[Lupus anticoagulant and ischemic strokes: about two case reports]. / Anticoagulant lupique et accidents vasculaires cérébraux ischémiques : à propos de deux observations.

Antiphospholipid syndrome (APS) is an autoimmune disease characterized by thrombotic clinical manifestations, including ischemic stroke. Testing for lupus anticoagulant (LA) among antiphospholipid antibodies is key to the diagnosis of antiphospholipid syndrome (APS). Given the impact on patient management, close clinician-pathologist collaboration is crucial for the presence of LA in a thrombotic setting. Testing for LA must be carried out using specific and appropriate clotting assays and the pathologist should be aware of interferences. We report here two cases of stroke associated with the presence of LA, and recall the strategy for screening for LA.

Endothelin type A receptor blockade reduces vascular calcification and inflammation in rats with chronic kidney disease.

OBJECTIVE: Arterial stiffness and calcification are nontraditional cardiovascular risk factors in chronic kidney disease (CKD). Using a rat model of CKD with mineral imbalance, medial vascular calcification has been associated with inflammation and increased endothelin-1 (ET-1) production. We therefore hypothesized that ET-1, through the endothelin type A (ETA) receptor, induces vascular inflammation, calcification and stiffness in CKD. METHODS: CKD was induced in Wistar rats by renal mass ablation. To induce medial vascular calcification, mineral imbalance was established with a identified as calcium-rich/phosphate-rich diet and vitamin D supplementation (Ca/P/VitD). One group of CKD + Ca/P/VitD rats was given the ETA receptor antagonist atrasentan (10 mg/kg/day) for 6 weeks. Hemodynamic parameters including SBP, pulse pressure (PP) and pulse wave velocity (PWV) were determined. Vascular calcification, smooth muscle cells osteoblastic differentiation and expression of inflammatory markers such as inflammatory cytokines and calgranulins S100A8 and S100A9 were assessed in the thoracic aorta. RESULTS: As compared with CKD control rats, CKD + Ca/P/VitD rats developed medal vascular calcification that was associated with increased SBP, PP and PWV. These changes were also associated with increased macrophage infiltration and expression of IL-6, calgranulins and osteoblastic markers. Treatment of CKD + Ca/P/VitD rats with atrasentan reduced vascular calcification, SBP, PP and PWV, macrophage infiltration and expression of IL-1ß, IL-6, tumor necrosis factor, calgranulins and osteoblastic markers. CONCLUSION: This study shows that ETA receptor blockade reduced vascular inflammation, smooth muscle cells differentiation, calcification and stiffness indicating a pivotal role for ET-1 in medial vascular calcification in this rat remnant kidney model of CKD with mineral imbalance. Therefore, the endothelin system may be a potential therapeutic target for improving cardiovascular morbidity in patients with CKD.