Antiphospholipid syndrome: an update

Eur J Clin Invest. 2015 Jun;45(6):653-62. doi: 10.1111/eci.12449. Epub 2015 Apr 24.

Abstract

Background: Antiphospholipid syndrome (APS) or 'Hughes syndrome' is a prothrombotic disease characterized by thrombosis and pregnancy morbidity in the presence of antiphospholipid antibodies (aPL). More than three decades have passed, and experts are still uncovering new pieces of this disease complex pathogenesis and management.

Materials and methods: We searched in literature using MEDLINE and PubMed databases focusing on the latest development on disease pathogenesis, risk assessment of thrombosis and treatment of APS.

Results: The phosphatidylinositol 3-kinase (PI3K)-AKT-mTORC pathway was most recently identified to have a crucial role in activating inflammation among endothelial vessel wall causing vascular lesions in APS. Additionally, new variables are being implemented to assess the risk of thrombosis in patients with APS. Global APS Score (GAPSS) utilizes cardiovascular risk factors and new autoimmune antibodies as part of the score assessment and is the most valid so far. It can be a promising tool in the future for prediction of thrombosis. Anticoagulation remains the cornerstone in APS; however, many new potential therapeutic agents are developing and are currently under investigation.

Conclusions: The most recent advances in pathogenesis, risk stratification and treatment provide a platform for high yield studies with the ultimate goal of providing the optimal management to patients with APS.

Keywords: Antiphospholipid antibodies; antiphospholipid syndrome; management; pathogenesis; risk stratification.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Animals
  • Annexin A2 / antagonists & inhibitors
  • Anticoagulants / therapeutic use
  • Antiphospholipid Syndrome / etiology
  • Antiphospholipid Syndrome / therapy*
  • Drugs, Investigational
  • Female
  • Humans
  • Hydroxychloroquine / therapeutic use
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Immunoglobulins, Intravenous / therapeutic use
  • Immunosuppressive Agents / therapeutic use
  • MAP Kinase Signaling System / physiology
  • Mice
  • Phosphatidylinositol 3-Kinases / metabolism
  • Plasmapheresis
  • Pregnancy
  • Pregnancy Complications, Cardiovascular / etiology*
  • Pregnancy Complications, Cardiovascular / prevention & control
  • Risk Assessment
  • Rituximab
  • Secondary Prevention
  • TOR Serine-Threonine Kinases / metabolism
  • Thromboplastin / antagonists & inhibitors
  • Thrombosis / etiology*
  • Thrombosis / prevention & control

Substances

  • ANXA2 protein, human
  • Adrenal Cortex Hormones
  • Annexin A2
  • Anticoagulants
  • Drugs, Investigational
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Immunoglobulins, Intravenous
  • Immunosuppressive Agents
  • Rituximab
  • Hydroxychloroquine
  • Thromboplastin
  • MTOR protein, human
  • TOR Serine-Threonine Kinases