodies rate was greater with increasing gestational age at time of first abortion. Almost mean antipospholipid and anticardiolipin antibodies in all patients remained in high level just in first 5 years with any number of abortions and five years later, antibodies began to fall.

Conclusions

Antipospholipid antibodies based on number of abortions and gestational age of abortions were increased. Mean antipospholipid and anticardiolipin antibodies in all patients remained in high level just in first 5 years post abortion and then began to fall.

Beta-2 glycoprotein I and its role in antiphospholipid syndrome—lessons from knockout mice

The antiphospholipid syndrome is characterized by the presence in serum of autoantibodies against beta2GPI. Although the role of beta2GPI in the pathogenesis of antiphospholipid antibody syndrome (APS) is well recognized, its exact physiological functions still remain undisclosed. Several interactions of beta2GPI with components of the coagulation cascade have been proposed, resulting in both procoagulant and anticoagulant effects. Additionally, beta2GPI has been implicated in the mechanism of recurrent fetal loss entailed in APS. Recently, using a homologous recombination approach, reproduction of mice homozygous for deletion of the beta2GPI gene has been feasible. beta2GPI knockout mice offer a valuable tool for revealing the physiological role of the protein. These mice show decreased in vitro ability for thrombin generation. Furthermore, although mice lacking beta2GPI are fertile, the success of early pregnancy is moderately compromised and functional beta2GPI is believed necessary for optimal implantation and placental morphogenesis.

Antiphospholipid antibodies: discovery, definitions, detection and disease

Antiphospholipid antibodies (aPL) are immunoglobulins of IgG, IgM and IgA isotypes that target phospholipid (PL) and/or PL-binding plasma proteins. Detection of aPL in the laboratory is done currently by both immunoassays and functional coagulation tests. Convention defines aPL specificity in immunoassays according to the particular PL substrate present, for example aPS represents antiphosphatidylserine antibodies. This may be technically incorrect inasmuch as a particular PL may be responsible for binding and highly concentrating a specific plasma protein, the latter then becomes the target for the aPL. The binding of beta(2)GP-I (apolipoprotein H) to the negatively charged PL, cardiolipin (CL) provides a good example of this circumstance. In contrast, aPL which specifically prolong coagulation times in in vitro are called lupus anticoagulants (LA). The precise PL target(s) of the aPL responsible for LA activities are unknown and often debated. The persistent finding of aPL in patients in association with abnormal blood clotting and a myriad of neurological, obstetrical and rheumatic disorders often compounded by autoimmune diseases has led to an established clinical diagnosis termed antiphospholipid syndrome (APS). The common denominator for these APS patients is the presence of circulating aPL on two or more occasions and the observation of events attributable to abnormal or accelerated blood clotting somewhere in vivo. The purpose of this review is to collect, collate, and consolidate information concerning aPL.

Placental pathology in systemic lupus erythematosus and phospholipid antibody syndrome

Fetal loss is increased in women who meet the Arthritis and Rheumatism Association criteria for systemic lupus erythematosus (SLE) and in women who have phospholipid antibody syndrome (APS). There are multiple causes for this fetal loss, and in patients with SLE, disease activity appears to be an important contributing factor. In APS patients, it appears that some individuals will experience recurrent fetal loss and will continuously fail to complete pregnancy naturally. Placental examination has helped to elucidate some of the pathology that may be contribute to this fetal loss and our studies have shown that the same pathology is repeated in subsequent pregnancies. Placental examination in SLE or APS patients with recurrent fetal loss is vital if we are going to be able to determine appropriate therapy to prevent fetal loss.

Myocardial infarction as the presenting manifestation of systemic lupus erythematosus with antiphosphatidylserine antibodies

BACKGROUND

The presence of antiphospholipid antibodies has been associated with thrombotic events in systemic lupus erythematosus and other diseases. Antiphosphatidylserine antibodies have been shown more recently to have clinical implications being noted in thrombocytopenia, positive VDRL test, prolonged partial thromboplastin time, and recurrent fetal loss.

