DoM Seminar: Dr Laura Andreoli

'Women's Health in Rheumatology: conversations between the clinic and the bench'

Dr Laura Andreoli, MD, PhD
Associate Professor of Rheumatology (2019-ongoing) at the University of Brescia

Host: Professor Ian Giles
Professor of Rheumatology
Department of Inflammation, Division of Medicine, UCL

Thursday 18h May 2023 at 13:00 -14:00
This seminar will take place in Second Floor Seminar Room of the Rayne Buiding and will also run on Teams (link)
Click here to join the meeting

Abstract

Autoimmune rheumatic diseases (ARD) are systemic disorders that mainly affect women, with onset more frequently during childbearing age.  The management of reproductive health is crucial for the quality of life of these patients.  Rheumatologists recognise the challenges in communication about reproductive issues during the patients’ journey (pregnancy, contraception, assisted reproduction techniques, menopause, etc.). Therefore, the research interest about these topics has been growing in the past few decades, alongside with the improvement in the treatment of ARD, making it possible for more and more women to think about having a family despite living with a chronic condition.

Systemic Lupus Erythematosus (SLE) and the Antiphospholipid Syndrome (APS) have several implications with regard to reproductive healthcare, especially the management of pregnancy. Particularly, pathogenic autoantibodies such as antiphospholipid antibodies (aPL) can mediate maternal and fetal complications through placental dysfunction and insufficiency (i.e. preeclampsia, HELLP syndrome, maternal thrombosis, intrauterine growth restriction, intrauterine fetal death).  There have been efforts in identifying risk factors for adverse pregnancy outcomes (APO) and maternal vascular events during pregnancy and the puerperium.  Among immunological risk factors, aPL subsets might be relevant. The fine specificity of anti-beta2glycoprotein I antibodies has been studied in terms of anti-domain reactivity (anti-domain 1 and anti-domain 4/5).  Anti-domain 1 antibodies seem to be the most pathogenic not only towards vascular events but also obstetric complications.  These findings are important for the design of future targeted treatments for APS.

The management of pregnancy in SLE and APS has improved over decades, thanks to better knowledge of the interplay between disease activity and APO.  The risk of APO can be minimised and made similar to that of the general obstetric population by preconception counselling and tailored management during pregnancy. The main goal of preconception planning is to stratify risk (preferably within a multidisciplinary team) and to offer preventative measures which are aimed at keeping disease activity in remission (use of compatible anti-rheumatic drugs during pregnancy) and counteract the negative effects of aPL (combination treatment of low dose acetylsalicylic acid and heparin).

Guidance for the management of pregnancy in women with SLE and/or APS has become available thanks to national and international scientific societies (EULAR, ACR, BSR) that supported recommendations/guidelines based on both systematic literature review and expert opinion.  Many recommendations still come from clinical experience, therefore there is a strong need for studies with a higher level of evidence and, hopefully, randomized clinical trials (which are hampered by numerous regulatory hurdles).  Meanwhile, efforts have been put in the prospective collection of data from pregnant patients and some national registries have been started, alongside the perspective of merging data and increase sample size, especially for low-prevalence and rare ARD.

Selected references from the research work by Laura Andreoli:

Chighizola CB, Pregnolato F, Andreoli L, Bodio C, Cesana L, Comerio C, Gerosa M, Grossi C, Kumar R, Lazzaroni MG, Mahler M, Mattia E, Nalli C, Norman GL, Raimondo MG, Ruffatti A, Tonello M, Trespidi L, Tincani A, Borghi MO, Meroni PL. Beyond thrombosis: Anti-β2GPI domain 1 antibodies identify late pregnancy morbidity in anti-phospholipid syndrome. J Autoimmun. 2018 Jun;90:76-83.

