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Reduced placental growth and hCG secretion in vitro induced by antiphospholipid antibodies but not by anti-Ro or anti-La: studies on sera from women with SLE/PAPS

Laboratory of Teratology, Department of Anatomy and Cell Biology, Hebrew University, Hadassah Medical School, Jerusalem, Israel

Y Shoenfeld

O Barzilai

The Autoimmune Disease Center, Department of Medicine, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel

R Cervera

J Font

Department of Autoimmune Diseases, Institut Clinic de Medicina i Dermatologia, Hospital Clinic, Barcelona, Catalonia, Spain

M Blank

The Autoimmune Disease Center, Department of Medicine, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel

S Yacobi

N Patlas

Laboratory of Teratology, Department of Anatomy and Cell Biology, Hebrew University, Hadassah Medical School, Jerusalem, Israel

A Cohen

D Mevorach

Laboratory for Cellular and Molecular Immunology, Department of Medicine, Hebrew University Hadassah Medical School, Jerusalem, Israel

A Ornoy

Laboratory of Teratology, Department of Anatomy and Cell Biology, Hebrew University, Hadassah Medical School, Jerusalem, Israel; ornoy{at}cc.huji.ac.il

Systemic lupus erythematosus (SLE) and primary anti-phospholipid syndrome (PAPS) are autoimmune diseases causing recurrent pregnancy loss. We hypothesized that anti-phospholipid antibodies (aPL), but not anti-Ro and anti-La antibodies, might have a role through direct placental damage. We cultured human placental explants in sera from women with SLE/PAPS with different antibodies. These sera were found to reduce placental growth and increase trophoblastic apoptosis. No effect was found on estradiol or progesterone secretion, but inhibition in ßhCG secretion was detected. ßhCG was reduced in women with a history of recurrent pregnancy loss or thromboembolic events, and was also the most sensitive marker when examining the effects of specific antibodies. High titers of aPL were found to cause the largest reduction in ßhCG. Anti-Ro and anti-La did not induce placental damage. A strong correlation was found between the rise in the number of different antibodies in the sera and the incidence of recurrent pregnancy loss, which was also accompanied by a decline in the ßhCG levels. In conclusion, aPL, but not anti-Ro or anti-La, may cause placental damage in vitro. Thus ßhCG levels might constitute a predictive marker for the risk of placental damage and pregnancy loss in women with SLE/PAPS.

Key Words: anti-phospholipid antibodies (aPL) • anti-Ro and anti-La • ßhCG • pregnancy loss • systemic lupus erythematosus/primary anti-phospholipid syndrome (SLE/PAPS)

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