Rational combinations of in vivo cancer antigen priming and adoptive T-cell therapy mobilize immune and clinical responses in terminal cancers.

PURPOSE: It is now recognized that solid tumors encroach on the host's immune microenvironment to favor its own proliferation. Strategies to enhance the specificity of the endogenous T-cell population against tumors have been met with limited clinical success. We aimed to devise a two-tier protocol coupling in vivo whole antigen priming with ex vivo cellular expansion to clinically evaluate survival in patients following re-infusion of primed, autologous T cells, thereby determining treatment efficacy. EXPERIMENTAL DESIGN: Treatment commenced with the acquisition of whole tumor antigens from tumor cell lines corresponding with patients' primary malignancy. Lysate mixture was inoculated intradermally, while peripheral blood mononuclear cells (PBMCs) were periodically extracted via phlebotomy and expanded in culture ex vivo for re-infusion. Post-treatment tumor-specific T-cell response and cytotoxicity was confirmed via Elispot and real-time cell analyzing (RTCA) assay. Serum cytokine levels and cytotoxicity scores were evaluated for associations with survival status and duration. RESULTS: There was a significant increase in cytotoxicity exhibited by T cells measured using both Elispot and RTCA following treatment. Correlation analysis determined significant association between higher post-treatment cytotoxicity scores and survival status (R = 0.52, p = 0.0028) as well as longer survival duration in months (R = 0.59, p = 0.005). CONCLUSIONS: Our treatment protocol successfully demonstrated significant correlation between tumor-associated antigen-specific immune response and objective prolongation of survival. Whole-cell cancer antigen priming and adoptive T-cell therapy is, therefore, a highly feasible clinical model which can be easily replicated to positively influence outcome in end-stage malignancy.

The effect of hydroxychloroquine on haemostasis, complement, inflammation and angiogenesis in patients with antiphospholipid antibodies.

Objectives: HCQ has been described as having a beneficial effect in patients with APS but its mechanism of action is unclear. We hypothesized that HCQ may have effects on subnormal angiogenesis, inflammation and haemostatic biomarkers seen in APS. The aim of our study was to assess laboratory markers [annexin A5 (AnxA5) anticoagulant activity, tissue factor (TF) levels, thromboelastography (TEG), CRP, Bb, C3a and VEGF] in HCQ-naïve patients with aPL at baseline and after commencing HCQ. Methods: Twenty-two patients with aPL [20 female, 2 male, median age 55 (range 18-70) years] had blood taken pre- and 3 months after starting HCQ 200 mg daily. Results: Soluble TF levels were significantly reduced comparing baseline and 3 months after HCQ commencement [401.8 (152.8) vs 300.9 (108) pg/ml (P = 0.010)]. No significant changes were found in the following [reported as pre- and post-HCQ commencement, mean (s.d.)]: AnxA5 anticoagulant ratio [187.1 (29.5) vs 193 (31) (P = 0.157)], anti-domain1 ß2 glycoprotein1 IgG activity [1.8 (2) vs 1.2 (1.4) µg/ml (P = 0.105)], complement C3a-des-Arg [147.8 (84.5) vs 154.4 (88.1) ng/ml (P = 0.905)], complement Bb [1.3 (0.7) vs 1.1 (0.7) µg/ml (P = 0.422)], VEGF [68.8 (40) vs 59.4 (19.6) pg/ml (P = 0.454)] and CRP [7 (3.5) vs 7 (3.9) µg/ml (P = 0.917)]. TEG results including TEG reaction time, achievement of clot firmness, TEG maximum amplitude and TEG percentage lysis 30 and 60 min after maximum amplitude showed no significant difference. Conclusion: HCQ significantly reduced soluble TF levels in patients with aPL. No significant change was observed in AnxA5 activity, anti-domain 1 IgG activity, TEG, CRP, complement Bb and C3a-des-Arg, and VEGF. Further studies of a larger patient cohort are needed.

Antiphospholipid antibodies promote tissue factor-dependent angiogenic switch and tumor progression.

