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Quresh Khairullah - One of the best experts on this subject based on the ideXlab platform.
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resolution of catastrophic anti Phospholipid Antibody syndrome with acute renal failure after treatment with rituximab
Blood, 2004Co-Authors: Muhammad Shurafa, Nidhika Babbar, Quresh KhairullahAbstract:AntiPhospholipid Antibody syndrome (APS) is a thrombophilic disorder defined by the presence of recurrent thrombosis associated with anticardiolipin antibodies (ACA). To date, there is no effdective therapy for this condition. Rituximab, a chimeric monoclonal Antibody B Cells has been shown to be effective in autoimmune disorders. Sporadic abstracts have reported the disappearance of ACA after Rituximab treatment. We have successfully treated a patient with primary catastrophic APS and renal failure with Rituximab. Case Report: A thirty seven year old male with history of DVT, ischemic cardiomyopathy and cerebrovascular accident was admitted to the Hospital for the treatment of acute renal failure and thrombocytopenia. Physical examination was significant for cognitive deficits, mild hepatomegaly, generalized livido reticulairs, and acrocyanosis. Laboratory data revealed platelet count of 97000, creatinine 3.4 mg/dl, IgG ACA titer of 43.8 and negative IgM ACA and ANA. He had proteinuria with benign urinary sediment. Kidney biopsy showed thrombotic microangiopathy. Plasmaphersis was initiated and hemodialysis for the rapidly progressing renal failure. He continued his treatment in an outpatient hemodialysis unit while on Coumadin. Four weekly cycles of Rituximab were given as an outpatient. Serial laboratory investigations showed gradual normalization of the platelet count and disappearance of the IgG ACA. Gradually renal function recovered and hemodialysis was discontinued after three months. He remains in remission with no further thrombotic events.Conclusion: Rituximab is promising in the treatment of APS and must be considered in the first;line treatment of catastrophic APS. A clinical trial is necessary to test the feasibility of discontinuing anticoagulation in these patients. PERTINENT LABORATORY DATA
M. Zuin - One of the best experts on this subject based on the ideXlab platform.
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Serum anti-Phospholipid Antibody prevalence and cardiovascular significance in the general population of the camelia study
'BMJ', 2016Co-Authors: C. Selmi, E. Generali, P.m. Battezzati, M. De Santis, A. Ceribelli, P.l. Meroni, M. ZuinAbstract:Background The serum anti-Phospholipid Antibody (aPLs) prevalence in the general population and the association with cardiovascular disease and risk factors remain unclear. Objectives To test serum samples from a population study for aPLs and determine the presence of cardiovascular and metabolic comorbidities in a Northern Italian city. Methods We performed a cross-sectional study on 1712 adult subjects (median age 47 year-old, interquartile range 37–61, 49.8% women), randomly enrolled in 2010 from the voting lists of a 32.000-population city in the Lombardia region. All subjects completed a questionnaire for medical history and ongoing/past medications and underwent physical examination and abdomen and carotid ultrasound. Anti-cardiolipin (aCL), anti-beta2 glycoprotein I (aGPI), anti-phosphatidylserine-prothrombin (aSP) IgG, IgM, and IgA antibodies were tested in all subjects by ELISA. Results At least one aPL was positive in 258 (15.1%), at high titer in 56 (3.3%) subjects; 35 (2%) were positive for two or more aPL, 15 (0.9%) at high titer. Serum aCL were positive in 26 (1.5%) subjects, at high titer in 17 (1%), without additional aPL in 2; IgG in 15 (0.9%; at high titer in 11), IgM in 18 (1.1%, at high titer in 10), IgA at high titer in 4 (0.2%). Serum aGPI were positive in 73 (4.3%) subjects, at high titer in 48 (2.8%), without additional aPL in 4; IgG in 20 (1.2%; at high titer in 3), IgM in 28 (1.6%, at high titer in 6), IgA in 35 (2%, at high titer in 12). Serum aSP were positive in 201 (11.7%) subjects, at high titer in 29 (1.7%), without additional aPL in 167; IgG in 157 (9.2%, at high titer in 19), IgM in 65 (3.8%, at high titer in 12). Women represented 53.1% of aPL positive subjects, with higher incidence for aGPI, especially IgA, and aSP. Among aPL positive subjects, there were 10 cases of acute myocardial infarction, 7 strokes, 17 peripheral arteriopathy and 22 increased intimal-medial-thickness. Positivity for aPL was associated with older age, particularly for aGPI and aSP, while high-titer aCL