Antiphospholipid syndrome – beyond thrombosis

Antiphospholipid syndrome (APS) is an autoimmune disease characterized by a hypercoagulable state in the setting of detectable antiphospholipid antibodies (APL). Notably, APS often presents alongside systemic lupus erythematosus (SLE), manifesting as secondary APS (SAPS) in approximately 70% of cases, while also occurring independently as primary APS (PAPS). The etiopathogenesis of the disease is only partially understood. While APS has traditionally been viewed as devoid of primary inflammatory processes, recent findings suggest otherwise. The lack of cellular inflammatory infiltration in the vessels occluded by a thrombus became even one of the criteria characterizing pathology typical for APS as opposed to vasculitic (inflammatory) features of SLE and ANCA-associated vasculitides (AAV). However, some studies highlight the potential influence of complement-mediated complications in APS, such as pregnancy failure, and propose inflammatory infiltrates as contributors to APS nephropathy. These insights indicate a closer functional relationship between coagulation and the immune system than previously acknowledged, warranting a comprehensive reassessment of APS pathology.

This Research Topic aims to investigate the interplay between thrombotic and inflammatory processes within APS, which may contribute significantly to its pathogenesis and diverse clinical outcomes. By examining these complex mechanisms, the research seeks to illuminate novel therapeutic avenues that could offer relief to treatment-resistant patients, particularly those with high-risk APL patterns or arterial thrombosis. A key objective is to assess the necessity for supplemental therapies beyond long-term anticoagulation with vitamin K antagonists.

To gather further insights into the multifaceted nature of APS and its association with lupus, we welcome articles addressing, but not limited to, the following themes:

o The role of inflammation and complement activation in APS development.

o The potential for additional therapies beyond standard anticoagulation for APS management.

o Exploration of novel biomarkers for APS diagnosis and risk stratification.

o Multidisciplinary strategies for managing obstetric APS.

o Implications of the 2023 ACR/EULAR classification criteria on APS diagnosis and treatment.

o Influence of genetic and epigenetic factors on APS pathogenesis and progression.

o Assessment of SLE development risk in patients with primary APS.

o Development of APS in SLE patients who were initially serologically negative.

We encourage contributions in the form of original research, reviews, and case analyses to foster a robust dialogue on expanding APS treatment strategies and understanding the link between APS and lupus beyond traditional thrombosis paradigms.

Article types and fees

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Clinical Trial
• Conceptual Analysis
• Editorial
• FAIR² Data
• General Commentary
• Hypothesis and Theory
• Methods
• ... View all formats

Articles that are accepted for publication by our external editors following rigorous peer review incur a publishing fee charged to Authors, institutions, or funders.

Article types

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Clinical Trial
• Conceptual Analysis
• Editorial
• FAIR² Data
• General Commentary
• Hypothesis and Theory
• Methods
• Mini Review
• Opinion
• Original Research
• Perspective
• Review
• Systematic Review
• Technology and Code

Keywords: antiphospholipid antibodies, thrombosis, inflammation, pregnancy outcome, anticoagulation, complement activation

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.