Review Pathophysiological mechanisms in antiphospholipid syndrome Antiphospholipid syndrome is a systemic autoimmune disease associated with thrombosis and recurrent fetal loss in the setting of detectable antiphospholipid (aPL) antibodies. The major antigenic target has been identified as b2-glycoprotein I (b2GPI), which mediates binding of aPL antibodies to target cells including endothelial cells, monocytes, platelets and trophoblasts, leading to prothrombotic and proinflammatory changes that ultimately result in thrombosis and fetal loss. This article summarizes recent insights into the role of b2GPI in normal hemostasis, interactions between aPL antibodies, b2GPI and cell- surface molecules, molecular prothrombotic and proinflammatory changes induced by aPL antibodies and pathogenic changes leading to fetal loss in antiphospholipid syndrome. New directions in therapy using these insights are examined. 1 n n Brock E Harper , KEYWORDS: annexin anti-b2-glycoprotein I antibody antiphospholipid antibodies n antiphospholipid syndrome n endothelial cell activation n pathogenesis n platelet Rohan Willis1 activation n pregnancy loss n thrombosis n treatment & Silvia S Pierangeli†1 1Department of Internal Medicine, Division of Rheumatology, University Antiphospholipid syndrome (APS) is a systemic and use of hormone-replacement therapy or oral of Texas Medical Branch, Galveston, autoimmune disease characterized by recurrent contraceptives [9]. By contrast, venous thrombo- TX, USA †Author for correspondence: thrombosis and fetal loss in the presence of per- sis was associated with presence of hypertriglyc-
[email protected] sistently positive antiphospholipid (aPL) antibod- eridemia, presence of a hereditary thrombophilia ies (Abs) including lupus anticoagulant (LAC), or aCL IgG more than 40 IU [9]. IgG/IgM anticardiolipin (aCL) Abs and anti-b2- Antiphospholipid syndrome causes significant glycoprotein I (b2GPI) Abs [1–3].