A prospective open-label pilot study of fluvastatin on proinflammatory and prothrombotic biomarkers in antiphospholipid antibody positive patients

Abstract

Objective: To determine if proinflammatory and prothrombotic biomarkers are differentially upregulated in persistently antiphospholipid antibody (aPL)-positive patients, and to examine the effects of fluvastatin on these biomarkers.

Methods: Four groups of patients (age 18-65) were recruited: (a) primary antiphospholipid syndrome; (b) systemic lupus erythematosus (SLE) with antiphospholipid syndrome (APS) (SLE/APS); (c) persistent aPL positivity without SLE or APS (Primary aPL); and (d) persistent aPL positivity with SLE but no APS (SLE/aPL). The frequency-matched control group, used for baseline data comparison, was identified from a databank of healthy persons. Patients received fluvastatin 40 mg daily for 3 months. At 3 months, patients stopped the study medication and they were followed for another 3 months. Blood samples for 12 proinflammatory and prothrombotic biomarkers were collected monthly for 6 months.

Results: Based on the comparison of the baseline samples of 41 aPL-positive patients with 30 healthy controls, 9/12 (75%) biomarkers (interleukin (IL)-6, IL1β, vascular endothelial growth factor (VEGF), tumour necrosis factor (TNF)-α, interferon (IFN)-α, inducible protein-10 (IP10), soluble CD40 ligand (sCD40L), soluble tissue factor (sTF) and intracellular cellular adhesion molecule (ICAM)-1) were significantly elevated. Twenty-four patients completed the study; fluvastatin significantly and reversibly reduced the levels of 6/12 (50%) biomarkers (IL1β, VEGF, TNFα, IP10, sCD40L and sTF).

Conclusions: Our prospective mechanistic study demonstrates that proinflammatory and prothrombotic biomarkers, which are differentially upregulated in persistently aPL-positive patients, can be reversibly reduced by fluvastatin. Thus, statin-induced modulation of the aPL effects on target cells can be a valuable future approach in the management of aPL-positive patients.

Keywords: Antiphospholipid Antibodies; Antiphospholipid Syndrome; Cytokines; Inflammation; Treatment.

Figures

Figure 1. Effects of Fluvastatin on Pro-inflammatory and Pro-thrombotic Biomarkers (BMR) in Antiphospholipid Antibody (aPL) Positive Patients

The percentage of patients with elevated (elev.) BMR levels at baseline (■) and with subsequent reduced (red.) levels following fluvastatin () is shown on the left primary vertical axis. The mean (±SD) maximum (max) level of BMR concentration (conc) reduction following fluvastatin is shown on the right secondary vertical axis (bars (Ξ). * p<0.05. IL: interleukin; IFN: interferon; IP10: inducible protein 10; sCD40L: soluble CD 40 ligand; sEsel: soluble E-selectin; sICAM-1: soluble intercellular adhesion molecule; sTF: soluble tissue factor; sVCAM-1: soluble vascular cell adhesion molecule 1; TNFα: tumor necrosis factor α; and VEGF: vascular endothelial growth factor.