Background: Specific autoantibodies and nailfold videocapillaroscopy (NVC) findings are serum and morphological diagnostic hallmarks of systemic sclerosis (SSc) as well as useful biomarkers which stratify the microvascular progression and prognosis of patients. Methods: The aim of our narrative review is to provide an update and overview of the link between SSc-related autoantibodies, used in clinical practice, and microvascular damage, evaluated by NVC, by exploring the interaction between these players in published studies. A narrative review was conducted by searching relevant keywords related to this field in Pubmed, Medline and EULAR/ACR conference abstracts with a focus on the findings published in the last 5 years. Results: Our search yielded 13 clinical studies and 10 pre-clinical studies. Most of the clinical studies (8/13, 61.5%) reported a significant association between SSc-related autoantibodies and NVC patterns: more specifically anti-centromere autoantibodies (ACA) were associated more often with an “Early” NVC pattern, whereas anti-topoisomerase autoantibodies (ATA) more frequently showed an “Active” or “Late” NVC pattern. Five studies, instead, did not find a significant association between specific autoantibodies and NVC findings. Among the pre-clinical studies, SSc-related autoantibodies showed different mechanisms of damage towards both endothelial cells, fibroblasts and smooth muscle vascular cells. Conclusions: The clinical and laboratory evidence on SSc-related autoantibodies and microvascular damage shows that these players are interconnected. Further clinical and demographic factors (e.g., age, sex, disease duration, treatment and comorbidities) might play an additional role in the SSc-related microvascular injury whose progression appears to be complex and multifactorial.
ObjectiveNailfold videocapillaroscopy (NVC) allows the detection of microvascular damage in autoimmune connective tissue diseases (CTDs). The prevalence of the morphological capillary findings was retrospectively evaluated in a wide cohort of patients with Raynaud’s phenomenon secondary to a CTD at the time of the first single NVC, independently from their current treatment, autoantibody profile and comorbidities.MethodsOne-thousand-one-hundred-eighty-one patients affected by CTDs were included from 2001 to 2021. The considered CTDs were systemic sclerosis (SSc), undifferentiated connective tissue disease (UCTD), mixed connective tissue disease (MCTD), dermatomyositis (DM), systemic lupus erythematosus, Sjögren’s syndrome and primary antiphospholipid syndrome (aPS). The capillaroscopic parameters were distinguished between scleroderma patterns and non-scleroderma patterns.ResultsGiant capillaries were significantly more frequent in SSc, DM and MCTD than in other CTDs (respectively, in 73%, 73% and 61% of patients, p<0.001 when comparing each rate vs the other CTDs). The mean capillary count was significantly lower in SSc, DM and MCTD (respectively, 7.04±0.18 vs 6.5±0.75 vs 7.7±2 capillaries/linear mm) compared with the other CTDs (p<0.001 for each rate vs the other CTDs). The non-specific abnormalities of capillary morphology were significantly more frequent in SSc, MCTD and aPS (respectively, in 48%, 41% and 36% of cases, all p<0.001 vs each other CTDs).ConclusionThis large size sample of patients with CTDs, collected over 20 years of analysis, confirms the highest prevalence of specific capillaroscopic alterations in patients with SSc, DM and MCTD, when compared with other CTDs.
BackgroundDuring pregnancy, exchanges between mother and fetus are provided by the placenta. Defects in the early stages of placentation prevent the creation of a high-flow, low-resistance circle resulting in an impaired maternal-fetal exchange. The development of aberrant microcirculation leads to placental abnormalities, detectable by placental histologic examination [1].ObjectivesTo assess whether nailfold videocapillaroscopy (NVC), in combination with umbilical artery doppler ultrasound (UA-dU), can detect microvascular status during pregnancy [2]; and to evaluate if NVC follow-up during pregnancy might operate as a red flag biomarker of placental microcirculation abnormalities.MethodsWe conducted a longitudinal observational exploratory study on 54 healthy pregnant women (age range 26-46 y) within the 16th gestational week, excluding those with cardiovascular comorbidities. We performed clinical, UA-dU and NVC evaluation with an optical probe (200x magnification) at each trimester of pregnancy and post-partum [3]. We performed an after-birth placenta histology (abPH) in a subgroup of 20 women (among the 54 women) who developed complications during pregnancy (e.g., gestational hypertension) evaluated through optical microscopic technique, according to Amsterdam criteria [4].ResultsWe noticed over time, in the whole cohort, a statistically significant increase in neo-angiogenesis (p<0.05), considering the absolute count of microvessel ramifications (abnormal shapes) (Figure 1a). Conversely, we did not observe any statistically significant variation in capillary density (n/linear mm), microhaemorrhages or dilated capillaries over time. Besides, a statistically significant difference in the absolute number of capillaries in the first trimester between subjects with and without areas of placental dysmaturity (aberrant placental microcirculation) was detected at abPH (7.0/mm ± 0.82 vs 8.2/mm ± 0.62;p=0.030), (Figure 1b). A receiver operating characteristic curve was drawn for calculating the Area Under the Curve (AUC: 0.87; 95%CI: 0.66–1.00), identifying the optimal discriminatory cut-off value for prediction of placental dysmaturity areas (≤7.50/mm capillaries, sensitivity: 88.9%; specificity: 75.0%). Of note, a similar difference was confirmed at the third trimester, although not reaching statistical significance (p=0.06). Not any significant association was found between UA-dU and any of the assessed NVC parameters.ConclusionThis study confirms, in a large cohort of pregnant women, the NVC detection of increased neoangiogenesis over time, even during post-partum. In addition, this is the first report suggesting the possible role of NVC (capillary density) for the early detection of aberrant placental microcirculation noticeable at abPH. A study in pregnant patients affected by autoimmune connective tissue diseases has already started, using those findings as reference parameters.References[1]Rana S. et al. Circ Res, vol. 124, n. 7, pp. 1094–1112, Mar 2019.[2]Pacini G. et al. Microvasc Res, vol. 141, May 2022.[3]Smith V. et al. Autoimmun Rev vol. 19, n. 3. Elsevier B.V., Mar. 01, 2020.[4]Khong T.Y. et al. Arch Pathol Lab Med, Jul. 2016, vol. 140, n. 7, pp. 698–713Figure 1.a. Neo-angiogenesis (arrows) at the 3rdtrimester (magnification 200x). b. Difference in the absolute number of capillaries in the 1sttrimester between women with and without areas of placental dysmaturity at abPH.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.