by Steven R. Levin and Robin L. Brey, 147 pp, with illus, $59.95, Woburn, Mass, Butterworth-Heinemann, 2000.
This well-structured overview of literature concerning molecular characteristics and clinical consequences of antiphospholipid (APL) antibodies reflects a recent, exponential development of an interdisciplinary field that began with scattered observations in the early 20th century. Chronological descriptions of discoveries are incorporated into relevant chapters on basic science and clinical studies, and explain the historical and immunological relationships between anticardiolipin antibodies and lupus anticoagulant, now both included in the large group of APL antibodies. The review of data reveals the complexity of the subject because of the heterogeneity of APL antibodies, with increasingly recognized diversity in antigenic specificities and in possible effector mechanisms, which often lead to multiple and interrelated clinicopathological events. The mechanism of production and pathogenic significance of APL immunoglobulins also varies. Antiphospholipid antibodies of the immunoglobulin (Ig) G isotype can arise by a primary mechanism and be associated with antiphospholipid syndrome (APS), presenting with recurrent arterial or venous thrombosis and recurrent fetal loss. Over time, APS may evolve into systemic lupus erythematosus, or can be part of lupus-like syndromes from the onset. In addition, APL antibodies of predominantly the IgM isotype (without pathogenic significance) are detected in low percentages of healthy individuals and in patients suffering from infections (eg, human immunodeficiency virus or syphilis) or taking certain drugs (phenothiazine, valproate, procainamide, etc). Among major epidemiological studies, the authors call attention to 2 collaborative trials, APASS (Antiphospholipid Antibodies in Stroke Study) and WARSS (Warfarin Aspirin Recurrent Stroke Study), which investigate the risk of recurrent thrombo-occlusive events in patients with stroke and APL positivity.
Kalman B, Urrutia V. Clinical Approach to Antiphospholipid Antibodies. Arch Neurol. 2002;59(4):650-651. doi:10.1001/archneur.59.4.650