Antiphospholipid syndrome: advances in diagnosis, pathogenesis, and management.
Review published in BMJ (Clinical research ed.) (2023)
Abstract
Antiphospholipid syndrome (APS) is a thrombo-inflammatory disease propelled by circulating autoantibodies that recognize cell surface phospholipids and phospholipid binding proteins. The result is an increased risk of thrombotic events, pregnancy morbidity, and various other autoimmune and inflammatory complications. Although antiphospholipid syndrome was first recognized in patients with lupus, the stand alone presentation of antiphospholipid syndrome is at least equally common. Overall, the diagnosis appears to affect at least one in 2000 people. Studies of antiphospholipid syndrome pathogenesis have long focused on logical candidates such as coagulation factors, endothelial cells, and platelets. Recent work has shed light on additional potential therapeutic targets within the innate immune system, including the complement system and neutrophil extracellular traps. Vitamin K antagonists remain the mainstay of treatment for most patients with thrombotic antiphospholipid syndrome and, based on current data, appear superior to the more targeted direct oral anticoagulants. The potential role of immunomodulatory treatments in antiphospholipid syndrome management is receiving increased attention. As for many systemic autoimmune diseases, the most important future direction is to more precisely identify mechanistic drivers of disease heterogeneity in pursuit of unlocking personalized and proactive treatments for patients.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Zusammenfassung
Antiphospholipid syndrome (APS) is a thrombo-inflammatory disease propelled by circulating autoantibodies that recognize cell surface phospholipids and phospholipid binding proteins. The result is an increased risk of thrombotic events, pregnancy morbidity, and various other autoimmune and inflammatory complications.
Warum dies für die Hirudotherapie relevant ist
Diese Übersichtsarbeit behandelt Fortschritte in Diagnose, Pathogenese und Management des Antiphospholipid-Syndroms (APS), einer thrombo-inflammatorischen Erkrankung, die durch Autoantikörper gegen Phospholipid-bindende Proteine getrieben wird, mit Diskussion von Gerinnungskaskaden, Endothelzellen, Thrombozyten, Komplement und neutrophilen extrazellulären Fallen. Sie merkt an, dass Vitamin-K-Antagonisten weiterhin die Hauptstütze der Behandlung des thrombotischen APS darstellen. Die Relevanz des Artikels für die Hirudotherapie ist höchstens indirekt: Obwohl APS pathologische Thrombosen umfasst, die theoretisch von Blutegel-abgeleiteten Antikoagulanzien wie Hirudin adressiert werden könnten, erwähnt die Übersichtsarbeit weder Blutegel noch Blutegel-abgeleitete Therapien, und es werden keine Daten präsentiert, die das APS-Management mit dem Blutegelsekretom verknüpfen.
Zitation
Antiphospholipid syndrome: advances in diagnosis, pathogenesis, and management.
Knight et al. · BMJ (Clinical research ed.), 2023
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