Insight into antiphospholipid syndrome: the role and clinical utility of neutrophils extracellular traps formation

Insight into antiphospholipid syndrome: the role and clinical utility of neutrophils extracellular traps formation

Antiphospholipid syndrome (APLS) is a systemic immune dysregulation distinguished by repetitive complications and pregnancy loss in the absence of definite etiology. Most research focuses on the laboratory detection and clinical features of APLS, but its precise etiology remains to be deeply explore...

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Published in:Thrombosis journal Vol. 22; no. 1; p. 32
Main Authors: Zaiema, Shams ElDoha Galal ElDin, Elwafa, Menna Allah Zakaria Mohammad Ali Abou, Hassan, Shaymaa Gamal Arafa, El Adwey, Radwa Hassan Abou El Fotoh, Ghorab, Raghda Mohammed Mostafa, Galal, Raghda El Sayed Abdel Monem
Format: Journal Article
Language:English
Published: England BioMed Central Ltd 28-03-2024
BioMed Central
BMC
Subjects:
Antibodies
Anticoagulants
Antiphospholipid antibodies
Antiphospholipid syndrome
Autoimmune diseases
Bioassays
Blood clot
Blood coagulation factors
Development and progression
DNA binding proteins
Enzyme-linked immunosorbent assay
Ethylenediaminetetraacetic acid
Hematology
Hemoglobin
Histones
Inflammation
Laboratories
Lupus
Medical research
Medicine, Experimental
Myeloperoxidase
NETosis
Neutrophils
Obstetrics
Thrombosis
Viral antibodies
Egypt
China
NETosis
Cutoff for NETs activation
Anti-NETosis therapy/NETs inhibitors
Histones
Myeloperoxidase
Antiphospholipid antibodies
Thrombosis
Antiphospholipid syndrome
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Summary:Antiphospholipid syndrome (APLS) is a systemic immune dysregulation distinguished by repetitive complications and pregnancy loss in the absence of definite etiology. Most research focuses on the laboratory detection and clinical features of APLS, but its precise etiology remains to be deeply explored. NETosis is a newly developed theory in the pathophysiology of APLS which may serve as the missing bridge between coagulation and inflammation reaching the disease progression and severity. We aimed in this study to navigate the prognostic role of NETosis in thrombotic APLS. Our study included 49 newly diagnosed APLS patients (both 1ry and 2ry) who met clinical and laboratory criteria as per the international consensus statement on the update of the classification criteria for definite APLS and were sub-classified according to the occurrence of thrombotic events in thrombotic and non-thrombotic types. In addition, 20 sex and age-matched reactive subjects and 20 sex and age-matched healthy volunteer controls were enrolled. NETosis formation was assessed by measuring serum Myeloperoxidase (MPO) and Histones level using the enzyme-linked immunosorbent assay (ELISA) technique. Both MPO and Histones levels were able to discriminate among APLS cases from normal controls, showing significant cutoffs of > 2.09 ng/ml for MPO and > 1.45 ng/ml for Histones (AUC values were 0.987and 1.000, respectively). These values can be used as predictors for NETosis pathophysiology in APLS patients. Additionally, these markers demonstrated a significant association with several prognostic indicators, including thrombosis, higher PT and INR, and lower hemoglobin (Hb) levels which are supposed to be ameliorated by using NETs inhibitors. In conclusion, we suggest that measuring NETosis markers, MPO, and Histones, in the early course of APLS using proposed cutoff values will facilitate the timely initiation of anti-NETosis therapy and improve the overall prognosis, particularly for patients with thrombotic APLS.
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ISSN:1477-9560
1477-9560
DOI:10.1186/s12959-024-00598-4