Antiphospholipid syndrome (APS) is an autoimmune disease that is characterized by arterial and/or venous thrombosis and/or recurrent pregnancy losses. Obstetric APS (OAPS) is considered as a distinct entity from vascular APS (VAPS). In the absence of any additional disease, APS is designated as primary (PAPS), while the term secondary APS (SAPS) is used when other diseases are associated. Catastrophic APS (CAPS) is characterized by the rapid development of multiple thrombosis in various vital organs. The presence of antiphospholipid antibodies (aPL Abs) is considered as a laboratory criterion for APS diagnosis. aPL Abs cause an increase in systemic and decidual TNF-alpha levels in experimental model of APS (eAPS), while paradoxically, administration of TNF-alpha blockers has been associated with de novo synthesis of aPL Abs in patients with various autoimmune diseases. While eAPS provides evidence for the fact that application of TNF-alpha blockers has beneficial effects, lack of randomized prospective studies is the main obstacle for consideration of TNF-alpha blockers administration as a therapeutic option not for all, but at least for selected cases of APS patients despite compelling evidence for detrimental roles of TNF-alpha for both VASP and OAPS. This article represents a review of previously published reports on detrimental roles of TNF-alpha in APS, reports on the application of anti-TNF-alpha agents in eAPS and articles that reported de novo synthesis of aPL Abs induced by biopharmaceuticals against TNF-alpha.

译文

:抗磷脂综合症(APS)是一种自身免疫性疾病,其特征是动脉和/或静脉血栓形成和/或反复流产。产科APS(OAPS)被认为是与血管APS(VAPS)不同的实体。在没有任何其他疾病的情况下,将APS称为原发性(PAPS),而在与其他疾病相关的情况下使用术语继发性APS(SAPS)。灾难性APS(CAPS)的特征在于各种重要器官中多发性血栓形成的快速发展。抗磷脂抗体(aPL Abs)的存在被认为是诊断APS的实验室标准。在APS(eAPS)实验模型中,aPL Abs导致全身和蜕膜TNF-α水平增加,而自相矛盾的是,在患有各种自身免疫性疾病的患者中,TNF-α阻滞剂的给药与aPL Abs的从头合成有关。尽管eAPS为使用TNF-α阻滞剂产生有益作用这一事实提供了证据,但缺乏随机的前瞻性研究是考虑将TNF-α阻滞剂作为治疗选择的主要障碍,但并非对所有患者(至少对于某些病例)尽管有令人信服的证据表明APS患者对VASP和OAPS都具有TNF-α的有害作用。本文代表对先前发表的有关TNF-α在APS中的有害作用的报道的综述,有关抗TNF-α药剂在eAPS中的应用的报道,以及报道了由生物药物诱导的针对TNF-α的aPL Ab的从头合成的文章。

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