AB1301 IMMUNE REGULATION THERAPY PROMOTED THE RECANALIZATION OF CORONARY ARTERY IN A PATIENT WITH ANTIPHOSPHOLIPID SYNDROME: A CASE REPORT AND LITERATURE REVIEW
Authors: Bin Wang, LI Fang, Chong Gao, LI Xiao-Feng
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Thrombosis is considered as a major feature of antiphospholipid syndrome (APS). Once formed, thrombosis will threaten life and long-term oral anticoagulant therapy is required. In addition, some patients underwent percutaneous coronary intervention (PCI), but in-stent restenosis (ISR) is the most common complication of PCI. There is currently insufficient treatment for such patients. Because APS is an autoimmune disease, we developed a new therapy (Sirolimus based immunomodulatory) to treat a APS patients with ISR after PCI. <h3>Objectives:</h3> Assess the degree of stenosis of the various branches of the coronary arteries, and to observe the changes in the number of regulatory T cells (Tregs) in the peripheral blood of patients. <h3>Methods:</h3> An APS patient with coronary artery involvement was found in-stent restenosis after implantation of the stent. After sirolimus and other immunomodulatory treatments, coronary angiography and coronary CTA were performed to assess the degree of stenosis of the various branches of the coronary arteries, and to observe the changes in the number of regulatory T cells (Tregs) in the peripheral blood of patients. <h3>Results:</h3> After 6 months of immunomodulation therapy, the patient did not have clinical symptoms such as chest tightness and tightness. Four consecutive coronary angiography and coronary CTA (dual source) showed disappearance of left main plaque. Stenosis, the degree of stenosis in the anterior descending stent was reduced from 90% to 66%; the degree of right coronary stenosis was reduced from 50% to 30%, new stenosis and new thrombosis did not occur in other branches. The absolute number of Treg cells in peripheral blood gradually increased from 34.41 to 50.83 cells/μL. <h3>Conclusion:</h3> Sirolimus is an inhibitor of mTOR that is a serine/threonine kinase in two different complexes (mTORC1 and mTORC2) to promote cell proliferation and neovascularization. Antiphospholipid antibodies activate the mTOR pathway in endothelial cells in culture. When pretreated with mTOR inhibitors prevents this process from occurring. Sirolimus specifically inhibits the mTOR pathway and prevents neointimal hyperplasia and neovascularization in the coronary arteries. In ASP patients with coronary artery involvement, the reduction of Treg cells may also be an important cause of immune tolerance deficiency. Sirolimus also increased the number of Treg cells. If early use of immunomodulators such as sirolimus for prophylaxis, it may prevent re-stenosis after stenting. The successful treatment of this patient also provided us with new diagnostic and therapeutic ideas. <h3>References</h3> [1] Chinese Medical Association Rheumatology Branch. Guidelines for the diagnosis and treatment of antiphospholipid syndrome. Chinese Journal of Rheumatology, June 2011, Vol. 15, No. 6. [2] Nayak AK,Komatireddy G.Cardiac manifestations of the antiphospholipid antibody syndrome: a review. Mo Med.2002 Apr;99(4):171-8. [3] Liu J, Liu Y, Jia K, et al. Clinical analysis of lectin-like oxidized low-density lipoprotein receptor-1 in patients with in-stent restenosis after percutaneous coronary intervention.Medicine (Baltimore).2018 Apr;97(17):e0366. [4] Watanabe R, Wei L, Huang J. mTOR signaling, function, novel inhibitors, and therapeutic targets. J Nucl Med.2011 Apr;52(4):497-500. [5] Van Laecke S, et al. Inhibition of the mTORC pathway in the antiphospholipid syndrome. N Engl J Med.2014 Jul 24;371(4):303-12. <h3>Disclosure of Interests:</h3> None declared