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Wen L, Li R, Wang J, Yi J. The reproductive stress hypothesis. Reproduction 2020; 158:R209-R218. [PMID: 31677601 PMCID: PMC6892456 DOI: 10.1530/rep-18-0592] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 07/23/2019] [Indexed: 12/16/2022]
Abstract
In this paper, we propose the reproductive stress hypothesis that describes the pregnant females response to reproductive events based upon the activation of the hypothalamic–pituitary–adrenal axis and sympathetic adrenomedullary system. The main components of the reproductive stress hypothesis can be summarized as follows: (1) events unique to reproduction including empathema, pregnancy, parturition and lactation cause non-specific responses in females, called active reproductive stress; (2) the fetus is a special stressor for pregnant females where endocrine hormones, including corticotropin-releasing hormones and fetal glucocorticoids secreted by the fetus and placenta, enter the maternal circulatory system, leading to another stress response referred to as passive reproductive stress and (3) response to uterine tension and intrauterine infection is the third type of stress, called fetal intrauterine stress. Appropriate reproductive stress is a crucial prerequisite in normal reproductive processes. By contrast, excessive or inappropriate reproductive stress may result in dysfunctions of the reproductive system, such as compromised immune function, leading to susceptibility to disease. The novel insights of the reproductive stress hypothesis have important implications for deciphering the pathogenesis of certain diseases in pregnant animals, including humans, which in turn may be applied to preventing and treating their occurrence.
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Affiliation(s)
- Lixin Wen
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Hunan Agricultural University, Changsha, People's Republic of China.,Hunan Collaborative Innovation Center of Animal Production Safety, Changsha, People's Republic of China
| | - Rongfang Li
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Hunan Agricultural University, Changsha, People's Republic of China.,Hunan Collaborative Innovation Center of Animal Production Safety, Changsha, People's Republic of China
| | - Ji Wang
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Hunan Agricultural University, Changsha, People's Republic of China.,Hunan Collaborative Innovation Center of Animal Production Safety, Changsha, People's Republic of China
| | - Jine Yi
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, Hunan Agricultural University, Changsha, People's Republic of China.,Hunan Collaborative Innovation Center of Animal Production Safety, Changsha, People's Republic of China
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Brosnihan KB, Merrill DC, Yamaleyeva LM, Chen K, Neves L, Joyner J, Givner C, Lanier K, Moorefield C, Westwood B. Longitudinal study of angiotensin peptides in normal and pre-eclamptic pregnancy. Endocrine 2020; 69:410-419. [PMID: 32319014 PMCID: PMC10519175 DOI: 10.1007/s12020-020-02296-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/28/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To address whether differential regulation of the renin-angiotensin-aldosterone system occurs in pre-eclampsia, we performed an analysis of the time course of circulating and urinary profiles of the vasoconstrictor (Ang II) and the vasodilator [Ang-(1-7)] peptides in normal pregnant (NP) and pre-eclamptic (PE) women. METHODS Urine and plasma samples from 86 nulliparous women were collected prospectively; 67 subjects continued as NP and 19 developed PE. Subjects were enrolled prior to 12 weeks of gestation and plasma and spot urine samples were obtained throughout gestation. Control samples were obtained at 6 weeks postpartum (PP). RESULTS Mean blood pressure (p < 0.001) was elevated at 31-37 weeks of gestation in PE subjects as compared with NP subjects. Plasma Ang I and Ang II levels were elevated in NP subjects as early as 16 weeks of gestation and maintained throughout gestation. In PE subjects both plasma Ang I and Ang II were elevated at 16-33 weeks as compared with PP levels. PE subjects showed reduced plasma Ang I and Ang II (at 35-37 weeks of gestation) compared with NP subjects. Plasma Ang-(1-7) was unchanged in both groups. All three urinary peptides increased throughout gestation in NP subjects. In PE subjects urinary Ang I was increased at 23-26 weeks and was maintained throughout gestation. Urinary Ang II was increased at 27-29 and 31-33 weeks of gestation. PE subjects had no change in urinary Ang-(1-7). CONCLUSION The activation of the RAS, particularly Ang II throughout normal gestation may contribute to the maintenance of vascular tone during normal pregnancy. However higher sensitivity to Ang II in pre-eclampsia may be potentiated by the higher circulating and urinary levels of Ang II, unopposed by local renal Ang-(1-7), and thus may contribute to the development of pre-eclampsia.
