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What is the Mechanism(s) of Antiphospholipid Antibody-Mediated Pregnancy Morbidity?

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Antiphospholipid Syndrome

Abstract

Pregnancy complications are a frequent and unsolved condition in patients with antiphospholipid syndrome (APS). Women with antiphospholipid antibodies (aPL) are at high risk of recurrent early pregnancy loss, as well as late obstetrical complications associated with impaired placental function, such as preeclampsia, intrauterine growth restriction, and prematurity. Thrombotic events at the maternal–fetal interface were originally thought to underlie aPL-associated pregnancy complications, due to the partial beneficial effects of heparin. However, more recent clinical and experimental observations suggest, instead, that non-thrombotic events may play a primary role in the pathophysiology of pregnancy complications in APS patients, including complement activation, inflammation, and disruption of normal trophoblast function. This chapter will review the known pathogenic mechanisms of pregnancy complications in APS and provide a helpful instrument to all the workers in the field from both a clinical and basic view.

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Acknowledgments

Dr. Jacob Rand would like to acknowledge his scientific collaborators who made this work possible, Dr. Xiao-Xuan Wu for her help in the preparation of this manuscript, and Dr. Lucy Wolgast for her help with Fig. 5.4. Dr. Rand’s studies were supported in part by grant HL-61331 from the NIH. Dr Salmon’s studies were supported by grants AR38889 and AR49772 from the NIH.

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Authors and Affiliations

  1. Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, LSOG 305C, New Haven, CT, 06510, USA

    Vikki M. Abrahams PhD

  2. Department of Internal Medicine, University of Milan, IRCCS Istituto Auxologico Italiano, Cusano Milanino, Milan, Italy

    Maria O. Borghi MD

  3. Department of Internal Medicine, Istituto G. Pini, University of Milan, Milan, Italy

    Pier Luigi Meroni MD

  4. Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA

    Jacob H. Rand MD

  5. Experimental Laboratory of Immunological & Rheumatological Researches, IRCCS Istituto Auxologico Italiano, Cusano Milanino, Milan, Italy

    Elena Raschi PhD

  6. Hospital for Special Surgery, Weill Cornell Medical College of Cornell University, New York, NY, USA

    Jane E. Salmon MD

  7. Department of Life Sciences, University of Trieste, Trieste, Italy

    Francesco Tedesco MD

  8. Rheumatology Unit, Department of Medicine, Brescia University and Hospital, Brescia, Italy

    Angela Tincani MD

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  1. Vikki M. Abrahams PhD
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Correspondence to Vikki M. Abrahams PhD .

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Editors and Affiliations

  1. The Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, New York, NY, USA

    Doruk Erkan

  2. University of Texas Medical Branch, 301 University Boulevard, Galveston, 77555-0883, Texas, USA

    Silvia S. Pierangeli

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Abrahams, V.M. et al. (2012). What is the Mechanism(s) of Antiphospholipid Antibody-Mediated Pregnancy Morbidity?. In: Erkan, D., Pierangeli, S. (eds) Antiphospholipid Syndrome. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-3194-7_5

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