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Platelets and neutrophils co-drive procoagulant potential in secondary antiphospholipid syndrome during pregnancy

  • Ejaife O. Agbani
    Correspondence
    Correspondence to: E.O. Agbani, Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Alberta, Canada.
    Affiliations
    Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Alberta, Canada

    Libin Cardiovascular Institute, Calgary, Alberta, Canada
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  • Etienne Mahe
    Affiliations
    Department of Pathology & Laboratory Medicine, University of Calgary, Alberta, Canada

    Division of Hematology & Hematological Malignancies, Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
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  • Shruti Chaturvedi
    Affiliations
    Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
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  • Lisa Yamaura
    Affiliations
    Department of Surgery, Cumming School of Medicine, University of Calgary, Alberta, Canada

    McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada
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  • Prism Schneider
    Affiliations
    Department of Surgery, Cumming School of Medicine, University of Calgary, Alberta, Canada

    McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada
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  • Megan R.W. Barber
    Affiliations
    Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
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  • May Choi
    Affiliations
    McCaig Institute for Bone and Joint Health, University of Calgary, Alberta, Canada

    Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
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  • Adrienne Lee
    Affiliations
    Division of Hematology & Hematological Malignancies, Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada

    Division of Hematology, Department of Medicine, University of Victoria, Victoria, British Columbia, Canada
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  • Leslie Skeith
    Correspondence
    Correspondence to: L. Skeith, Division of Hematology & Hematological Malignancies, Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada.
    Affiliations
    Libin Cardiovascular Institute, Calgary, Alberta, Canada

    Division of Hematology & Hematological Malignancies, Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
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Published:November 03, 2022DOI:https://doi.org/10.1016/j.thromres.2022.10.018
      Antiphospholipid syndrome (APS) is characterised by thrombosis and/or pregnancy morbidity with persistent antiphospholipid antibodies (aPL), and is commonly associated with systemic lupus erythematosus (SLE) [
      • Schreiber K.
      • Sciascia S.
      • de Groot P.G.
      • Devreese K.
      • Jacobsen S.
      • Ruiz-Irastorza G.
      • Salmon J.E.
      • Shoenfeld Y.
      • Shovman O.
      • Hunt B.J.
      Antiphospholipid syndrome.
      ]. APS is characterised by a prothrombotic and proinflammatory cytokine profile [
      • Schreiber K.
      • Sciascia S.
      • de Groot P.G.
      • Devreese K.
      • Jacobsen S.
      • Ruiz-Irastorza G.
      • Salmon J.E.
      • Shoenfeld Y.
      • Shovman O.
      • Hunt B.J.
      Antiphospholipid syndrome.
      ], and neutrophil activation and placental inflammation contributing to placental injury and fetal loss [
      • Schreiber K.
      • Sciascia S.
      • de Groot P.G.
      • Devreese K.
      • Jacobsen S.
      • Ruiz-Irastorza G.
      • Salmon J.E.
      • Shoenfeld Y.
      • Shovman O.
      • Hunt B.J.
      Antiphospholipid syndrome.
      ,
      • Redecha P.
      • Tilley R.
      • Tencati M.
      • Salmon J.E.
      • Kirchhofer D.
      • Mackman N.
      • Girardi G.
      Tissue factor: a link between C5a and neutrophil activation in antiphospholipid antibody induced fetal injury.
      ,
      • Redecha P.
      • Franzke C.W.
      • Ruf W.
      • Mackman N.
      • Girardi G.
      Neutrophil activation by the tissue factor/Factor VIIa/PAR2 axis mediates fetal death in a mouse model of antiphospholipid syndrome.
      ]. Platelet activation and platelet-leucocyte aggregates (PLAs) are increased in APS [
      • Joseph J.E.
      • Harrison P.
      • Mackie I.J.
      • Isenberg D.A.
      • Machin S.J.
      Increased circulating platelet-leucocyte complexes and platelet activation in patients with antiphospholipid syndrome, systemic lupus erythematosus and rheumatoid arthritis.
      ], but their contribution to pregnancy complications is unclear. Platelets promote coagulation by providing a catalytic procoagulant surface and amplifying thrombin generation [
      • Agbani E.O.
      • Van den Bosch M.T.J.
      • Brown E.
      • Williams C.M.
      • Mattheij N.J.A.
      • Cosemans J.M.E.M.
      • Collins P.W.
      • Heemskerk J.W.M.
      • Hers I.
      • Poole A.W.
      Coordinated membrane ballooning and procoagulant spreading in human platelets.
      ,
      • Agbani E.O.
      • Poole A.W.
      Procoagulant platelets:-generation, function and therapeutic targeting in thrombosis.
      ]. Despite therapy with low-molecular-weight heparin (LMWH) and aspirin, pregnancy in APS is associated with high rates of pregnancy loss, placenta-mediated complications and thromboembolism [
      • Lo J.O.
      • Mission J.F.
      • Caughey A.B.
      Hypertensive disease of pregnancy and maternal mortality.
      ]. Understanding mechanisms underlying hypercoagulability and fetal loss is critical to improving pregnancy outcomes in APS.

      Keywords

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