Alterations of the complement system in patients with catastrophic antiphospholipid syndrome

Abstract

AIM: To investigate alterations of the complement system in patients with catastrophic antiphospholipid syndrome (CAPS)/MATERIAL AND METHODS: Four patients (2 men aged 23 and 40 years and 2 women aged 39 and 58 years) diagnosed as having CAPS, including 3 patients with systemic lupus erythematosus and secondary antiphospholipid syndrome (APS) and 1 patient with primary APS, were examined. The activity of the complement components C1-C5 and total hemolytic activity were determined in all the patients at the moment of an acute episode and in 1 patient after treatment/RESULTS: The activity of the studied complement components and total hemolytic complement activity proved to be significantly decreased in all the patients. That of complement components recovered after treatment using fresh frozen plasma. The possibility and mechanisms of complement system activation in the patients with CAPS are discussed/CONCLUSION: The preliminary results obtained by the examination of few cases may lead to the conclusion that the complement system may be involved in the development of CAPS.

Full Text

Изменения в системе комплемента у больных с "катастрофическим" антифосфолипидным синдромом. - Резюме. Цель исследования. Изучить изменения в системе комплемента у больных с "катастрофическим" антифосфолипидным синдромом (КАФС). Материалы и методы. Описаны 4 больных с диагнозом КАФС (2 мужчин в возрасте 23 и 40 лет и 2 женщин 39 и 58 лет), из которых 3 страдали системной красной волчанкой с вторичным АФС и 1 - первичным АФС. У всех пациентов определены активность компонентов комплемента С1-С5 и общая гемолитическая активность в момент острого эпизода и у 1 пациента - после лечения. Результаты. У всех больных активность изученных компонентов комплемента и общая гемолитическая активность комплемента оказались значительно сниженными. После лечения с применением свежезамороженной плазмы отмечалось восстановление активности компонентов комплемента. Обсуждаются возможность и механизмы активации системы комплемента у больных с КАФС. Заключение. Предварительные результаты, полученные на основании изучения небольшого числа наблюдений, позволяют сделать вывод об участии системы комплемента в развитии КАФС.
×