Progression to an angiogenic state is a critical event in tumor development, yet few patient characteristics have been identified that can be mechanistically linked to this transition. Antiphospholipid autoantibodies (aPLs) are prevalent in many human cancers and can elicit proangiogenic expression in several cell types, but their role in tumor biology is unknown. Herein, we observed that the elevation of circulating aPLs among breast cancer patients is specifically associated with invasive-stage tumors. By using multiple in vivo models of breast cancer, we demonstrated that aPL-positive IgG from patients with autoimmune disease rapidly accelerates tumor angiogenesis and consequent tumor progression, particularly in slow-growing avascular tumors. The action of aPLs was local to the tumor site and elicited leukocytic infiltration and tumor invasion. Tumor cells treated with aPL-positive IgG expressed multiple proangiogenic genes, including vascular endothelial growth factor, tissue factor (TF), and colony-stimulating factor 1. Knockdown and neutralization studies demonstrated that the effects of aPLs on tumor angiogenesis and growth were dependent on tumor cell-derived TF. Tumor-derived TF was essential for the development of pericyte coverage of tumor microvessels and aPL-induced tumor cell expression of chemokine ligand 2, a mediator of pericyte recruitment. These findings identify antiphospholipid autoantibodies as a potential patient-specific host factor promoting the transition of indolent tumors to an angiogenic malignant state through a TF-mediated pathogenic mechanism.

Palladium-Catalyzed Intermolecular Dehydrogenative C-2 Pentenylation of Indoles with 2-Methyl-2-butene.

Five-carbon (C5) units are the fundamental building blocks that constitute a multitude of natural products. Herein we report an unprecedented unusual C5 functionalization of indole regioselectively at the C-2-position enabled by a (2-pyridyl)sulfonyl-directing palladium-catalyzed dehydrogenative strategy with a bulk chemical 2-methyl-2-butene as a C5 source. Compared to typical C5 functionalization using pentenyl alcohols, carbonates, borates, or halides as the C5 source, the protocol not only has a low cost advantage but also is of atom and step economy.

Hydroxychloroquine protects the annexin A5 anticoagulant shield from disruption by antiphospholipid antibodies: evidence for a novel effect for an old antimalarial drug.

Annexin A5 (AnxA5) is a potent anticoagulant protein that crystallizes over phospholipid bilayers (PLBs), blocking their availability for coagulation reactions. Antiphospholipid antibodies disrupt AnxA5 binding, thereby accelerating coagulation reactions. This disruption may contribute to thrombosis and miscarriages in the antiphospholipid syndrome (APS). We investigated whether the antimalarial drug, hydroxychloroquine (HCQ), might affect this prothrombotic mechanism. Binding of AnxA5 to PLBs was measured with labeled AnxA5 and also imaged with atomic force microscopy. Immunoglobulin G levels, AnxA5, and plasma coagulation times were measured on cultured human umbilical vein endothelial cells and a syncytialized trophoblast cell line. AnxA5 anticoagulant activities of APS patient plasmas were also determined. HCQ reversed the effect of antiphospholipid antibodies on AnxA5 and restored AnxA5 binding to PLBs, an effect corroborated by atomic force microscopy. Similar reversals of antiphospholipid-induced abnormalities were measured on the surfaces of human umbilical vein endothelial cells and syncytialized trophoblast cell lines, wherein HCQ reduced the binding of antiphospholipid antibodies, increased cell-surface AnxA5 concentrations, and prolonged plasma coagulation to control levels. In addition, HCQ increased the AnxA5 anticoagulant activities of APS patient plasmas. In conclusion, HCQ reversed antiphospholipid-mediated disruptions of AnxA5 on PLBs and cultured cells, and in APS patient plasmas. These results support the concept of novel therapeutic approaches that address specific APS disease mechanisms.

Hydroxychloroquine reduces binding of antiphospholipid antibodies to syncytiotrophoblasts and restores annexin A5 expression.

OBJECTIVE: Antibody-mediated disruption of the annexin A5 anticoagulant shield has been posited to be a thrombogenic mechanism in the antiphospholipid syndrome. We recently showed that the antimalarial drug, hydroxychloroquine, dissociates antiphospholipid immune complexes and restores annexin A5 binding to planar phospholipid bilayer. Using quantitative immunoassays, we demonstrated similar effects on BeWo trophoblasts. We therefore, investigated the effects of the drug on localization of annexin A5 in primary cultures of human placental syncytiotrophoblasts. STUDY DESIGN: Laser confocal microscopy with computer-based morphometric analysis was used to localize annexin A5 and antiphospholipid antibodies on syncytiotrophoblasts exposed to polyclonal and monoclonal antiphospholipid and control immunoglobulin-Gs. RESULTS: Hydroxychloroquine reversed the effects of the antiphospholipid antibodies on the syncytiotrophoblasts by markedly reducing immunoglobulin-G binding and restoring annexin A5 expression. CONCLUSION: These results provide the first morphologic evidence for this effect of hydroxychloroquine on human placental syncytiotrophoblasts and support the possibility of novel treatments that target antiphospholipid antibody binding.

