Immunologic manipulation for the threatened fetus.
Management of the pregnant woman with the antiphospholipid syndrome (APLS) has improved over the last 10 years. The recurrent pregnancy loss that is associated with this disease is managed with prophylactic low dose aspirin and heparin therapy. This therapy leads to a 40% absolute risk reduction in pregnancy loss. However, many women still fail to deliver a live infant despite this therapy so immunologic manipulation of the mother's disease in this group needs to be considered. Intravenous immunoglobulin and plasma exchange may have a role. New immunosuppressive drugs such as tacrolimus have yet to be tried. Monoclonal antibodies to B cells, B-cell growth factors, complement proteins and integrin molecules, all of which appear to play a role in the disease process, may also offer patients some hope. Similarly, biologics such as C1 esterase inhibitor protein, cell surface complement regulator proteins or interleukin-3 need to be tried given their efficacy in models of antibody-induced cell injury.
Benson
Elizabeth M
EM
Department of Immunopathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Australia. elizab@westgate.wh.usyd.edu.au
D000026:Abortion, Habitual / Q000276:immunology; D016736:Antiphospholipid Syndrome / Q000276:immunology* / Q000628:therapy*; D001241:Aspirin / Q000627:therapeutic use; D001402:B-Lymphocytes / Q000276:immunology; D003174:Complement C1 Inactivator Proteins / Q000378:metabolism; D005260:Female; D005333:Fetus; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000737:chemistry / Q000378:metabolism; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016023:Integrins / Q000378:metabolism; D007377:Interleukin-3 / Q000378:metabolism; D008954:Models, Biological; D010641:Phenotype; D010951:Plasma Exchange; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology; D011247:Pregnancy; D011256:Pregnancy Outcome; D012306:Risk
D003174:Complement C1 Inactivator Proteins; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D016023:Integrins; D007377:Interleukin-3; D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D001241:Aspirin