Antiphospholipid syndrome: an update for clinicians and scientists

Area of Science:

• Immunology
• Rheumatology
• Vascular Biology

Background:

• Antiphospholipid syndrome (APS) is a primary cause of acquired thrombosis and pregnancy loss.
• Current treatments, primarily anticoagulants, are not fully effective and do not address autoimmune complications.
• A deeper understanding of APS pathophysiology is crucial for developing improved therapeutic strategies.

Purpose of the Study:

• To provide an update on recent mechanistic and clinical studies in APS, focusing on inflammatory aspects.
• To highlight advancements in understanding how antiphospholipid antibodies mediate cellular activation.
• To review emerging therapeutic targets and repurposed medications for APS.

Main Methods:

• Review of mechanistic studies defining antiphospholipid antibody interactions with cellular receptors and signaling pathways.
• Analysis of recent in-vivo animal studies and clinical trials.
• Evaluation of emerging concepts, including the role of neutrophils in APS pathogenesis.

Main Results:

• Increased understanding of how antiphospholipid antibodies activate cells via specific receptors and signaling pathways.
• Intensive study of established mediators (endothelial cells, complement) alongside emerging factors (neutrophils).
• Evidence from animal models and clinical trials suggests benefits of repurposed drugs (hydroxychloroquine, statins, rivaroxaban) in APS.

Conclusions:

• Anticoagulant therapy alone is insufficient for comprehensive APS management.
• Targeting the inflammatory aspects of APS is essential for improving patient outcomes.
• Novel and repurposed therapies hold promise for modulating APS pathophysiology and addressing associated inflammatory complications.