OBJECTIVE

To report a patient with systemic lupus erythematosus who presented with a myocardial infarction resulting from a single clot in the distal left anterior descending coronary artery and to discuss the merits of evaluating such patients for the presence of antiphospholipid antibodies.

METHODS

Case report and review of the literature.

RESULTS

A 55-year-old woman with no risk factors for coronary artery disease presented with a myocardial infarction. A distal left anterior descending coronary artery clot was seen on angiography. Evaluation for the presence of a hypercoagulable state revealed evidence for systemic lupus erythematosus. Although lupus anti-coagulant and anticardiolipin antibody titers were negative, antiphosphatidylserine IgA antibodies were detected.

CONCLUSION

Because antiphosphatidylserine antibodies of the IgA isotype have been shown to be associated with thrombosis and other manifestations of systemic lupus erythematosus, a complete evaluation for antiphospholipid antibodies should include testing for all three isotypes.

Effect of bone marrow transplantation on antiphospholipid antibody syndrome in murine lupus mice

The (NZW x BXSB)F1 (W/BF1) mouse is known to be an animal model of systemic lupus erythematosus (SLE) and immune thrombocytopenic purpura (ITP). These mice produce not only anti-DNA antibodies but also anti-platelet antibodies, resulting in decreased platelet counts. They show a high level of proteinuria, increased white blood cell (WBC) counts, hypertension, and myocardial infarction due to the high levels of anti-cardiolipin antibodies. When W/BF1 mice (4-5 months) were lethally irradiated and then reconstituted with T cell-depleted bone marrow cells of normal BALB/c mice (8 weeks), 60% of the mice survived more than one year. The WBC and platelet counts in the mice were normalized, and the levels of anti-DNA and anti-platelet antibodies decreased. The renal dysfunction was also ameliorated as indicated by a lower level of proteinuria, lower levels of serum creatinine (S-CRTN) and blood urea nitrogen (BUN), and by improved histology. The blood pressure (BP) of the treated W/BF1 mice decreased due to the improved renal functions. In contrast to the non-treated W/BF1 mice which died of myocardial infarction or renal failure by the age of 7 months, the treated W/BF1 mice showed no evidence of myocardial infarction even one year after BMT. This was due to the lower cardiolipin levels.

Lymphocyte subsets and autoantibodies in pregnancies complicated by placental disorders

PROBLEM

The survival of the fetoplacental unit might partly depend on down-regulation of rejection reactions. Pathological maternal cellular immune response mechanisms could therefore be of pathogenic importance in pregnancies complicated by placental disorders.

METHOD

A flow-cytometric analysis of T-cell subsets and B-cell, as well as serological tests for anticardiolipin antibodies (aCL), antinuclear antibodies (ANA), and rheumatoid factor (RF) were done on 90 women with complicated pregnancies. The results were compared with that of nonpregnant women (n = 5), and normal pregnant women (n = 5) in the third trimester.

RESULTS

Two women, suffering from severe preeclampsia and eclampsia respectively, had aCL on 12 and 13 units, respectively. ANA occurred in 11 patients with moderate and severe preeclampsia and intrauterine growth retardation. All women had negative RF tests. Within the CD4 T-helper subpopulations, the proportion of suppressor/inducer T-cell population (CD4+CD45RA+) significantly increased, while the memory and helper/inducer T-cells (CD4+CD45RO+ and CD4+CD29+) significantly decreased during normal pregnancy compared to nonpregnant controls. This deviation of CD4 subpopulations was not found, or was less pronounced, in complicated pregnancies. The proportion of cytotoxic T cells (CD8+S6F1+) was significantly reduced during normal pregnancy. This reduction was less pronounced in complicated pregnancies.

CONCLUSION

Systemic immunological deviations toward suppression or decreased activity of the immunological response as seen in normal pregnancies, was not observed in preeclampsia, intrauterine growth retardation, intrauterine fetal death, and abruptio placentae. This lack of suppression or increased T-cell activity may have a primary pathogenic role in some women with a complicated pregnancy, or it may be secondary to the placental disorders.