Resistance to annexin A5 anticoagulant activity in women with histories for obstetric antiphospholipid syndrome.

OBJECTIVE: The objective of the study was to investigate whether resistance to annexin A5 anticoagulant activity (AnxA5) occurs in women with histories for obstetric complications of antiphospholipid syndrome (Obs-APS) and whether this correlates with antibody recognition of domain 1 of ß2-glycoprotein. STUDY DESIGN: One hundred thirty-six women with antiphospholipid antibodies, including 70 with histories for Obs-APS and 30 controls, were investigated. RESULTS: Women with Obs-APS showed resistance to AnxA5 activity (median, 216%; range, 130-282% vs controls; median, 247%; range, 217-283%; P < .0001) and elevated levels of anti-domain I immunoglobulin (Ig) G (optical density: median, 0.056; range, 0.021-0.489 vs median, 0.042; range, 0.020-0.323; P = .002). Those in the lowest tertile of AnxA5 anticoagulant ratios had an odds ratio for Obs-APS of 58.0 (95% confidence interval, 3.3-1021.5). There was an inverse correlation between levels of annexin A5 anticoagulant activity and anti-domain I IgG. CONCLUSION: Resistance to AnxA5 anticoagulant activity is associated with antibody recognition of domain I of ß2-glycoprotein I and identifies a subset of women with histories for Obs-APS.

Hydroxychloroquine directly reduces the binding of antiphospholipid antibody-beta2-glycoprotein I complexes to phospholipid bilayers.

Treatment with the antimalarial drug hydroxychloroquine (HCQ) has been associated with reduced risk of thrombosis in the antiphospholipid (aPL) syndrome (APS) and, in an animal model of APS, with reduction of experimentally induced thrombosis. Recognition of beta2-glycoprotein I (beta2GPI) by aPL antibodies appears to play a major role in the disease process. We therefore used the techniques of ellipsometry and atomic force microscopy (AFM) to investigate whether HCQ directly affects the formation of aPL IgG-beta2GPI complexes on phospholipid bilayers. HCQ, at concentrations of 1 mug/mL and greater, significantly reduced the binding of aPL-beta2GPI complexes to phospholipid surfaces and THP-1 (human acute monocytic leukemia cell line) monocytes. The drug also reduced the binding of the individual proteins to bilayers. This HCQ-mediated reduction of binding was completely reversed when the HCQ-protein solutions were dialyzed against buffer. HCQ also caused modest, but statistically significant, reductions of clinical antiphospholipid assays. In conclusion, HCQ reduces the formation of aPL-beta2GPI complexes to phospholipid bilayers and cells. This effect appears to be due to reversible interactions between HCQ and the proteins and may contribute to the observed reduction of thrombosis in human and experimental APS. These results support the possibility that HCQ, or analogous molecules, may offer novel nonanticoagulant therapeutic strategies for treating APS.

Theoretical investigations of the EPR parameters for Cr3+ and Mn4+ ions in PbTiO3 crystals.

The complete high-order perturbation formulas of EPR parameters (g factors g( parallel), g( perpendicular) and zero-field splitting D), containing the crystal-field (CF) mechanism and charge-transfer (CT) mechanism (the latter is omitted in crystal-field theory which is often used to study the EPR parameters), are established from a cluster approach for 3d3 ions in tetragonal octahedral sites. According to the calculations based on these formulas, the EPR parameters g( parallel), g( perpendicular) and zero-field splitting D for Cr3+ and Mn4+ ions in PbTiO3 crystals are explained reasonably. The calculations show that (i) the sign of g-shift Deltag(i)(CT) (=g(i)-g(s), where g(s)=2.0023 is free-electron value and i= parallel and perpendicular) in CT mechanism is opposite to, but that of D(CT) is the same as, the corresponding signs in the CF mechanism and (ii) the relative importance of CT mechanism for the high valence state 3d3 ion (e.g., Mn4+) is large and so the contributions to EPR parameters from CT mechanism should be taken into account. The different sign of splitting D and the different defect structure for Cr3+ and Mn4+ impurity centers in PbTiO3 crystals are also suggested from the calculations. The results are discussed.

