2020 Recipients of the Lupus Canada Catalyst Award
Researchers: Leslie Skeith & Megan Barber
Mentor: Ann Clarke
University of Calgary
A prospective cohort study evaluating complement and platelet activation among lupus patients with antiphospholipid syndrome.
Problem: There is a high rate of obstetrical complications, such as preeclampsia, among women with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). The pathophysiology of APS is poorly understood and involves a complex interplay between the complement and coagulation systems. Our plan: We are completing a prospective cohort study to longitudinally evaluate complement activation during pregnancy among women with APS and matched pregnant controls. We are initiating an area of research to evaluate platelets in pregnant SLE patients with obstetric APS (oAPS) using a novel 4D platelet imaging method. By assessing how platelet activation relates to complement activation in real-time, we can better understand the pathophysiology of oAPS.
Antiphospholipid syndrome (APS) is an autoimmune disorder and acquired blood clotting condition that is commonly seen in patients with lupus. Pregnant women with lupus and APS are at risk of blood clots, and have high rates of pregnancy loss and other pregnancy complications like preeclampsia (high blood pressure and protein in the urine) despite receiving blood thinner and aspirin medication during their pregnancy. We still don’t know why these pregnancy complications happen or the best way to prevent them.
What causes APS is poorly understood; based on earlier research we think it involves both the complement system and platelets. The complement system is made up of a group of proteins and is part of the immune system. Platelets are one of the blood cells and are needed to form blood clots. Using a new test of complement activation and new high-resolution platelet imaging, we are studying what the changes are in the complement system and platelets in pregnant patients with lupus and APS, and how the two systems may be linked.
Our study will include pregnant lupus patients with APS and a pregnant control group without lupus or APS. We will ask questions about their health and follow them throughout their pregnancy. We will get monthly blood work in their pregnancy, and then every two weeks in their third trimester, is possible. The blood we take will allow us to measure complement activation and image their platelets and see how these tests change over a pregnancy.
We will use what we learn from this study to better identify how the problems of pregnancy happen in women with lupus and APS, so we can better predict who may get problems and then study targeted therapies to improve outcomes for mothers and their babies.