IgG and aSP IgG were associated with tobacco smoking. Hypertension and hypercholesterolemia were significantly associated to aGPI IgG and IgM positivity, respectively. Hyperhomocystinemia was significantly associated with high titer multiple aPLs. Hyperuricemia was associated with aSP IgG positivity. Subjects with positive aPL had significantly higher frequency of thyroid disease (p=0.02 for high titer), peripheral arteriopathy (crude odds ratio –OR- 2; 95% confidence interval –CI- 1.2–3.6; isolated aCL crude OR 25.1; 95% CI 1.6–405.4), myocardial infarction (isolated aCL crude OR 28.5; 95%CI 1.8–460.5). Importantly, adjusted ORs for cardiovascular risk factors were not statistically significant. Conclusions We confirm that serum aPL are common in the general population, particularly at older age and possibly in association with smoking. Serum aPL is associated with common cardiovascular risk factors and specific events, however this latter effect needs to be clarified in the follow-up study to determine the real impact of aPL on the risk of cardiovascular events
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fri0327 serum anti Phospholipid Antibody prevalence and cardiovascular significance in the general population of the camelia study
Annals of the Rheumatic Diseases, 2016Co-Authors: C. Selmi, E. Generali, P.m. Battezzati, M. De Santis, A. Ceribelli, P.l. Meroni, M. ZuinAbstract:Background The serum anti-Phospholipid Antibody (aPLs) prevalence in the general population and the association with cardiovascular disease and risk factors remain unclear. Objectives To test serum samples from a population study for aPLs and determine the presence of cardiovascular and metabolic comorbidities in a Northern Italian city. Methods We performed a cross-sectional study on 1712 adult subjects (median age 47 year-old, interquartile range 37–61, 49.8% women), randomly enrolled in 2010 from the voting lists of a 32.000-population city in the Lombardia region. All subjects completed a questionnaire for medical history and ongoing/past medications and underwent physical examination and abdomen and carotid ultrasound. Anti-cardiolipin (aCL), anti-beta2 glycoprotein I (aGPI), anti-phosphatidylserine-prothrombin (aSP) IgG, IgM, and IgA antibodies were tested in all subjects by ELISA. Results At least one aPL was positive in 258 (15.1%), at high titer in 56 (3.3%) subjects; 35 (2%) were positive for two or more aPL, 15 (0.9%) at high titer. Serum aCL were positive in 26 (1.5%) subjects, at high titer in 17 (1%), without additional aPL in 2; IgG in 15 (0.9%; at high titer in 11), IgM in 18 (1.1%, at high titer in 10), IgA at high titer in 4 (0.2%). Serum aGPI were positive in 73 (4.3%) subjects, at high titer in 48 (2.8%), without additional aPL in 4; IgG in 20 (1.2%; at high titer in 3), IgM in 28 (1.6%, at high titer in 6), IgA in 35 (2%, at high titer in 12). Serum aSP were positive in 201 (11.7%) subjects, at high titer in 29 (1.7%), without additional aPL in 167; IgG in 157 (9.2%, at high titer in 19), IgM in 65 (3.8%, at high titer in 12). Women represented 53.1% of aPL positive subjects, with higher incidence for aGPI, especially IgA, and aSP. Among aPL positive subjects, there were 10 cases of acute myocardial infarction, 7 strokes, 17 peripheral arteriopathy and 22 increased intimal-medial-thickness. Positivity for aPL was associated with older age, particularly for aGPI and aSP, while high-titer aCL IgG and aSP IgG were associated with tobacco smoking. Hypertension and hypercholesterolemia were significantly associated to aGPI IgG and IgM positivity, respectively. Hyperhomocystinemia was significantly associated with high titer multiple aPLs. Hyperuricemia was associated with aSP IgG positivity. Subjects with positive aPL had significantly higher frequency of thyroid disease (p=0.02 for high titer), peripheral arteriopathy (crude odds ratio –OR- 2; 95% confidence interval –CI- 1.2–3.6; isolated aCL crude OR 25.1; 95% CI 1.6–405.4), myocardial infarction (isolated aCL crude OR 28.5; 95%CI 1.8–460.5). Importantly, adjusted ORs for cardiovascular risk factors were not statistically significant. Conclusions We confirm that serum aPL are common in the general population, particularly at older age and possibly in association with smoking. Serum aPL is associated with common cardiovascular risk factors and specific events, however this latter effect needs to be clarified in the follow-up study to determine the real impact of aPL on the risk of cardiovascular events. Disclosure of Interest None declared
Muhammad Shurafa - One of the best experts on this subject based on the ideXlab platform.