[Studies of the g factor and optical spectra for CaZrO3:Mn4+ crystal].

The complete high-order perturbation formula of g factor for 3d(3) ions in cubic octahedral site was derived. In the formula, both the contribution delta g(CF) to g-shift delta g (= g-g(s), where g(s) = 2.0023) due to crystal-field (CF) mechanism (related to the interactions of CF excited states with the ground state) and that (delta g(CT)) due to charge-transfer (CT) mechanism (related to the interactions of CT excited states with the ground state, which is omitted in crystal-field theory) are included. By using the formula and the parameters obtained from the optical spectra of CaZrO3:Mn4+ crystal, the g factor of CaZrO3:Mn4+ was calculated. The result is consistent with the experimental value. The calculations show that the contribution is opposite in sign and about 62% in magnitude compared with the contribution delta g(CF). It appears that both CF and CT mechanisms should be considered in the calculation of g factor for the high valence 3d(3) (e. g. , Mn4+ and Fe3+) ions in crystals.

Investigations of the EPR zero-field splitting and the defect structure for Mn(2+) and Fe(3+) ions in anatase crystals.

The EPR zero-field splittings D of Mn(2+) and Fe(3+) ions in anatase crystals at room and low temperatures are calculated from the high-order perturbation formula of zero-field splitting D for 3d(5) ions in tetragonal symmetry based on the dominant spin-orbit coupling mechanism. The calculated results are consistent with the observed values. From the calculations, Mn(2+) and Fe(3+) ions are suggested to substitute for Ti(4+) ions in anatase (in the previous paper, Mn(2+) ion was suggested at an interstitial site rather than substitutional site) and the defect structures (characterized mainly by the local oxygen parameter u) for both tetragonal Mn(2+) and Fe(3+) impurity centers are estimated. The different zero-field splitting at room and low temperatures are due mainly to the change of local oxygen parameter u with the temperature. These results are discussed.

Studies of the trigonal field parameters and g factors for magnetic semiconductor NaCrS2.

The trigonal field parameters v and v' of magnetic semiconductor NaCrS2 are calculated from the superposition model, and its g factors g parallel and g perpendicular are calculated from the high-order perturbation formulas of 3d3 ions in trigonal symmetry obtained by the one and two spin-orbit coupling parameter models. These calculations are based on the structural data of NaCrS2 crystal. The calculated results suggest that the superposition model is effective to the analyses of the low-symmetry field parameters of 3dn ions in crystals and that the two spin-orbit coupling parameter model (where the contributions from both the spin-orbit coupling parameter of 3dn ion and that of ligand are considered) is preferable to the one spin-orbit coupling parameter model (in which the contribution from only the spin-orbit coupling parameter of 3dn ion is considered) in the explanations of g factors in the cases that ligands have large spin-orbit coupling parameter in 3dn clusters.

Investigations of the EPR g factors and hyperfine structure constants for two trigonal Co2+ centers in Al2O3 crystals.

The EPR g factors gparallel, gperpendicular and the hyperfine structure constants Aparallel, Aperpendicular for two trigonal Co2+ centers (i.e. Co2+(I) center at the substitutional site and Co2+(II) center at the interstitial site) in Al2O3 crystals are calculated from the second-order perturbation formulas based on the cluster approach. In these formulas, the contributions to EPR parameters from both the spin-orbit coupling parameter of central 3dn ion and that of ligand are included. The calculated results are in reasonable agreement with the observed values. Based on the calculations, the defect structures of both Co2+ centers in Al2O3 crystals are obtained and the negative sign of Aparallel for Co2+(I) center is suggested. The results are discussed.

Theoretical calculation of EPR g factors for Ni(3+) ion at the interstitial site of SnO(2) crystal.

The EPR g factors g(x), g(y) and g(z) for Ni(3+) ion at the interstitial site in the rutile-type SnO(2) crystal are calculated from the second-order perturbation formulas of g factors based on the cluster approach for 3d(7) ion in rhombic symmetry. The calculated results are in agreement with the experimental values. The local lattice distortion induced by the impurity Ni(3+) at the interstitial site of SnO(2) is also estimated from the calculations. These results are discussed.

[Study on the contribution of the charge transfer excited states in Ba2MgGe2O7 : Cr4+ crystal to g factor].

