Antiphospholipid antibodies and the antiphospholipid syndrome: pathogenic mechanisms.
Antiphospholipid antibodies (Abs) are associated with thrombosis and are a risk factor for recurrent pregnancy loss and obstetric complications in patients with the antiphospholipid syndrome. It is generally accepted that the major autoantigen for aPL Abs is beta (2) glycoprotein I, which mediates the binding of aPL Abs to target cells (i.e., endothelial cells, monocytes, platelets, trophoblasts, etc.) leading to thrombosis and fetal loss. This article addresses molecular events triggered by aPL Abs on endothelial cells, platelets, and monocytes and complement activation, as well as a review of the current knowledge with regard to the putative receptor(s) recognized by aPL Abs on target cells as well as novel mechanisms that involve fibrinolytic processes. A section is devoted to the description of thrombotic and inflammatory processes that lead to obstetric complications mediated by aPL Abs. Based on experimental evidence using in vitro and in vivo models, new targeted therapies for treatment and/or prevention of thrombosis and pregnancy loss in antiphospholipid syndrome are proposed.
Pierangeli
Silvia S
SS
Division of Rheumatology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555-1165, USA. sspieran@utmb.edu
Chen
Pojen P
PP
Raschi
Elena
E
Scurati
Silvia
S
Grossi
Claudia
C
Borghi
Maria Orietta
MO
Palomo
Ivan
I
Harris
E Nigel
EN
Meroni
Pier Luigi
PL
D000026:Abortion, Habitual / Q000209:etiology / Q000503:physiopathology; D017152:Antibodies, Antiphospholipid / Q000276:immunology*; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000209:etiology / Q000276:immunology* / Q000503:physiopathology; D001324:Autoantigens / Q000276:immunology; D001792:Blood Platelets / Q000276:immunology / Q000502:physiology; D003167:Complement Activation; D042783:Endothelial Cells / Q000276:immunology / Q000502:physiology; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D018836:Inflammation Mediators / Q000502:physiology; D009000:Monocytes / Q000276:immunology / Q000502:physiology; D010920:Placenta / Q000473:pathology; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D013917:Thrombin / Q000502:physiology; D019851:Thrombophilia / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D013925:Thromboplastin / Q000502:physiology; D014327:Trophoblasts / Q000276:immunology / Q000473:pathology; D020246:Venous Thrombosis / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D053482:beta 2-Glycoprotein I / Q000276:immunology
D017152:Antibodies, Antiphospholipid; D001324:Autoantigens; D018836:Inflammation Mediators; D053482:beta 2-Glycoprotein I; D013925:Thromboplastin; D013917:Thrombin