Auto-Antibody Profile

Antibodies are produced by B-cells of the immune system. They are small Y-shaped proteins that target anything thought to threaten the body's health. This can include foreign, 'non-self' targets such as bacteria and viruses or 'self' targets including cancerous or damaged cells.

Auto-antibodies are antibodies that target the bodies own 'self' proteins, cells, tissues and organs. Sometimes these auto-antibodies can mistakenly target healthy 'self' proteins, cells, tissues and organs leading to autoimmune conditions such as rheumatoid arthritis, lupus, Crohn's disease, vasculitis, Graves' disease etc.

Certain auto-antibodies are also known to affect fertility.
These auto-antibodies can cause pregnancy loss through miscarriage, intrauterine fetal death or stillbirth. They can also cause intrauterine growth restriction, pre-eclampsia and pre-term birth (Shoenfeld, Y., et al., 2008).
Auto-antibodies can cause inflammation around the embryo at the time of implantation or in the placenta after implantation.

Auto-antibodies are divided into different broad categories depending on what they target.

  • Anti-phospholipid antibodies target components in cell membranes
  • Anti-thyroid antibodies target the thyroid
  • Anti-nuclear antibodies target contents of a cell's nucleus, where DNA is stored

Anti-phospholipid Antibodies (APA)
22% of women with recurrent miscarriage have APA. This increases by 15% with each pregnancy that is lost.

Phospholipids are a type of lipid found in cell membranes. They are important for cell membrane function.
Examples of phospholipids include: Cardiolipin, Ethanolamine, Glycerol, Inositol, Phosphatidic Acid and Serine.

When damage occurs to a cell membrane, phospholipids can be released into the bloodstream. Immune cells can then target these phospholipids using APA. There are a number of different types of APA but two important ones are lupus anticoagulant and anti-cardiolipin antibodies. APA can also attach to a phospholipid protein co-factor called beta 2-glycoprotein1. When these APA are found in women with a history of recurrent miscarriage a diagnosis of Anti-phospholipid Syndrome (APS) or Hughes Syndrome is made. This is named after the doctor who discovered the condition in 1983. These APA cause blood to clot more easily, becoming more 'sticky' and restricting the blood supply to the growing embryo.
The placenta is more vulnerable to this clotting because it's phospholipids are more exposed on their membrane's surface than other cells of the body.

St. Mary's Hospital, London, found that pregnant women with APS have a 90% miscarriage rate. This usually happens between 7-12 weeks gestation. However, when women with APS were treated with low dose aspirin, the chance of a successful pregnancy was 42%. This increases to 71% when treated with low dose aspirin and the blood thinning drug heparin (Rai, R., et al., 1997).

Anti-thyroid Antibodies (ATA)
Increased levels of ATA such as thyroglobulin (anti-TG) or thyroid peroxidase (anti-TPO) auto-antibodies, are associated with recurrent pregnancy loss. These ATA have been found to cause fetal wastage and lower fetal/placenta weights in animal models (Tartakover-Matalon, S., et al., 2003). ATA can be found independent of thyroid dysfunction or thyroid specific disease.

Anti-nuclear Antibodies (ANA)
ANA describes auto-antibodies that attack components of the nucleus in a cell. The nucleus is the information and administrative centre of the cell. It contains the cell's genetic material (DNA) and issues directions to organise the cell.
There are many subtypes of ANA which target different components that make up the nucleus such as anti-DNA antibodies, anti-histone antibodies, anti-Ro antibodies, anti-La antibodies, anti-centromere antibodies etc.
A study found that the incidence of ANAs was 32% in patients with a history of miscarriages, opposed to 6% in healthy patients (Cubillos, J., et al., 1997).

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