A complete high-order perturbation formula of g factor for cubic 3d2 MX4 clusters was established. In the formula, not only the contributions of the crystal-field (CF) mechanism (which is related to the CF excitations) to the g-shift deltag(=g-gs), but also the contributions of the charge-transfer (CT) mechanism (related to CT excitations) were considered. Using the formula, the g factor of Ba2MgGe27 : Cr4+ was calculated. The result was in agreement with the observed value. It was found that the calculated Agcr due to the charge-transfer mechanism is opposite in sign and about 38% in magnitude, compared with the calculated deltagcF due to the crystal-field mechanism. So, for a high valence 3d(n) ion in crystals, the reasonable explanation of g factor should take into account the contributions of both crystal-field and charge-transfer mechanisms.

[Investigation of optical and EPR spectra of ZnO : V3+ crystal].

In the present paper, the 45 X 45 energy matrix of the 3d2 ions in trigonal symmetry with the strong-field-coupling mechanism is established. The forty-five optical energy levels and five EPR parameters (including the zero-field splitting D, g factors g//, g perpendicular and hyperfine structure constants A//, A perpendicular) of ZnO : V3+ cryst are calculated from the diagonalization of this complete energy matrix. The calculated results are in agreement with the observed values. Based on the calculation, it was found that the local structure of V3+ impurity center is different from the corresponding structure in the host crystal, i. e., the V3+ ion in ZnO does not occupy the exact Zn2+ site, but is displaced by DeltaZ approximately 0.003 nm along the c3 axis. The reasonableness of these results is discussed.

Elevated plasma levels of copeptin linked to diabetic retinopathy in type 2 diabetes.

BACKGROUND: The arginine vasopressin (AVP) system has been postulated to play a role in glucose homeostasis, insulin resistance, and diabetes mellitus in human and animal studies. The aim of this study was to evaluate the role of plasma copeptin in Chinese patients with type 2 diabetes mellitus (T2DM) with and without diabetic retinopathy (DR). METHOD: Plasma copeptin concentrations were determined in 281 patients with T2DM. At baseline, demographic and clinical information including presence of DR and vision-threatening DR (VTDR) was collected. The relationship between copeptin and DR or VTDR was investigated using logistic regression. RESULTS: T2DM participants with DR or VTDR had significantly higher plasma copeptin concentrations on admission (P < 0.0001). Receiver operating characteristics to predict DR and VDTR demonstrated areas under the curve for copeptin of 0.784 (95% confidence interval [CI] 0.724-0.844) and 0.834 (95% CI 0.781-0.904), respectively, which were superior to those for the homeostasis model assessment of insulin resistance (DR AUC 0.736, 95% CI 0.676-0.797; VTDR AUC 0.754, 95% CI 0.703-0.828; P < 0.01). Multivariate logistic regression analysis adjusted for common DR risk factors showed plasma copeptin concentrations ≥28.6 pmol/L (>3rd quartile) to be an independent marker of DR (OR 3.68, 95% CI 2.04-6.79; P < 0.0001) and VTDR (OR 4.32, 95% CI 2.12-8.14; P < 0.0001). CONCLUSIONS: We found that increased plasma copeptin concentrations were an independent marker of DR and VDTR in Chinese patients with T2DM, suggesting a possible role of copeptin in the pathogenesis of DR complications.

A novel 2-stage approach that detects complement activation in patients with antiphospholipid antibody syndrome.

INTRODUCTION: The antiphospholipid syndrome (APS) is marked by autoantibodies that recognize anionic phospholipids in a cofactor-dependent manner. A role for complement has been implicated in the pathophysiology, however, elevations of complement activation markers have not been consistently demonstrated in clinical studies. We therefore designed a proof-of-principle study to determine whether complement activation might be detectable in APS by first exposing plasmas to phospholipid vesicles. METHODS: We examined complement activation markers in patients with APS, non-APS thrombosis, systemic lupus erythematosus, cancer, patients with antiphospholipid antibodies without thrombosis (APL) and healthy controls. Direct measurements of plasma C5a and sC5b-9 levels were compared to levels that were generated in normal serum by phospholipid vesicles that had been pre-incubated with the same plasmas. We then determined the effects of the C5 inhibitor, eculizumab, examined the complement pathways involved, and determined whether the effects could be reproduced with purified IgGs and ß2-glycoprotein I (ß2GPI). RESULTS: Plasma levels of C5a and sC5b-9 were higher, but not significantly increased in APS patients compared to healthy controls. In contrast, phospholipid vesicles pre-incubated with APS plasmas generated significantly higher levels than healthy controls and the other groups, except for APL patients. Complement activation was abrogated by addition of eculizumab. The results with substrate sera indicated that the alternative and classical/lectin pathways were involved. The results were reproducible with purified IgGs and ß2GPI. CONCLUSION: This proof-of-principle study confirms a role for complement in APS and opens the possibility of monitoring complement activation by including phospholipid vesicles in assay systems.