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Affiliation(s)
- K Bridget Brosnihan
- Department of Surgery/Hypertension and Vascular Research, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.
| | | | - Liliya M Yamaleyeva
- Department of Surgery/Hypertension and Vascular Research, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Kai Chen
- Aspirus Wausau Medical Center, Wausau, WI, 54401, USA
| | - Liomar Neves
- Department of Surgery/Hypertension and Vascular Research, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - JaNae Joyner
- Department of Surgery/Hypertension and Vascular Research, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Courtney Givner
- Department of Surgery/Hypertension and Vascular Research, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Kristy Lanier
- Department of Surgery/Hypertension and Vascular Research, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Cheryl Moorefield
- Department of Surgery/Hypertension and Vascular Research, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Brian Westwood
- Department of Surgery/Hypertension and Vascular Research, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
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Berberich AJ, Penava D, Sun D, MacDougall A, Lum A, Van Uum S. High aldosterone, hypertension and adrenal adenoma in a 36-year-old pregnant patient: Is this primary aldosteronism? Obstet Med 2020; 13:88-91. [PMID: 32714441 DOI: 10.1177/1753495x18786422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 06/08/2018] [Indexed: 11/16/2022] Open
Abstract
A 36-year-old woman presented at 16 weeks' gestation with severe hypertension. In comparison to the non-pregnant reference normal ranges, potassium was 3.1-3.9 mmol/L, aldosterone 2570-3000 pmol/L (N 250-2885) renin was unsuppressed (24-76.4 ng/L (N1.7-23.9)), with aldosterone to renin ratios in the reference range. An adrenal MRI scan demonstrated a 1.8 × 1.4 cm left adrenal adenoma. Primary aldosteronism was strongly suspected and surgery considered. However, she was managed conservatively with labetalol and modified-release nifedipine with no obstetric complications. Post-partum blood pressures remained elevated with normal aldosterone (539 pmol/L), unsuppressed renin (5.2 ng/L) and normal aldosterone-to-renin ratio (104 (N < 144)). Suspected primary hyperaldosteronism is challenging to investigate and manage in pregnancy. The accepted screening and confirmatory tests are either contraindicated or not validated in pregnancy. Pregnancy has significant effects on the renin-angiotensin-aldosterone pathway leading to physiologic elevations in both aldosterone and renin. While primary hyperaldosteronism has been associated with poor pregnancy outcomes, optimal management in pregnancy is not clearly established.
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Affiliation(s)
- Amanda J Berberich
- Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Deborah Penava
- Department of Obstetrics and Gynecology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Dongmei Sun
- Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Arlene MacDougall
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Andrea Lum
- Department of Radiology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Stan Van Uum
- Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Menopause-Related Estrogen Decrease and the Pathogenesis of HFpEF. J Am Coll Cardiol 2020; 75:1074-1082. [DOI: 10.1016/j.jacc.2019.12.049] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 01/27/2023]
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Mottelson MN, Lundsgaard CC, Møller S. Mechanisms in fluid retention - towards a mutual concept. Clin Physiol Funct Imaging 2019; 40:67-75. [PMID: 31823451 DOI: 10.1111/cpf.12615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 12/04/2019] [Indexed: 12/12/2022]
Abstract
Fluid retention is a common and challenging condition in daily clinical practice. The normal fluid homoeostasis in the human body is based on accurately counter-balanced physiological mechanisms. When compromised fluid retention occurs and is seen in pathophysiologically different conditions such as liver cirrhosis, heart and kidney failure, and in preeclampsia. These conditions may share pathophysiological mechanisms such as functional arterial underfilling, which seems to be a mutual element in cirrhosis, cardiac failure, cardiorenal and hepatorenal syndromes, and in pregnancy. However, there are also distinct differences and it is still unclear whether kidney dysfunction or arterial underfilling is the initiating factor of fluid retention or if they happen simultaneously. This review focuses on similarities and differences in water retaining conditions and points to areas where important knowledge is still needed.
