title: Plasma exchange and immunoadsorption effectively remove antiphospholipid antibodies in pregnant patients with antiphospholipid syndrome.
abstract: Conventional therapy with aspirin and/or heparin is at times incapable of preventing complications in high risk pregnancies of patients with antiphospholipid syndrome (APS). In those cases, a so-called second-line treatment protocol is used in addition to conventional therapy strategies. This manuscript is a report on three APS pregnant patients who were successfully treated with plasma exchange (PE) (two cases) or with immunoadsorption (IA) (one case) as a second-line treatment strategy. The efficacy of these procedures in removing anticardiolipin (aCL) and anti-β(2)glycoprotein I (aβ(2)GPI) antibodies from blood was evaluated. Serum samples were collected before and after 87 apheretic treatment sessions. Serum IgG/M aCL and IgG/M aβ(2)GPI antibodies were determined using an "in-house" enzyme-linked immunosorbent assay and showed that all three patients had medium/high IgG aCL and aβ(2)GPI titers. All three women had a successful pregnancy. A significant decrease in IgG aCL (P = 0.0001) and aβ(2)GPI (P = 0.0001) antibody titers was observed after PE and IA sessions. There was moreover a significant, steady fall in serum IgG aCL pretreatment levels during the course of all three pregnancies (P = 0.0001, P = 0.0001, P = 0.001). The fall in IgG aβ(2)GPI was significant in two of the patients (P = 0.0001, P = 0.0001) both with high antibody titers, but not in one with medium antibody titers, who was treated with PE (P = 0.17).
authors.affiliation: Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy. agnese.bontadi@unipd.it
authors.forename: Agnese
authors.initials: A
authors.lastname: Bontadi
authors.forename: Amelia
authors.initials: A
authors.lastname: Ruffatti
authors.forename: Piero
authors.initials: P
authors.lastname: Marson
authors.forename: Tiziana
authors.initials: T
authors.lastname: Tison
authors.forename: Marta
authors.initials: M
authors.lastname: Tonello
authors.forename: Ariela
authors.initials: A
authors.lastname: Hoxha
authors.forename: Giustina
authors.initials: G
authors.lastname: De Silvestro
authors.forename: Leonardo
authors.initials: L
authors.lastname: Punzi
mesh_terms: D000328:Adult; D017153:Antibodies, Anticardiolipin / Q000097:blood / Q000302:isolation & purification; D017152:Antibodies, Antiphospholipid / Q000097:blood* / Q000302:isolation & purification*; D016736:Antiphospholipid Syndrome / Q000150:complications* / Q000276:immunology / Q000628:therapy*; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000302:isolation & purification; D007163:Immunosorbent Techniques; D007231:Infant, Newborn; D008297:Male; D010951:Plasma Exchange; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology / Q000628:therapy*; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk / Q000276:immunology; D011446:Prospective Studies; D053482:beta 2-Glycoprotein I / Q000276:immunology
chemical_list: D017153:Antibodies, Anticardiolipin; D017152:Antibodies, Antiphospholipid; D007074:Immunoglobulin G; D053482:beta 2-Glycoprotein I