title: From antibody to clinical phenotype, the black box of the antiphospholipid syndrome: pathogenic mechanisms of the antiphospholipid syndrome.
abstract: The antiphospholipid syndrome (APS) is diagnosed by the combination of vascular thrombosis and/or pregnancy morbidity and the detection of antiphospholipid antibodies (aPLs) in plasma. In the last few years, a great effort has been made to unravel the mechanism by which aPLs cause thrombosis and a vast amount of mechanisms have been proposed. aPLs were proposed to induce a prothrombotic state by influencing the cellular blood compartment, the plasma compartment, the vascular wall and even metabolic pathways beyond the hemostatic system. However, due to the diversity in the mechanisms and the differences in the methodology, the focus of the mechanistical studies in this field seems to be largely diffused. It is hard to imagine that aPLs can exert such a diversity of effects, resulting in either thrombosis and/or pregnancy morbidity and the relationship between aPLs and the clinical manifestations remains to be a mysterious "black box". In an attempt to get insight in what takes place inside the black box, we have analyzed 126 mechanistical studies on aPLs and discussed differences in the type of antibodies that were used, the involvement of beta2-glycoprotein I (β2GPI), and the criteria used to diagnose APS patients.
authors: Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands; Sanquin Research, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands.
authors: Vivian X
authors: VX
authors: Du
authors: Hilde
authors: H
authors: Kelchtermans
authors: Philip G
authors: PG
authors: de Groot
authors: Bas
authors: B
authors: de Laat
mesh_terms: D000818:Animals; D017152:Antibodies, Antiphospholipid / Q000276:immunology*; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000276:immunology* / Q000473:pathology*; D005260:Female; D006801:Humans; D010641:Phenotype; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000276:immunology / Q000473:pathology; D013927:Thrombosis / Q000097:blood / Q000276:immunology / Q000473:pathology
chemical_list: D017152:Antibodies, Antiphospholipid
keywords: APS; Antiphospholipid antibodies; Antiphospholipid syndrome; CNS; Central nervous system; EC; Endothelial cells; GPIb; Glycoprotein Ib; ICAM; IL; Interleukin; Intracellular adhesion molecule; LAC; Lupus anticoagulant; TF; TLR; Tissue factor; Toll-like receptor; aPLs; antiphospholipid antibodies; beta2-glycoprotein I; thrombosis; β(2)GPI