Apoptosis and antiphospholipid antibodies

Objective: To analyze the potential links between antiphospholipid antibodi es (aPL) and apoptosis in the pathogenesis of the antiphospholipid antibody syndrome (APS). Methods: A review was undertaken of the most relevant scientific literature on apoptosis and autoimmune phenomena. Experimental and human pathology we re reviewed to substantiate the hypothesis that apoptosis is involved in th e generation of aPL. Results: Several considerations suggest that exposure of phospholipids (PL) during apoptosis may be a driving antigenic stimulus to the production of aPL. Furthermore, the molecular PL-protein complexes formed during apoptosi s are targeted by "pathogenic" aPL. The binding and the clearance of apopto tic cells by these autoantibodies likely further enhances the aPL immune re sponse. Experimental models and human pathology suggest that a restricted g enetic background is key to the development of this immune response. Conclusions: Abnormalities of apoptosis observed in the course of autoimmun e conditions likely provide an antigenic stimulus to the production of aPL, Copyright (C) 1998 by W.B. Saunders Company.