Antiphospholipid Antibodies: Discussion

Antiphospholipid Antibodies: DiscussionTherefore, the presence of immune type aPL is thought to be responsible for the occurrence of thrombotic complications because foGPI is a well-known plasma protein with anticoagulant activity.
The enzyme-linked immunosorbent assay method we applied in the present study for the detection of aPL can detect these two types of aPL, but cannot distinguish them. Therefore, it is unknown whether aPL detected in patients with sarcoidosis in the present study belongs to the autoimmune type or the infective type other asthma inhalers online. In sarcoidosis, arterial or venous thrombosis and recurrent spontaneous fetal loss do not usually occur, suggesting that the aPL detected in sarcoidosis is mainly the infective type.
In tuberculosis, another epithelioid cell granuloma-forming disease, the presence of infective type aPL also has been reported. The fact that the cell membrane of patients who have Mycobacterium tuberculosis-caused tuberculosis is mainly composed of phospholipids is thought to be responsible for the induction of aPL in tuberculosis. The same mechanism in syphilis is considered responsible for the induction of aPL. Therefore, bacterial infection may well be involved in the induction of aPL in sarcoidosis. However, further study will be necessary to clarify this.
On the other hand, the presence of infective type aPL has been reported in patients with hepatitis or infectious mononucleosis, indicating that bacterial infection is not essential for the induction of aPL.
In the present study, we examined the presence of antibodies against five types of phospholipids which are all negatively charged. The fo-GPI is known to have an affinity for these negatively charged phospholipids, so cross-reactions could easily occur with the autoimmune type aPL. The detected aPL in patients with sarcoidosis displayed cross-reactivity, suggesting that aPL in sarcoidosis may at least partially involve the autoimmune type. Further evaluation will be necessary to confirm this.
The elevation of serum angiotensin-converting enzyme and lysozyme levels in patients with sarcoidosis is thought to be due to increased production by activated macrophages and epithelioid cells, reflecting the amount of granuloma in the body. Both of these enzymes are useful in diagnosis and assessment of disease activity of sarcoidosis. In the present study, there was no correlation between the frequency of aPL and serum levels of angiotensin-converting enzyme or lysozyme. Therefore, the presence of aPL is not thought to be related to the disease activity of sarcoidosis.
Patients with two or more extrathoracic organ lesions had aPL at a significantly higher rate. In general, it has been accepted that sarcoidosis patients with multi-organ lesions tend to have a prolonged clinical course, indicating that the occurrence of aPL may imply a prolongation of sarcoidosis.
In the present study, aPL very frequently occurred in the groups with a continuous abnormal shadow for over 2 or 5 years. From this retrospective observation, it could be said that the presence of aPL may be one of the prognostic factors in sarcoidosis. In order to clarify this matter, since we are interested in whether or not the changes in aPL are indeed related to the extension of the disease, a time course study is now in progress. Using sequential samples obtained from the same patient with time, we analyze changes in the antibody titers with time. This study will determine whether their appearance is related to extension of the disease or is lost when the pulmonary lesions disappear.
It is concluded that the appearance of aPL is not related to disease activity of sarcoidosis but is an important prognostic factor.

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