Complement activation predicts adverse pregnancy outcome in patients with systemic lupus erythematosus and/or antiphospholipid antibodies
| Autor: | Joan T. Merrill, Mimi Y. Kim, Carl A. Laskin, T. Flint Porter, Jane E. Salmon, Anne M. Lynch, Michael D. Lockshin, Lisa R. Sammaritano, Jill P. Buyon, D. Ware Branch, Elianna Kaplowitz, Marta M. Guerra, Allen D. Sawitzke, Michelle Petri |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
0301 basic medicine medicine.medical_specialty Immunology Inflammation Complement Membrane Attack Complex Logistic regression Gastroenterology Article General Biochemistry Genetics and Molecular Biology 03 medical and health sciences 0302 clinical medicine Rheumatology immune system diseases Pregnancy Antiphospholipid syndrome Internal medicine medicine Humans Lupus Erythematosus Systemic Immunology and Allergy In patient Complement Activation 030203 arthritis & rheumatology biology business.industry Pregnancy Outcome medicine.disease Complement system Pregnancy Complications 030104 developmental biology Case-Control Studies Antibodies Antiphospholipid Alternative complement pathway biology.protein Female medicine.symptom Antibody business Complement Factor B |
| Zdroj: | Annals of the Rheumatic Diseases. 77:549-555 |
| ISSN: | 1468-2060 0003-4967 |
| DOI: | 10.1136/annrheumdis-2017-212224 |
| Popis: | ObjectiveStudies in mouse models implicate complement activation as a causative factor in adverse pregnancy outcomes (APOs). We investigated whether activation of complement early in pregnancy predicts APOs in women with systemic lupus erythematosus (SLE) and/or antiphospholipid (aPL) antibodies.MethodsThe PROMISSE Study enrolled pregnant women with SLE and/or aPL antibodies (n=487) and pregnant healthy controls (n=204) at ResultsAPO occurred in 20.5% of SLE and/or aPL pregnancies. As early as 12–15 weeks, levels of Bb and sC5b-9 were significantly higher in patients with APOs and remained elevated through 31 weeks compared with those with normal outcomes. Moreover, Bb and sC5b-9 were significantly higher in patients with SLE and/or aPL without APOs compared with healthy controls. In logistic regression analyses, Bb and sC5b-9 at 12–15 weeks remained significantly associated with APO (ORadj=1.41 per SD increase; 95% CI 1.06 to 1.89; P=0.019 and ORadj=1.37 per SD increase; 95% CI 1.05 to 1.80; P=0.022, respectively) after controlling for demographic and clinical risk factors for APOs in PROMISSE. When analyses were restricted to patients with aPL (n=161), associations between Bb at 12–15 weeks and APOs became stronger (ORadj=2.01 per SD increase; 95% CI 1.16 to 3.49; P=0.013).ConclusionIn pregnant patients with SLE and/or aPL, increased Bb and sC5b-9 detectable early in pregnancy are strongly predictive of APOs and support activation of complement, particularly the alternative pathway, as a contributor to APOs. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|