The association of complement system activation and TNF alpha with pregnancy prognosis in pregnants with systemic lupus erythematosus and antiphospholipid syndrome

The Association of Complement System Activation and TNF Alpha with Pregnancy Prognosis in Pregnants with Systemic Lupus Erythematosus and Antiphospholipid Syndrome Objectives: Systemic lupus erythematosus (SLE) and Antiphospholipid syndrome (APS) are associated with poor pregnancy outcome. We aimed to investigate 'Relation of Complement(c) activation and Tumor necrozis factor –alpha (TNF-alpha) with poor pregnancy outcomes among SLE and APS patients. Patients and Methods: Patients were categorized into 4 groups. SLE/APS pregnants(n=37), SLE/APS patients (n=15), healthy pregnants(n=20), healthy volunteers (n=14). C3b, C5a and TNF-alpha were studied (ELISA) in serum (s) samples which belonged to the last trimester. After delivery placental tissues were collected then histopathologic and immunohistochemistry examination were performed. Results: sC3b levels and positivity ratio in SLE/APS pregnant were higher than SLE/APS non-pregnant, healthy pregnant and healthy group (p<0.05 for all). Pregnancy loss (%18,9) and preeclempsia (%16,2) were the most common pregnancy morbidities. The most common disease activation findings in SLE patients were renal flare (%30,5) followed by thrombocytopenia (%19,4). The associations between sTNF-alpha and this activation were statistically significant (p<0,05). In addition, the ratio of sTNF-alpha positivity was significantly higher in SLE/APS patients with preeclampsia (p<0.05). Compared to healthy pregnants, SLE/APS pregnancies resulted more preterm (%56,7), intrauterine growth restriction(IUGR)(%36,7), low birth weight-length and APGAR scores. Staining with placental C4d and TNF-alpha were higher in pregnant women with SLE/AFS(p<0,001). Decidual vasculopathy, desidual inflamation and villous infarct were more common in SLE/APS pregnants. Associations were detected between these findings and preeclampsia, IUGR, the need for neonatal intensive care, respectively (p<0,001). Conclusions: Findings in our study support the importance of complement and TNF-alpha, especially at the tissue in pregnant patients with SLE/APS. In the coming years, the use of these biomarkers in pregnancy follow-up and new therapies targeting the pathways related to these markers may positively affect maternal/fetal prognosis.