References

  1. Asherson R.A., Cervera R., Piette J.C. et al. Catastrophic antiphospholipid syndrome. Clinical and laboratory features of 50 patients. Medicine 1998; 77: 195-207.
  2. Asherson R.A., Cervera R., Piette J.C. et al. Catastrophic antiphospholipid syndrome: clues to the pathogenesis from a series of 80 patients. Medicine 2001; 80: 355-77.
  3. Asherson R.A., Cervera R., de Groot P. et al. Catastrophic antiphospholipid syndrome (CAPS): International consensus statement on classification criteria and treatment guidelines. Lupus 2003; 12: 530-534.
  4. Asherson R.A., Shoenfeld Y. The role of infection in the pathogenesis of catastrophic antiphospholipid syndrome-molecular mimicry? J Rhematol 2000; 27: 12-14.
  5. Kitchens C.S. Thrombotic storm: when thrombosis begets thrombosis. Am J Med 1998; 104: 381-385.
  6. Meroni P.L., Raschi E., Camera G. et al. Endothelial activation by aPL: a potential pathogenetic mechanism for the clinical manifestation of the syndrome. J Autoimmun 2000; 15: 237-240.
  7. Espinosa G., Cervera R. Antiphospholipid syndrome. Arthritis Res Ther 2008; 10: 230-238.
  8. Pierangelli S.S., Vega-Ostertag M.E., Raschi E. et al. Toll-like receptor and antiphospholipid thrombosis: in vivo studies. Ann Rheum Dis 2007; 66: 1327-1333.
  9. Espinosa G., Cervera R., Asherson R.A. Catastrophic antiphospholipid syndrome and sepsis. A common link? J Rheumatol 2007; 34 (5): 923-926.
  10. Levy M.M., Fink M.P., Marshall D.C. et al. SCCM/ESICM/ACCPATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003; 31: 1250-1256.
  11. Noris M., Remuzzi G. Atypical Hemolytic-Uremic Syndrome. N Engl J Med 2009; 361: 1676-1687.
  12. Campistol J., Arias M., Ariceta G., Espinosa M. An update for atypical haemolytic uraemic syndrome: diagnosis and treatment. A consensus document. Nefrologia 2013; 33 (1): 27-45.
  13. Лора Ш., Фремю-Бачи В. Атипичный гемолитико-уремический синдром. Нефрология 2012; 2: 16-46.
  14. Noris M., Mescia F., Remuzzi G. STEC-HUS, atypical HUS and TTP are all diseases of complement activation. Nat Rev Nephrol 2012; 8: 622-633.
  15. Козловская Н.Л., Шилов Е.М., Метелева Н.А. и др. Клинические и морфологические особенности волчаночного нефрита при системной красной волчанке с антифосфолипидным синдромом. Тер арх 2006; 5: 21-31.
  16. Козлов Л.В. Исследование функциональной активности компонентов и факторов системы комплемента человека. Вопр мед химии 2002; 6: 634-641.
  17. Cervera R. On behalf of the CAPS Registry Project Group Catastrophic antiphospholipid syndrome (CAPS): update from the CAPS Registry. Lupus 2010; 19: 412-418.
  18. Asherson R.A., Pierangelli S., Cervera R. Is there a microangiopathic antiphospholipid syndrome? Ann Rheum Dis 2007; 66: 429-432.
  19. Pierangeli S.S., Colden-Standfield M., Liu X. et al. Antiphospholipid antibodies from antiphospholipid syndrome patients: activation of endothelial cells in vitro and in vivo. Circulation 1999; 99: 1007-1022.
  20. Asherson R.A., Pierangeli S., Cervera R. Microangiopathic antiphospholipid-associated syndromes revisited - new concepts relating to antiphospholipid antibodies and syndromes. J Rheum 2007; 34: 1793-1795.
  21. Giannakopoulos B., Passam F., Rahgozar S., Krillis S.A. Current concepts on the pathogenesis of the antiphospholipid syndrome. Blood 2007; 109: 422-430.
  22. Salmon J.E., Girardi G. The role of complement in antiphospholipid syndrome. Curr Dir Autoimmun 2004; 7: 133-148.
  23. Levine J.S., Branch W., Rauch J. The antiphospholipid syndrome. N Eng J Med 2002; 346: 752-763.
  24. Davis W.D., Brey R.L. Antiphospholipid antibodies and complement activation in patients with cerebral ischemia. Clin Exp Immunol 1992; 10: 445-460.
  25. Shinzato M.M., Bueno C., Trindade-Viana V.S. et al. Complement-fixing activity of anticardiolipin antibodies in patients with and without thrombosis. Lupus 2005; 14: 953-958.
  26. Markiewsky M.M., Nilsson B., Nilson Ekdahl K. et al. Complement and coagulation: strangers or partners in crime? TRENDS in Immunol 2007; 28: 184-192.
  27. Peerschke E.I., Yin W., Ghebrehiwet B. Complement activation on platelet: implications for vascular inflammation and thrombosis. Mol Immunol 2010; 47: 2170-2175.
  28. Amara U., Fliery M.A., Rittirsch D. et al. Molecular Intercommunication between the Complement and Coagulation Systems. J Immunol 2010; 185: 5628-5636.
  29. Huber-Lang M., Sarma J.V., Zetoune F.S. et al. Generation of C5a in the absence of C3: a new complement activation pathway. Nature Med 2006; 12: 682-687.
  30. Lonze B.E., Singer A.L., Montgomery R.A. Eculizumab and renal transplantation in a patient with CAPS. N Engl J Med 2010; 362: 1744-1745.
  31. Shapira I., Andrade D., Allen S.L., Salmon J.E. Induction of Sustained Remission in Recurrent Catastrophic Antiphospholipid Syndrome via Inhibition of Terminal Complement With Eculizumab. Arthritis Rheum 2012; 64: 2719-2723.
  32. Weiler J.M., Yurt R.W., Fearon D.T., Austen K.F. Modulation of the formation of the amplification convertase of complement, C3bBb by native and commercial heparin. J Exp Med 1978; 147: 409-421.
  33. Ninomiya H., Kawashima Y., Nagasawa T. Inhibition of complement-mediated haemolysis in paroxysmal nocturnal haemoglobinuria by heparin or low-molecular weight heparin. Br J Haematol 2000; 109: 875-881.

Supplementary files

Supplementary Files
Action
1. JATS XML

Copyright (c) 2014 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 

Address of the Editorial Office:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Correspondence address:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Managing Editor:

  • Tel.: +7 (926) 905-41-26
  • E-mail: e.gorbacheva@ter-arkhiv.ru

 

© 2018-2021 "Consilium Medicum" Publishing house


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies