Antiphospholipid antibodies: paradigm in transition

Area of Science:

• Immunology
• Rheumatology
• Neurology

Background:

• Anti-phospholipid antibodies (aPL) are primarily associated with anti-phospholipid syndrome (APS), a condition characterized by thrombosis and often neurological symptoms.
• Recent evidence suggests aPL may also be implicated in non-thrombotic autoimmune disorders, expanding their recognized clinical relevance.

Purpose of the Study:

• To critically review the role of anti-phospholipid antibodies (aPL).
• To highlight the potential significance of aPL in non-thrombotic autoimmune conditions, including multiple sclerosis and immune thrombocytopenia (ITP).

Main Methods:

• Review of historical context and the expanding array of aPL target antigens.
• Examination of current theories regarding aPL in thrombosis and their pathological consequences.
• Analysis of methodological factors contributing to conflicting research results.
• Discussion of lupus anticoagulant (LA) as a predictor of thrombosis.
• Review of aPL in non-thrombotic disorders.

Main Results:

• The proliferation of known aPL target antigens suggests a broader antigenic landscape than previously understood.
• Existing theories on aPL in thrombosis offer valuable insights, but aPL may exert more diverse pathological effects than currently recognized.
• Methodological variations in studies contribute to discrepancies in findings regarding aPL.
• Lupus anticoagulant (LA) is a strong predictor of thrombosis, though the underlying mechanisms remain under investigation.

Conclusions:

• The established role of aPL in thrombosis is significant.
• aPL may possess broader clinical implications beyond thrombosis, particularly in neurological conditions.
• This review underscores the need to consider aPL in the differential diagnosis of various autoimmune diseases.