Efficacy of olopatadine hydrochloride 0.1%, emedastine difumarate 0.05%, and loteprednol etabonate 0.5% for Chinese children with seasonal allergic conjunctivitis: a randomized vehicle-controlled study.

BACKGROUND: Allergic conjunctivitis (AC) is a disease of various agents that affects the physical and mental health of children. Although the most effective therapy has not been found so far, it is essential to explore the considerable therapeutic method. We compared the clinical efficacy of olopatadine, emedastine, loteprednol etabonate (LE), and vehicle for treating seasonal allergic conjunctivitis (SAC) in Chinese children. METHODS: Eighty cases of 160 eyes aged from 5 to 10 years with SAC were available and those subjects were randomly distributed into 4 groups. Both their eyes received olopatadine hydrochloride 0.1% twice a day, emedastine difumarate 0.05% twice a day, or LE 0.5% 4 times a day, respectively, whereas those of the control group received artificial tears (AT) 0.5% 3 times a day. This study was conducted successfully and the observations were collected before treatment and on day 8 (±1 day) and day 15 (±2 days) afterward. The principal measurement of efficacy was focused on the signs and symptoms of the subjects, evaluated before and after treatment, in addition to visual acuity (VA) and fundus oculi. RESULTS: On day 8 (±1 day) and day 15 (±2 days), all the antiallergic agents were found to be more effective than vehicle (p < 0.05) in terms of all the symptoms and signs. However, there was no statistical significance (p ≥ 0.05) shown among the treatment groups. There were no evident changes in VA and no clinically significant changes were observed in fundus oculi. CONCLUSION: After the treatment, the efficacy presented a similar distribution among the trial groups.

Visualization of macro-immune complexes in the antiphospholipid syndrome by multi-modal microscopy imaging.

The antiphospholipid syndrome (APS) is an autoimmune thrombotic condition that is marked by autoantibodies against phospholipid-binding proteins. The mechanism(s) of thrombogenesis has (have) resisted elucidation since its description over thirty years ago. Nevertheless, a defining aspect of the disorder is positivity for clinical laboratory tests that confirm antibody binding to anionic phospholipids. It is remarkable that, to our knowledge, the binding of proteins from plasmas of APS patients to phospholipid has not been previously imaged. We therefore investigated this with high resolution microscopy-based imaging techniques that have not been previously used to address this question, namely atomic force microscopy and scanning electron microscopy. Atomic force microscopy imaging of APS plasmas incubated on an anionic planar phospholipid layer revealed the formation of distinct complex three-dimensional structures, which were morphologically dissimilar to structures formed from control plasmas from healthy patients. Likewise, scanning electron microscopy analysis of phospholipid vesicles incubated with APS plasmas in suspension showed formation of layered macro-immune complexes demonstrated by the significant agglomeration of a complex proteinaceous matrix from soluble plasma and aggregation of particles. In contrast, plasmas from healthy control samples bound to phospholipid vesicles in suspension generally displayed a more flattened, mat-like appearance by scanning electron microscopy. Scanning electron microscopy of plasma samples incubated on planar phospholipid layers and previously imaged by atomic force microscopy, corroborated the results obtained by mixing the plasmas with phospholipids in solution. Analysis of the incorporated proteins by silver stained SDS-polyacrylamide gel electrophoresis indicated considerable heterogeneity in the composition of the phospholipid vesicle-adsorbed proteins among APS patients. To our knowledge, these results provide the first images of plasma-derived APS immune complexes at high resolution, and show their consistent presence and heterogeneous compositions in APS patients. These findings demonstrate how high resolution microscopic techniques can contribute to advancing the understanding of an enigmatic disorder and may lay additional groundwork for furthering mechanistic understanding of APS.