ANTIPHOSPHOLIPID SYNDROME Edited by Alena Bulikova Antiphospholipid Syndrome Edited by Alena Bulikova Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Dragana Manestar Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published April, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com Antiphospholipid Syndrome, Edited by Alena Bulikova p. cm. ISBN 978-953-51-0526-8 Contents Preface IX Section 1 Introduction 1 Introductory Antiphospholipid Syndrome: Chapter Changing Knowledge During the Time – The ”Four P” Pattern 3 Alena Buliková Section 2 Pathophysiologic Mechanisms Involved in Antiphospholipid Antibodies Action 11 Chapter 1 2 -Glycoprotein I – A Protein in Search of Function 13 Anthony Prakasam and Perumal Thiagarajan Chapter 2 Structural Changes in 2 -Glycoprotein I and the Antiphospholipid Syndrome 23 Çetin Ağar, Philip G. De Groot and Joost C.M. Meijers Chapter 3 Genetics of Antiphospholipid Syndrome 35 Jesús Castro-Marrero, Eva Balada, Josep Ordi-Ros and Miquel Vilardell-Tarrés Section 3 Antiphospholipid Antibodies Detection, Clinical Manifestation and Treatment 67 Chapter 4 Antiphospholipid Antibodies – Detection and Clinical Importance 69 Jakub Swadzba and Jolanta Kolodziejczyk Chapter 5 Presence of Antibodies Against Mycoplasma penetrans in Patients with Antiphospholipid Syndrome 85 Elizabeth Herrera-Saldivar, Antonio Yáñez, David Bañuelos, Constantino Gil and Lilia Cedillo VI Contents Chapter 6 Antiphospholipid Antibodies and Their Association with Atherosclerotic Changes in Patients with Systemic Lupus Erythematosus – Review of Literature and Own Experiences 97 Katarzyna Fischer, Jacek Fliciński and Marek Brzosko Chapter 7 The Kidney in Antiphospholipid Syndrome 125 Alexandru Caraba, Viorica Crişan, Andreea Munteanu, Corina Şerban, Diana Nicoară and Ioan Romoşan Chapter 8 The Management of Antiphospholipid Antibodies Affected Pregnancy 139 Kenji Tanimura, Yashuhiko Ebina, Yoko Maesawa, Ryoichi Hazama and Hideto Yamada Chapter 9 Antiphospholipid Autoantibodies in Women with Recurrent Gestational Failures – Controversies in Management 151 Áurea García Segovia, Margarita Rodríguez-Mahou, Pedro Caballero and Silvia Sánchez-Ramón Chapter 10 Antiphospholipid Syndrome in Pregnancy 161 Kjell Haram, Eva-Marie Jacobsen and Per Morten Sandset Chapter 11 Update on Antiphospholipid Antibody Syndrome Management 175 Rocco Manganelli, Salvatore Iannaccone, Serena Manganelli and Mario Iannaccone Section 4 Conclusion 197 Chapter 12 Antiphospholipid Syndrome – An Evolving Story of a Multisystemic Disease 199 Silvia S. Pierangeli, Rohan Willis, Brock Harper and E. Nigel Harris Preface Immunity seems to be a fascinating system in the human body, whose role has never been understood in detail, despite the great progress in our knowledge about its role, regulation and its disorders. The same goes for autoimmunity diseases as well as antiphospholipid antibodies presence and antiphospholipid syndrome. Due to humoral nature of these autoantibodies they can impact every tissue and due to their heterogeneity and complex actions they can be connected with wide spectrum of clinical manifestations. This leads to the fact that almost every medical doctor, regardless of his or her specialty, can come across a patient affected by some of these manifestations. This is why it is necessary to share the knowledge possessed by experts in this subject with the aim to help patients with antiphospholipid antibodies presence. Finally, this is why this book is presented to a wide range of readers. Forty seven contributors from nine countries bring together their knowledge and also their own experience from different fields of their professional work with the aim of providing a valuable resource for improving some of the points of view, decisions and treatment success in the antiphospholipid antibodies positive patients’ management. May the authors' hopeful expectations fulfil. May the readers find the answers for their questions. May the patients with antiphospholipid syndrome meet the doctor who has read this book that had changed his/her knowledge. Best regards. Alena Buliková, M.D., Ph.D. University Hospital Brno Czech Republic . ANTIPHOSPHOLIPID SYNDROME Edited by Alena Bulikova Antiphospholipid Syndrome Edited by Alena Bulikova Published by InTech Janeza Trdine. Antiphospholipid Syndrome, Edited by Alena Bulikova p. cm. ISBN 978-953-51-0526-8 Contents Preface IX Section 1 Introduction 1 Introductory Antiphospholipid Syndrome: . accompanied by antiphospholipid syndrome s definition were created in patients with systemic lupus erythematosus in the late eightieths and early ninetieths Antiphospholipid Syndrome 4