Pregnancies complicated with antiphospholipid syndrome: The pathogenic mechanism of antiphospholipid antibodies. A review of the literature

Nicoletta Di Simone, Meroni Pier Luigi, D'Asta Marco, Di Nicuolo Fiorella, D'Ippolito Silvia, D'Alessio Maria Clara, Caruso Alessandro

Research output: Chapter in Book/Report/Conference proceedingConference contribution

Abstract

There are several possible mechanisms by which antiphospholipid antibodies (aPL) may have adverse effects on placental functions. Examination of placentas and first-trimester decidua from antiphospholipid syndrome-complicated pregnancies has found little evidence of specific thrombotic placental pathology. It is now generally accepted that the clinically relevant aPL bind to proteins with affinity for phospholipids. The most important epitope for antiphospholipid syndrome-related aPL resides on β2-glycoprotein-I (β2GPI). aPL detected by anti-β2GPI assays are associated with fetal loss. During differentiation to syncytium, trophoblasts express cellmembrane anionic phospholipids that can bind β2GPI. Adhered β2GPI can be recognized by the antibodies that, once bound, interfere with trophoblast cell maturation, resulting in defective placentation. The improved outcome of pregnancies treated with heparin stimulated interest on the drug's mechanism of action. Several mechanisms could explain its beneficial effects in addition to a direct effect of heparin on the coagulation cascade. It might reduce the binding of aPL, inflammation by inhibiting complement activation, and might facilitate implantation. Further investigations are needed to better understand how aPL induce obstetric complications and to better clarify the functional role of heparin in the human placenta, leading to more successful therapeutic options.

Original languageEnglish
Title of host publicationAnnals of the New York Academy of Sciences
Pages505-514
Number of pages10
Volume1108
DOIs
Publication statusPublished - Jun 2007

Publication series

NameAnnals of the New York Academy of Sciences
Volume1108
ISSN (Print)00778923
ISSN (Electronic)17496632

Keywords

  • Anti-β2-glycoprotein-I
  • Antiphospholipid syndrome
  • Heparin
  • Trophoblast cells

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

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