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Affiliation(s)
- Mathis N Mottelson
- Department of Clinical Physiology and Nuclear Medicine, Centre of Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Department of Internal Medicine, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Christoffer C Lundsgaard
- Department of Clinical Physiology and Nuclear Medicine, Centre of Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Søren Møller
- Department of Clinical Physiology and Nuclear Medicine, Centre of Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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Shabtaie SA, Witt CM, Asirvatham SJ. Natural history and clinical outcomes of inappropriate sinus tachycardia. J Cardiovasc Electrophysiol 2019; 31:137-143. [PMID: 31749258 DOI: 10.1111/jce.14288] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/24/2019] [Accepted: 11/16/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Limited data are available regarding the demographics, disease associations, and long-term prognosis of patients with inappropriate sinus tachycardia (IST). OBJECTIVE To establish epidemiologic data for patients with IST, including symptom onset, comorbid disease, and long-term outcomes. METHODS We retrospectively reviewed all patients with an IST diagnosis at the Mayo Clinic (Rochester, MN) during a 20-year period (1998-2018). We extracted demographic data and clinical outcomes compared to an age and gender-matched control group with atrioventricular nodal reentry tachycardia (AVNRT). RESULTS Within the study period, a total of 305 patients with IST were identified (mean follow-up 3.5 years) with 92.1% female and mean age 33.2 ± 11.2 years. The most frequently identified circumstances triggering the condition included pregnancy (7.9%) and infectious illness (5.9%) while the most common comorbid conditions were depression (25.6%) and anxiety (24.6%). At diagnosis, the mean left ventricular ejection fraction (LVEF) was 62.3 ± 6.2%, with 77 patients having follow-up echocardiographic data. No significant difference in LVEF was seen after a mean 4.9 ± 4.3-year follow-up (baseline LVEF 59.8 ± 10.7% vs subsequent 61.4 ± 8.1%; P = .2971). Two deaths occurred within the study period, with one related to myocardial infarction and the other noncardiac; compared to an age and gender-matched AVNRT control group there was no excess mortality during the follow-up period. CONCLUSIONS In our study cohort, IST predominately affects young females with structurally normal hearts and modest coexistent psychiatric disease. In most cases of IST, a major event occurring just before or at the time of diagnosis could not be identified, although nearly 8% of patients first noted symptoms during or shortly after pregnancy. In our cohort, there was no evidence of cardiomyopathy or mortality related to IST.
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Affiliation(s)
| | - Chance M Witt
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Abstract
The physiological state of a woman experiences multiple changes in the body during pregnancy. These alterations could be of particular importance in the medical care of pregnant women. This review article highlights the physiological developments of various organ systems throughout gestation with a focus on endocrinology, the cardiovascular system, hematology, the respiratory system and water balance.
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Ling HZ, Guy GP, Bisquera A, Poon LC, Nicolaides KH, Kametas NA. The effect of parity on longitudinal maternal hemodynamics. Am J Obstet Gynecol 2019; 221:249.e1-249.e14. [PMID: 30951684 DOI: 10.1016/j.ajog.2019.03.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/24/2019] [Accepted: 03/27/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Parous women have a lower risk for pregnancy complications, such as preeclampsia or delivery of small-for-gestational-age neonates. However, parous women are a heterogeneous group of patients because they contain a low-risk cohort with previously uncomplicated pregnancies and a high-risk cohort with previous pregnancies complicated by preeclampsia and/or small for gestational age. Previous studies examining the effect of parity on maternal hemodynamics, including cardiac output and peripheral vascular resistance, did not distinguish between parous women with and without a history of preeclampsia or small for gestational age and reported contradictory results. OBJECTIVE The objective of the study was to compare maternal hemodynamics in nulliparous women and in parous women with and without previous preeclampsia and/or small for gestational age. STUDY DESIGN This was a prospective, longitudinal study of maternal hemodynamics, assessed by a bioreactance method, measured at 11+0 to 13+6, 19+0 to 24+0, 30+0 to 34+0, and 35+0 to 37+0 weeks' gestation in 3 groups of women. Group 1 was composed of parous women without a history of preeclampsia and/or small for gestational age (n = 632), group 2 was composed of nulliparous women (n = 829), and group 3 was composed of parous women with a history of preeclampsia and/or small for gestational age (n = 113). A multilevel linear mixed-effects model was performed to compare the repeated measures of hemodynamic variables controlling for maternal characteristics, medical history, and development of preeclampsia or small for gestational age in the current pregnancy. RESULTS In groups 1 and 2, cardiac output increased with gestational age to a peak at 32 weeks and peripheral vascular resistance showed a reversed pattern with its nadir at 32 weeks; in group 1, compared with group 2, there was better cardiac adaptation, reflected in higher cardiac output and lower peripheral vascular resistance. In group 3 there was a hyperdynamic profile of higher cardiac output and lower peripheral vascular resistance at the first trimester followed by an earlier sharp decline of cardiac output and increase of peripheral vascular resistance from midgestation. The incidence of preeclampsia and small for gestational age was highest in group 3 and lowest in group 1. CONCLUSION There are parity-specific differences in maternal cardiac adaptation in pregnancy.
