Antiphospholipid antibodies: paradigm in transition.
OBJECTIVE
This is a critical review of anti-phospholipid antibodies (aPL). Most prior reviews focus on the aPL syndrome (APS), a thrombotic condition often marked by neurological disturbance. We bring to attention recent evidence that aPL may be equally relevant to non-thrombotic autoimmune conditions, notably, multiple sclerosis and ITP.


METHODS
After a brief history, the recent proliferation of aPL target antigens is reviewed. The implication is that many more exist. Theories of aPL in thrombosis are then reviewed, concluding that all have merit but that aPL may have more diverse pathological consequences than now recognized. Next, conflicting results are explained by methodological differences. The lupus anticoagulant (LA) is then discussed. LA is the best predictor of thrombosis, but why this is true is not settled. Finally, aPL in non-thrombotic disorders is reviewed.


CONCLUSIONS
The current paradigm of aPL holds that they are important in thrombosis, but they may have much wider clinical significance, possibly of special interest in neurology.
Horstman
Lawrence L
LL
Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, LA 71130, USA. lhorstman@med.miami.edu
Jy
Wenche
W
Bidot
Carlos J
CJ
Ahn
Yeon S
YS
Kelley
Roger E
RE
Zivadinov
Robert
R
Maghzi
Amir H
AH
Etemadifar
Masoud
M
Mousavi
Seyed Ali
SA
Minagar
Alireza
A
D000818:Animals; D017152:Antibodies, Antiphospholipid / Q000276:immunology / Q000502:physiology*; D000941:Antigens / Q000276:immunology; D004195:Disease Models, Animal; D006801:Humans; D016682:Lupus Coagulation Inhibitor / Q000502:physiology; D009103:Multiple Sclerosis / Q000503:physiopathology*; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000503:physiopathology*; D013927:Thrombosis / Q000503:physiopathology
D017152:Antibodies, Antiphospholipid; D000941:Antigens; D016682:Lupus Coagulation Inhibitor