Andreoli L, Chighizola CB, Nalli C, Gerosa M, Borghi MO, Pregnolato F, Grossi C, Zanola A, Allegri F, Norman GL, Mahler M, Meroni PL, Tincani A. Clinical characterization of antiphospholipid syndrome by detection of IgG antibodies against β2 -glycoprotein i domain 1 and domain 4/5: ratio of anti-domain 1 to anti-domain 4/5 as a useful new biomarker for antiphospholipid syndrome. Arthritis Rheumatol. 2015 May;67(8):2196-204.

Andreoli L, Nalli C, Motta M, Norman GL, Shums Z, Encabo S, Binder WL, Nuzzo M, Frassi M, Lojacono A, Avcin T, Meroni PL, Tincani A. Anti-β₂-glycoprotein I IgG antibodies from 1-year-old healthy children born to mothers with systemic autoimmune diseases preferentially target domain 4/5: might it be the reason for

their 'innocent' profile? Ann Rheum Dis. 2011 Feb;70(2):380-3.

Tektonidou MG, Andreoli L, Limper M, Amoura Z, Cervera R, Costedoat-Chalumeau N, Cuadrado MJ, Dörner T, Ferrer-Oliveras R, Hambly K, Khamashta MA, King J, Marchiori F, Meroni PL, Mosca M, Pengo V, Raio L, Ruiz-Irastorza G, Shoenfeld Y, Stojanovich L, Svenungsson E, Wahl D, Tincani A, Ward MM. EULAR recommendations for the management of antiphospholipid syndrome in adults. Ann Rheum Dis. 2019

Oct;78(10):1296-1304.

Andreoli L, Bertsias GK, Agmon-Levin N, Brown S, Cervera R, Costedoat-Chalumeau N, Doria A, Fischer-Betz R, Forger F, Moraes-Fontes MF, Khamashta M, King J, Lojacono A, Marchiori F, Meroni PL, Mosca M, Motta M, Ostensen M, Pamfil C, Raio L, Schneider M, Svenungsson E, Tektonidou M, Yavuz S, Boumpas D, Tincani

A. EULAR recommendations for women's health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Ann Rheum Dis. 2017 Mar;76(3):476-485.

Biography

Laura Andreoli specialized in Rheumatology in 2010 and obtained her PhD degree in “Methodology of Clinical Research” in 2015 at the University of Brescia (Italy).

She’s been working as Assistant Professor (2014-2019) and Associate Professor of Rheumatology (2019-ongoing) at the University of Brescia and as Consultant Physician at the Rheumatology and Clinical Immunology Unit of Spedali Civili in Brescia, where a Lupus Clinic has been active since 2013.

Her main interests include the pathogenesis, diagnosis and treatment of systemic autoimmune diseases, particularly systemic lupus erythematosus and the antiphospholipid syndrome, and their related autoantibodies. The research activity has been conducted within the frame of national/international networks.

Since 2006 she’s been working in the Pregnancy Clinic in Brescia (joined team of rheumatologists, gynecologists, neonatologists), which is dedicated to the management of pregnancy in patients with inflammatory arthritis and systemic autoimmune diseases, and to the study of predictors of outcome and implications of the use of anti-rheumatic drugs (conventional and biologic) in pregnant patients.

She served as fellow in charge of the literature review for the “2017 EULAR Recommendations for women’s health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome” and for the “2019 EULAR Recommendations for the management of antiphospholipid syndrome in adults”.

Since 2018 she’s been co-PI (together with Prof. Angela Tincani) of the “Italian Registry of Pregnancy in Rheumatic Diseases” (P-RHEUM.it Study) supported by the Italian Society for Rheumatology).

She is co-leading the EULAR study group for Reproductive Healthcare and Family Planning (ReHFaP study group) alongside Prof Karen Schreiber.

She is author/coauthor of nearly 200 publications on international journals indexed by PubMed.

The seminars are open to UCL & UCLH staff, students and their visitors. Please contact alison.kelly@ucl.ac.uk for all enquires  
Audience members: Please ensure that your mic is muted and video turned off during the talk. There will be a 10-minute Q&A at the end of the talk. Please ensure that you use the ‘raise hand’ function if you would like to ask a question. Thank you.