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Gyselaers W, Thilaganathan B. Preeclampsia: a gestational cardiorenal syndrome. J Physiol 2019; 597:4695-4714. [PMID: 31343740 DOI: 10.1113/jp274893] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/13/2019] [Indexed: 12/12/2022] Open
Abstract
It is generally accepted today that there are two different types of preeclampsia: an early-onset or placental type and a late-onset or maternal type. In the latent phase, the first one presents with a low output/high resistance circulation eventually leading in the late second or early third trimester to an intense and acutely aggravating systemic disorder with an important impact on maternal and neonatal mortality and morbidity; the other type presents initially as a high volume/low resistance circulation, gradually evolving to a state of circulatory decompensation usually in the later stages of pregnancy, with a less severe impact on maternal and neonatal outcome. For both processes, numerous dysfunctions of the heart, kidneys, arteries, veins and interconnecting systems are reported, most of them presenting earlier and more severely in early- than in late-onset preeclampsia; however, some very specific dysfunctions exist for either type. Experimental, clinical and epidemiological observations before, during and after pregnancy are consistent with gestation-induced worsening of subclinical pre-existing chronic cardiovascular dysfunction in early-onset preeclampsia, and thus sharing the pathophysiology of cardiorenal syndrome type II, and with acute volume overload decompensation of the maternal circulation in late-onset preeclampsia, thus sharing the pathophysiology of cardiorenal syndrome type 1. Cardiorenal syndrome type V is consistent with the process of preeclampsia superimposed upon clinical cardiovascular and/or renal disease, alone or as part of a systemic disorder. This review focuses on the specific differences in haemodynamic dysfunctions between the two types of preeclampsia, with special emphasis on the interorgan interactions between heart and kidneys, introducing the theoretical concept that the pathophysiological processes of preeclampsia can be regarded as the gestational manifestations of cardiorenal syndromes.
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Affiliation(s)
- Wilfried Gyselaers
- Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.,Department Physiology, Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium
| | - Basky Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, UK.,Molecular and Clinical Sciences Research Institute, St George's University of London, UK
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Wang Y, Che H, Kang K, Zhao G, Li X, Che X, Xu M, Zhao L. Perinatal changes in estradiol and Ang II concentrations in pregnant women with pulmonary arterial hypertension and their correlation. Hypertens Pregnancy 2019; 38:163-170. [PMID: 31204528 DOI: 10.1080/10641955.2019.1625365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: This study aimed to analyze the perinatal changes of plasma estradiol (E2) and angiotensin II (Ang II) in pregnant women with pulmonary arterial hypertension before and after cesarean section. Methods: Depending on pulmonary arterial pressure, the subjects were divided into two groups, moderate group, and severe group. Plasma concentrations of E2 and Ang II were determined at different time points using electrochemiluminescence immunoassay and ELISA, respectively. The correlation between E2 and Ang II concentrations was analyzed. Results: Intragroup comparison indicated that E2 levels at different time points after surgery decreased in the two groups than before, with a greater reduction in the severe group. Besides, both groups showed a reduction in Ang II concentrations after surgery. As indicated by intragroup comparison, there was a significant difference at each time point in the two groups. The reduction in Ang II concentrations was more conspicuous at 48 h and 72 h after surgery (cesarean section) than before for the two groups. Moreover, E2 concentrations were correlated positively with AngII concentrations. Conclusion: Plasma concentrations of E2 and Ang II decreased after delivery. The plasma concentrations of E2 and Ang II were correlated with each other.
