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Reimagining the antiphospholipid syndrome, an enigmatic thrombophilic disorder, through the looking glass of microscopic imaging

Authors
  • Rand, Jacob H.1
  • Taatjes, Douglas J.2
  • 1 Weill Cornell Medical College, Department of Pathology and Laboratory Medicine, New York, NY, USA , New York (United States)
  • 2 University of Vermont, Department of Pathology and Laboratory Medicine, and Microscopy Imaging Center, Larner College of Medicine, 89 Beaumont Avenue, Burlington, VT, 05405, USA , Burlington (United States)
Type
Published Article
Journal
Histochemistry and Cell Biology
Publisher
Springer Berlin Heidelberg
Publication Date
Aug 18, 2018
Volume
150
Issue
5
Pages
529–543
Identifiers
DOI: 10.1007/s00418-018-1709-2
Source
Springer Nature
Keywords
License
Yellow

Abstract

The antiphospholipid syndrome (APS) is an autoimmune thrombophilic disorder that was described as a diagnostic entity over 30 years ago. And yet the pathogenic mechanisms that are responsible for its clinical manifestations remain to be definitively established. The syndrome is defined by (1) the concurrence of vascular thrombosis and/or pregnancy complications together with (2) positivity for immunoassays and coagulation tests that were derived from clinical observations of two anomalous laboratory test results—specifically, false positivity for syphilis infection in uninfected individuals and the finding of inhibitors of blood coagulation in patients who lacked any bleeding tendencies. Over the years, these were standardized into immunoassays and coagulation assays for APS. Here, we describe how prior knowledge of the immunologic and coagulation aspects of the disorder led to research involving a range of imaging modalities including light microscopy, immunohistochemistry, confocal scanning laser microscopy, transmission and scanning electron microscopy, and atomic force microscopy. In turn, the results from those studies led to a “reimagining” of APS that has advanced the understanding of pathogenic mechanisms of the disorder and has led to the development of novel mechanistically based diagnostics along with potential new treatment approaches that target disease mechanisms.

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