Predictors of Pregnancy Outcome in Antiphospholipid Syndrome: A Review

Carolis, Sara De; Botta, Angela; Santucci, S.; Garofalo, Serafina; Martino, Carmelinda; Perrelli, Alessandra; Salvi, Silvia; Ferrazzani, Sergio; Caforio, Leonardo; Scambia, Giovanni

doi:10.1007/s12016-009-8144-z

Cited by 39 publications

(25 citation statements)

References 47 publications

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“…IVIG intravenous immunoglobulins, HCQ hydroxychloroquine virus tests) was an independent predictor of lower neonatal birth weight [46]. However, a subsequent study failed to report any association between hypocomplementemia and obstetric complications [47].…”

Section: Authors (Reference) Year Clinical Reports Treatment Protocolmentioning

confidence: 96%

Additional Treatments for High-Risk Obstetric Antiphospholipid Syndrome: a Comprehensive Review

Ruffatti

Hoxha

Favarò

et al. 2016

Clinic Rev Allerg Immunol

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Most investigators currently advocate prophylactic-dose heparin plus low-dose aspirin as the preferred treatment of otherwise healthy women with obstetric antiphospholipid syndrome, whilst women with a history of vascular thrombosis alone or associated with pregnancy morbidity are usually treated with therapeutic heparin doses in association with low-dose aspirin in an attempt to prevent both thrombosis and pregnancy morbidity. However, the protocols outlined above fail in about 20 % of pregnant women with antiphospholipid syndrome. Identifying risk factors associated with pregnancy failure when conventional therapies are utilized is an important step in establishing guidelines to manage these high-risk patients. Some clinical and laboratory risk factors have been found to be related to maternal-foetal complications in pregnant women on conventional therapy. However, the most efficacious treatments to administer to high-risk antiphospholipid syndrome women in addition to conventional therapy in order to avoid pregnancy complications are as yet unestablished. This is a comprehensive review on this topic and an invitation to participate in a multicentre study in order to identify the best additional treatments to be used in this subset of antiphospholipid syndrome patients.

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Section: Authors (Reference) Year Clinical Reports Treatment Protocolmentioning

confidence: 96%

Additional Treatments for High-Risk Obstetric Antiphospholipid Syndrome: a Comprehensive Review

Ruffatti

Hoxha

Favarò

et al. 2016

Clinic Rev Allerg Immunol

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“…Outcome studies have shown that the rate of fetal loss is up to 18% during APS pregnancies compared with a rate of early fetal loss of 1% and a rate of second and third trimester fetal demise of 5% in the general population (3;8;9). The reported frequency of IUGR in APS pregnancies ranges from 13 to 33% (8;10;11), and aPL are detected in 25% of women whose infants suffer from IUGR (3). Premature delivery occurs in 16 to 50% of APS pregnancies despite maternal therapy, with an average gestational age at birth of 31 weeks in one study (8;11;12).…”

Section: Introductionmentioning

confidence: 99%

ApoE Receptor 2 Mediation of Trophoblast Dysfunction and Pregnancy Complications Induced by Antiphospholipid Antibodies in Mice

Ulrich

Gelber

Vukelic

et al. 2016

Arthritis & Rheumatology

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Objective Pregnancies in women with the antiphospholipid syndrome (APS) are frequently complicated by fetal loss and intrauterine growth restriction (IUGR). How circulating antiphospholipid antibodies (aPL) cause pregnancy complications in APS is poorly understood. We sought to determine if the LDL receptor family member apoE receptor 2 (apoER2) mediates trophoblast dysfunction and pregnancy complications induced by aPL. Methods Placental and trophoblast apoER2 expression was evaluated by immunohistochemistry and immunoblotting. Normal human IgG (NHIgG) and aPL were purified from healthy individuals and APS patients, respectively. The role of apoER2 in aPL-induced changes in trophoblast proliferation, migration and kinase activation was assessed using RNA interference in HTR-8/SVneo cells. The participation of apoER2 in aPL-induced pregnancy loss and IUGR was evaluated in pregnant apoER2+/+ and apoER2−/− mice injected with aPL or NHIgG. Results We found that apoER2 is abundant in human and mouse placental trophoblasts, and in multiple trophoblast-derived cell lines including HTR-8/SVneo cells. ApoER2 and its interaction with the cell surface protein β2-glycoprotein I were required for aPL-induced inhibition of cultured trophoblast proliferation and migration. In parallel, aPL antagonism of Akt kinase activation by EGF in trophoblasts was mediated by apoER2. Furthermore, in a murine passive transfer model of pregnancy complications of APS, apoER2−/− mice were protected from both aPL-induced fetal loss and aPL-induced IUGR. Conclusion ApoER2 plays a major role in the attenuation of trophoblast function by aPL, and the receptor mediates aPL-induced pregnancy complications in vivo in mice. ApoER2-directed interventions can now potentially be developed to combat the pregnancy complications associated with APS.

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“…Conventional treatment based on low molecular weight heparin (LMWH) and low-dose aspirin (LDA) is associated with a rate of live birth of almost 80% [1][2][3]. Despite these encouraging results, some APS patients remain unable to give birth to healthy neonates.…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have been performed in order to identify risk factors predictive of complications despite the conventional treatment [3,4].…”

Section: Introductionmentioning

confidence: 99%