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resolution of catastrophic anti Phospholipid Antibody syndrome with acute renal failure after treatment with rituximab
Blood, 2004Co-Authors: Muhammad Shurafa, Nidhika Babbar, Quresh KhairullahAbstract:AntiPhospholipid Antibody syndrome (APS) is a thrombophilic disorder defined by the presence of recurrent thrombosis associated with anticardiolipin antibodies (ACA). To date, there is no effdective therapy for this condition. Rituximab, a chimeric monoclonal Antibody B Cells has been shown to be effective in autoimmune disorders. Sporadic abstracts have reported the disappearance of ACA after Rituximab treatment. We have successfully treated a patient with primary catastrophic APS and renal failure with Rituximab. Case Report: A thirty seven year old male with history of DVT, ischemic cardiomyopathy and cerebrovascular accident was admitted to the Hospital for the treatment of acute renal failure and thrombocytopenia. Physical examination was significant for cognitive deficits, mild hepatomegaly, generalized livido reticulairs, and acrocyanosis. Laboratory data revealed platelet count of 97000, creatinine 3.4 mg/dl, IgG ACA titer of 43.8 and negative IgM ACA and ANA. He had proteinuria with benign urinary sediment. Kidney biopsy showed thrombotic microangiopathy. Plasmaphersis was initiated and hemodialysis for the rapidly progressing renal failure. He continued his treatment in an outpatient hemodialysis unit while on Coumadin. Four weekly cycles of Rituximab were given as an outpatient. Serial laboratory investigations showed gradual normalization of the platelet count and disappearance of the IgG ACA. Gradually renal function recovered and hemodialysis was discontinued after three months. He remains in remission with no further thrombotic events.Conclusion: Rituximab is promising in the treatment of APS and must be considered in the first;line treatment of catastrophic APS. A clinical trial is necessary to test the feasibility of discontinuing anticoagulation in these patients. PERTINENT LABORATORY DATA
C. Selmi - One of the best experts on this subject based on the ideXlab platform.
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anti Phospholipid Antibody prevalence and association with subclinical atherosclerosis and atherothrombosis in the general population
International Journal of Cardiology, 2020Co-Authors: C. Selmi, E. Generali, P.m. Battezzati, Maria De Santis, Simone Aldo Lari, Angela Ceribelli, Natasa Isailovic, P Zermiani, Sandra Neidhofer, Torsten MatthiasAbstract:Abstract Background There is no agreement on the prevalence of anti-Phospholipid antibodies (aPLs) and the correlation with atherosclerosis and cardiovascular (CV) events in the general population. Methods We performed a cross-sectional study on 1712 randomly enrolled subjects from a Northern Italian city to investigate the presence of aPLs and the association with subclinical atherosclerosis (using the carotid artery intima media thickness measured as inter-adventitia common carotid artery diameters - ICCAD) and retrospectively collected CV factors and events (i.e. acute myocardial infarction, stroke, and peripheral obliterans arterial vasculopathy) using physician-assisted questionnaires. We tested serum IgG, IgM, and IgA anti-cardiolipin, anti-beta2glycoprotein I (aGPI), and anti-phosphatidylserine-prothrombin antibodies. Results Positive aPLs were found in 15.1% of the subjects, with no differences between sex but with higher rates in older subjects. Carotid subclinical atherosclerosis was more frequent in aPL positive subjects; more specifically, aGPI IgA were associated with higher ICCAD average (adjusted beta 0.51, 95% confidence interval (CI)0.17–0.84; p = 0.003). A positive history of CV events was also more frequent in aPL positive subjects (odds ratio (OR) 1.67, 95%CI 1.08–2.54; p = 0.012), particularly peripheral obliterans arterial vasculopathy ( OR 2.02 ; 95%CI 1.14–3.57; p = 0.015). Among subjects with a Framingham risk score >20, and/or diabetes, and/or body mass index >3 5 kg/m 2 , aPL positivity was associated to the highest risk of CV events (OR 2.52, 95%CI 1.24–5.11; p = 0.011). Conclusions APL prevalence in the general population is higher than previously reported. CV events and subclinical atherosclerosis are more frequent in the presence of aPL, particularly when a high CV risk coexists.
