Antiphospholipid syndrome (APS) is an autoimmune disease characterised by:
Clinical criteria
Increased risk of blood clots (thrombosis) affecting the arteries and veins and/or
Increased risk of pregnancy complications e.g. recurrent miscarriages.
Blood testing criteria persistently positive antiphospholipid antibodies detected by:
a positive lupus anticoagulant antibodies test and/or
a positive anticardiolipin antibodies test and/or
a positive anti-Beta-2-glycoprotein-I antibodies test.
Pathophysiology
Increasing evidence on APS pathophysiology suggests an interplay between inflammatory and thrombotic mechanisms. Both the innate and adaptive branches of the immune system may be involved, causing various autoimmune and autoinflammatory complications.
Antiphospholipid antibodies are thought to cause dysfunction to endothelial cells that line blood vessels, leading to oxidative stress, inflammation and a thrombotic state.
Despite the mechanism not yet being fully understood, the 'two-hit' theory is at present time, the most accepted.
The first hit is where genetically susceptible individuals develop phospholipid antibodies via infection or an autoimmune disease, creating a clotting-prone environment. This involves antiphospholipid antibodies binding to phospholipids and phospholipid binding proteins on cell surfaces triggering coagulation and immune complement cascades.
The second hit is an additional insult such as infection, stress, medicines, obesity, diabetes, hypertension, hyperlipidemia, smoking, immobility, pregnancy, resulting in clot formation.
How can natural supplements help?
The standard medical care for APS may involve antiplatelet or anticoagulation measures such as vitamin K antagonists e.g. warfarin and supporting the cardiovascular system.
Since it is very important in APS to promote antithrombotic, anti-inflammatory and antioxidant pathways, the evidence behind the uses and benefits of natural supplements for APS should be considered:
VITAMIN D
The evidence continues to stack up for Vitamin D's immunomodulatory, anti-inflammatory and antithrombotic properties.
Studies demonstrate vitamin D deficiencies in APS patients by up to 70%, with up to half of those patients having severe deficiency.
The 16th International Congress on Antiphospholipid Antibodies Task Force Report in 2020, recommended that vitamin D deficiency be corrected in all APS patients.
OMEGA 3
Numerous studies advocate that omega-3 polyunsaturated fatty acids specifically EPA & DHA, improve endothelial function and reduce inflammation.
In a 2018 clinical trial, 16 weeks of omega-3 supplementation improved endothelial function in patients with primary APS.
COENZYME Q10
A naturally occurring biochemical cofactor found throughout the body in cell membranes, especially in the mitochondrial membranes. It is a significant lipid antioxidant preventing the generation of free radicals and modifications to lipids, proteins and DNA.
36 patients with APS who received CoQ10 supplementation in APS showed improved endothelial function and mitochondrial performance and decreased prothrombotic and proinflammatory mediators.
GINGER
A staple throughout history that contains anti-inflammatory and antioxidative bioactive compounds. It has been investigated for antithrombotic benefits.
Studies, mostly in-vivo, conclude that ginger possesses an anti-thrombotic property, probably through inhibition of platelet function.
QUERCETIN
Quercetin is known to have anti-inflammatory and antithrombotic properties, and studies have demonstrated its benefits in cardiovascular diseases.
One study evaluated the effect of quercetin in a cohort of patients with persistently elevated antiphospholipid antibodies. Oral administration of quercetin decreased platelet-dependent thrombin generation by 64%.
VITAMIN E
Known for its antioxidant, anti-inflammatory and antithrombotic properties and has been studied extensively in several conditions, particularly atherosclerosis.
Randomised clinical trials have demonstrated that supplementation with Vitamin E reduced oxidative stress markers and thrombin generation in patients with APS.
EPIGALLOCATECHIN-3-GALLATE (EGCG)
EGCG is the major polyphenolic component of green tea and has been shown to have antithrombotic, antioxidant and cardioprotective properties.
In an experimental study, a human culture was treated with anti-β2 glycoprotein complex (an APS antibody). This complex increases the risk of thrombosis and secretion of proinflammatory cytokines. EGCG significantly blocked the effects of the anti-β2 glycoprotein complex concluding anti-thrombosis and anti-inflammatory properties.
CURCUMIN
Curcumin, the bioactive constituent of turmeric, has been used for medical reasons for approximately 4000 years due to its antimicrobial, antioxidant, and anti-inflammatory properties. Curcumin has been found to dampen platelet activation and reduce platelet aggregation to endothelial cells.
RESVERATROL
Resveratrol, a polyphenol found in grapes, berries and red wine. It is known for antioxidant, anti-inflammatory, immunomodulatory, glucose control, lipid control, cardiovascular and neuroprotective beneficial effects.
Resveratrol improved endothelial function, in 19 patients with obesity and has been proposed to help with stroke as it improves blood flow, blood pressure, body mass index and lipid profile.
Unfortunately, there is still scarce human clinical data on the benefits, safety and dosage levels of natural supplements for APS. Natural supplements are not substitutes for medical care in APS. They may however be very beneficial in supporting the patient's underlying biology through anti-inflammatory and antioxidant mechanisms.
Patients should always consult with their medical professionals and work with a knowledgeable healthcare practitioner who can advise on supplement-medicine interactions and the correct dosages to use. This is particularly important for blood thinning medications in APS, due to their many interactions with herbal supplements.
A note on Vitamin K - It is important to note that Vitamin K supplements should not be taken by patients with APS due to the increased risk of clotting. This includes being careful with multivitamins that may contain vitamin K.
References: