Antiphospholipid Antibodies overlapping in Isolated Neurological Syndrome and Multiple Sclerosis: Neurobiological Insights and Diagnostic Challenges.
- 1Department of Medical, Oral and Biotechnological Sciences, D'Annunzio University of Chieti–Pescara, Italy
- 2Department of Neurology, Hospital Ruber Internacional, Spain
- 3Facultad de Medicina, Universidad Complutense de Madrid, Spain
- 4Servicio de Neurología, Hospital Clínico San Carlos, Spain
Antiphospholipid syndrome (APS) is characterized by arterial and venous thrombosis, pregnancy morbidity and fetal loss caused by pathogenic autoantibodies against phospholipids and PL-cofactors. Isolated neurological APS may represent a significant diagnostic challenge, as epidemiological, clinical and neuroimaging features may overlap with those of multiple sclerosis (MS). In an open view, MS could be considered as an organ-specific anti-lipid (phospholipid and glycosphingolipid associated proteins) disease, in which autoreactive B cells and CD8+ T cells play a dominant role in its pathophysiology. In MS, diverse autoantibodies against the lipid-protein cofactors of the myelin sheath have been described, whose pathophysiologic role remains unknown. Several studies have determined a wide range of organ-specific antiphospholipid (aPL) autoantibodies in the so-called MS-like syndrome, whose presence ranging between 2% and 88%, particularly aCL and aβ2GPI, with predominant IgM isotype and suggesting worse prognosis. We have revised the current knowledge about the pathophysiological events responsible for these conditions, and the clinical relevance to be aware of isolated neurological APS. Prompt and accurate diagnosis and antiaggregant and anticoagulant treatment of APS could be vital to prevent or reduce APS-related morbidity and mortality.
Keywords: Antiphospholipid Syndrome, MS-like syndrome, Pathogenesis, Thrombosis, vasculopathy
Received: 15 Sep 2018;
Accepted: 04 Mar 2019.
Edited by:Sriharsha Kantamneni, University of Bradford, United Kingdom
Reviewed by:Tatsuro Mutoh, Fujita Health University, Japan
Ian P. Giles, Division of Medicine, Faculty of Medical Sciences, University College London, United Kingdom
Copyright: © 2019 D'Angelo, Franch, Fernández Paredes, Oreja-Guevara, Nuñez-Beltran, Comins, Reale and Sánchez-Ramón. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: MD, PhD. Silvia Sánchez-Ramón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain, firstname.lastname@example.org