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Serum anti-Phospholipid Antibody prevalence and cardiovascular significance in the general population of the camelia study
'BMJ', 2016Co-Authors: C. Selmi, E. Generali, P.m. Battezzati, M. De Santis, A. Ceribelli, P.l. Meroni, M. ZuinAbstract:Background The serum anti-Phospholipid Antibody (aPLs) prevalence in the general population and the association with cardiovascular disease and risk factors remain unclear. Objectives To test serum samples from a population study for aPLs and determine the presence of cardiovascular and metabolic comorbidities in a Northern Italian city. Methods We performed a cross-sectional study on 1712 adult subjects (median age 47 year-old, interquartile range 37–61, 49.8% women), randomly enrolled in 2010 from the voting lists of a 32.000-population city in the Lombardia region. All subjects completed a questionnaire for medical history and ongoing/past medications and underwent physical examination and abdomen and carotid ultrasound. Anti-cardiolipin (aCL), anti-beta2 glycoprotein I (aGPI), anti-phosphatidylserine-prothrombin (aSP) IgG, IgM, and IgA antibodies were tested in all subjects by ELISA. Results At least one aPL was positive in 258 (15.1%), at high titer in 56 (3.3%) subjects; 35 (2%) were positive for two or more aPL, 15 (0.9%) at high titer. Serum aCL were positive in 26 (1.5%) subjects, at high titer in 17 (1%), without additional aPL in 2; IgG in 15 (0.9%; at high titer in 11), IgM in 18 (1.1%, at high titer in 10), IgA at high titer in 4 (0.2%). Serum aGPI were positive in 73 (4.3%) subjects, at high titer in 48 (2.8%), without additional aPL in 4; IgG in 20 (1.2%; at high titer in 3), IgM in 28 (1.6%, at high titer in 6), IgA in 35 (2%, at high titer in 12). Serum aSP were positive in 201 (11.7%) subjects, at high titer in 29 (1.7%), without additional aPL in 167; IgG in 157 (9.2%, at high titer in 19), IgM in 65 (3.8%, at high titer in 12). Women represented 53.1% of aPL positive subjects, with higher incidence for aGPI, especially IgA, and aSP. Among aPL positive subjects, there were 10 cases of acute myocardial infarction, 7 strokes, 17 peripheral arteriopathy and 22 increased intimal-medial-thickness. Positivity for aPL was associated with older age, particularly for aGPI and aSP, while high-titer aCL IgG and aSP IgG were associated with tobacco smoking. Hypertension and hypercholesterolemia were significantly associated to aGPI IgG and IgM positivity, respectively. Hyperhomocystinemia was significantly associated with high titer multiple aPLs. Hyperuricemia was associated with aSP IgG positivity. Subjects with positive aPL had significantly higher frequency of thyroid disease (p=0.02 for high titer), peripheral arteriopathy (crude odds ratio –OR- 2; 95% confidence interval –CI- 1.2–3.6; isolated aCL crude OR 25.1; 95% CI 1.6–405.4), myocardial infarction (isolated aCL crude OR 28.5; 95%CI 1.8–460.5). Importantly, adjusted ORs for cardiovascular risk factors were not statistically significant. Conclusions We confirm that serum aPL are common in the general population, particularly at older age and possibly in association with smoking. Serum aPL is associated with common cardiovascular risk factors and specific events, however this latter effect needs to be clarified in the follow-up study to determine the real impact of aPL on the risk of cardiovascular events
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fri0327 serum anti Phospholipid Antibody prevalence and cardiovascular significance in the general population of the camelia study
Annals of the Rheumatic Diseases, 2016Co-Authors: C. Selmi, E. Generali, P.m. Battezzati, M. De Santis, A. Ceribelli, P.l. Meroni, M. ZuinAbstract:Background The serum anti-Phospholipid Antibody (aPLs) prevalence in the general population and the association with cardiovascular disease and risk factors remain unclear. Objectives To test serum samples from a population study for aPLs and determine the presence of cardiovascular and metabolic comorbidities in a Northern Italian city. Methods We performed a cross-sectional study on 1712 adult subjects (median age 47 year-old, interquartile range 37–61, 49.8% women), randomly enrolled in 2010 from the voting lists of a 32.000-population city in the Lombardia region. All subjects completed a questionnaire for medical history and ongoing/past medications and underwent physical examination and abdomen and