Antiphospholipid syndrome treatment beyond anticoagulation: are we there yet?
Persistently positive antiphospholipid antibodies in association with thromboses and/or pregnancy morbidity is the hallmark of the antiphospholipid syndrome. The management of antiphospholipid antibody-positive patients has been focused on utilizing anti-thrombotic medications such as heparin or warfarin. Given that our understanding of the molecular mechanisms of antiphospholipid antibody-mediated thrombosis has been growing, it is highly likely that the current 'anti-thrombotic' approach to these patients will be replaced by an 'immunomodulatory' approach in the near future. This review article will address the experimental and/or clinical evidence behind some of these potential 'immunomodulatory' approaches (tissue factor inhibition, P38 mitogen-activated protein kinase inhibition, nuclear factor-kappaB inhibition, platelet glycoprotein receptor inhibition, hydroxychloroquine, statins, inhibition of beta(2)GPI and/or anti-beta(2)GPI binding to target cells, complement inhibition, and B cell inhibition) in antiphospholipid syndrome.
Pierangeli
S S
SS
Division of Rheumatology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555-0883, USA. sspieran@utmb.edu
Erkan
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D
D000818:Animals; D017152:Antibodies, Antiphospholipid / Q000276:immunology*; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D016503:Drug Delivery Systems; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000209:etiology / Q000276:immunology; D013927:Thrombosis / Q000188:drug therapy / Q000209:etiology / Q000276:immunology; D014859:Warfarin / Q000627:therapeutic use
D017152:Antibodies, Antiphospholipid; D000925:Anticoagulants; D007155:Immunologic Factors; D014859:Warfarin; D006493:Heparin