carotid ultrasound. Anti-cardiolipin (aCL), anti-beta2 glycoprotein I (aGPI), anti-phosphatidylserine-prothrombin (aSP) IgG, IgM, and IgA antibodies were tested in all subjects by ELISA. Results At least one aPL was positive in 258 (15.1%), at high titer in 56 (3.3%) subjects; 35 (2%) were positive for two or more aPL, 15 (0.9%) at high titer. Serum aCL were positive in 26 (1.5%) subjects, at high titer in 17 (1%), without additional aPL in 2; IgG in 15 (0.9%; at high titer in 11), IgM in 18 (1.1%, at high titer in 10), IgA at high titer in 4 (0.2%). Serum aGPI were positive in 73 (4.3%) subjects, at high titer in 48 (2.8%), without additional aPL in 4; IgG in 20 (1.2%; at high titer in 3), IgM in 28 (1.6%, at high titer in 6), IgA in 35 (2%, at high titer in 12). Serum aSP were positive in 201 (11.7%) subjects, at high titer in 29 (1.7%), without additional aPL in 167; IgG in 157 (9.2%, at high titer in 19), IgM in 65 (3.8%, at high titer in 12). Women represented 53.1% of aPL positive subjects, with higher incidence for aGPI, especially IgA, and aSP. Among aPL positive subjects, there were 10 cases of acute myocardial infarction, 7 strokes, 17 peripheral arteriopathy and 22 increased intimal-medial-thickness. Positivity for aPL was associated with older age, particularly for aGPI and aSP, while high-titer aCL IgG and aSP IgG were associated with tobacco smoking. Hypertension and hypercholesterolemia were significantly associated to aGPI IgG and IgM positivity, respectively. Hyperhomocystinemia was significantly associated with high titer multiple aPLs. Hyperuricemia was associated with aSP IgG positivity. Subjects with positive aPL had significantly higher frequency of thyroid disease (p=0.02 for high titer), peripheral arteriopathy (crude odds ratio –OR- 2; 95% confidence interval –CI- 1.2–3.6; isolated aCL crude OR 25.1; 95% CI 1.6–405.4), myocardial infarction (isolated aCL crude OR 28.5; 95%CI 1.8–460.5). Importantly, adjusted ORs for cardiovascular risk factors were not statistically significant. Conclusions We confirm that serum aPL are common in the general population, particularly at older age and possibly in association with smoking. Serum aPL is associated with common cardiovascular risk factors and specific events, however this latter effect needs to be clarified in the follow-up study to determine the real impact of aPL on the risk of cardiovascular events. Disclosure of Interest None declared
Lee W Riley - One of the best experts on this subject based on the ideXlab platform.
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anti Phospholipid Antibody levels as biomarker for monitoring tuberculosis treatment response
Tuberculosis, 2012Co-Authors: Amador Goodridge, Carla Cueva, Maureen Lahiff, Grace Muzanye, John L Johnson, Payam Nahid, Lee W RileyAbstract:Standard methods to monitor tuberculosis (TB) treatment response rely on sputum microscopy and culture conversion. Alternatives to these methods are needed for those patients whose sputum tests are smear or culture negative. Here, we examine anti-Phospholipid IgM Antibody level changes as a biomarker for treatment response in smear positive TB patients. Serum samples were obtained from 40 pulmonary TB patients at the start and end of the intensive phase treatment (IPT) from the CDC-TB Trials Consortium randomized clinical trial in Kampala, Uganda. Samples were screened by ELISA for IgM levels against five Phospholipids found in Mycobacterium tuberculosis and host cells. Lipid antigens included cardiolipin (CL), phosphatidyl inositol (PI), phosphatidyl ethanolamine (PE), phosphatidyl choline (PTC), and sphingolipid (SL). Levels of IgM against all Phospholipids significantly decreased (p = 0.034, 0.001, 0.008 0.008, 0.040, respectively) following anti-TB drug treatment in patients without lung cavitary disease at baseline. The mean sensitivity of this test in these patients was 83% when the IgM response to a single lipid antigen was used; it was >90% when responses to 2 or more lipids were assessed. In contrast, cavitary TB patients showed an overall IgM increase, with a significant rise against PE (p = 0.025). There was no significant difference in the change in Antibody levels between patients who remained culture-positive and those who culture-converted after 40 doses of drug therapy. The measurement of IgM anti-Phospholipid antibodies may be a useful biomarker to monitor treatment response in non-cavitary TB patients.