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Affiliation(s)
- Yanshuang Wang
- a Department of Anesthesiology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
| | - Hao Che
- b Department of Anesthesiology , Beijing Anzhen Hospital China Capital Medical University , Beijing , China
| | - Kai Kang
- a Department of Anesthesiology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
| | - Guosheng Zhao
- a Department of Anesthesiology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
| | - Xiaoguang Li
- a Department of Anesthesiology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
| | - Xiangming Che
- a Department of Anesthesiology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
| | - Mingjun Xu
- a Department of Anesthesiology , Beijing Obstetrics and Gynecology Hospital, Capital Medical University , Beijing , China
| | - Liyun Zhao
- b Department of Anesthesiology , Beijing Anzhen Hospital China Capital Medical University , Beijing , China
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Karakucuk Y, Altinkaynak H, Karakuçuk S, Beyoglu A, Çömez A, Demir M. Density of crystalline lens and cornea in different trimesters of pregnancy. Cont Lens Anterior Eye 2019; 42:283-288. [DOI: 10.1016/j.clae.2018.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/17/2018] [Accepted: 10/22/2018] [Indexed: 10/27/2022]
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Cristina Dos Santos Lopes A, Perucci LO, Gontijo Evangelista FC, Godoi LC, de Paula Sabino A, Gomes KB, Talvani A, Dusse LMS, Alpoim PN. Association among ACE, ESR1 polymorphisms and preeclampsia in Brazilian pregnant women. Mol Cell Probes 2019; 45:43-47. [PMID: 31028794 DOI: 10.1016/j.mcp.2019.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 03/25/2019] [Accepted: 04/22/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Genetic, immune and environmental factors are involved in preeclampsia (PE) etiopathogenesis. Considering that hypertension and poor placental perfusion are important features in PE, polymorphisms in the angiotensin-converting enzyme (ACE) and estrogen nuclear receptor 1 (ESR1) genes could be involved in the predisposition and/or development of the disease. The aim of this study was to evaluate if polymorphisms in ACE and ESR1 genes were associated with PE occurrence. MATERIAL AND METHODS This case-control study included 209 Brazilian pregnant women (107 with severe PE and 102 normotensive controls). The polymorphisms were investigated by polymerase chain reaction (PCR) followed by polyacrylamide gel electrophoresis. RESULTS No significant difference between PE versus normotensive pregnant women, as well as early versus late PE, was observed when compared the allelic and genotypic frequencies of insertion/deletion polymorphism in intron 16 of the ACE gene and the single nucleotide polymorphisms (SNPs - rs2234693 and rs9340799) of the ESR1 gene. CONCLUSION This pioneer study involving Brazilian women showed no association among the studied polymorphisms and PE, which suggests that ins/del ACE and SNPs ESR1 do not contribute to this disease occurrence in Brazil.
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Affiliation(s)
- Ana Cristina Dos Santos Lopes
- Department of Clinical and Toxicological Analyses - Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Luiza Oliveira Perucci
- Nucleus of Research in Biological Sciences, Universidade Federal de Ouro Preto, Ouro Preto, Brazil
| | | | - Lara Carvalho Godoi
- Department of Clinical and Toxicological Analyses - Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Adriano de Paula Sabino
- Department of Clinical and Toxicological Analyses - Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Karina Braga Gomes
- Department of Clinical and Toxicological Analyses - Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - André Talvani
- Department of Biological Sciences - Institute of Exact and Biological Sciences, Universidade Federal de Ouro Preto, Ouro Preto, Brazil
| | - Luci Maria S Dusse
- Department of Clinical and Toxicological Analyses - Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| | - Patrícia Nessralla Alpoim
- Department of Clinical and Toxicological Analyses - Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Braunthal S, Brateanu A. Hypertension in pregnancy: Pathophysiology and treatment. SAGE Open Med 2019; 7:2050312119843700. [PMID: 31007914 PMCID: PMC6458675 DOI: 10.1177/2050312119843700] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/22/2019] [Indexed: 12/14/2022] Open
Abstract
Hypertensive disorders of pregnancy, an umbrella term that includes preexisting and gestational hypertension, preeclampsia, and eclampsia, complicate up to 10% of pregnancies and represent a significant cause of maternal and perinatal morbidity and mortality. Despite the differences in guidelines, there appears to be consensus that severe hypertension and non-severe hypertension with evidence of end-organ damage need to be controlled; yet the ideal target ranges below 160/110 mmHg remain a source of debate. This review outlines the definition, pathophysiology, goals of therapy, and treatment agents used in hypertensive disorders of pregnancy.
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Affiliation(s)
| | - Andrei Brateanu
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
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Wiles K, Bramham K, Seed PT, Kurlak LO, Mistry HD, Nelson-Piercy C, Lightstone L, Chappell LC. Diagnostic Indicators of Superimposed Preeclampsia in Women With CKD. Kidney Int Rep 2019; 4:842-853. [PMID: 31194119 PMCID: PMC6551530 DOI: 10.1016/j.ekir.2019.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/11/2019] [Accepted: 03/11/2019] [Indexed: 12/23/2022] Open
Abstract
Introduction Diagnosis of superimposed preeclampsia in women with chronic kidney disease (CKD) is complicated by the presence of hypertension and proteinuria due to renal disease. The aims of this study were to determine mechanistic links between superimposed preeclampsia and renin-angiotensin system activation, endothelial pathology, complement dysfunction, and tubular injury, and to explore the role of diagnostic indicators of superimposed preeclampsia. Methods Plasma and urinary biomarkers derived from the renin-angiotensin system (active renin, angiotensinogen), endothelial glycocalyx (hyaluronan, intercellular adhesion molecule, vascular cell adhesion molecule [VCAM], P-selectin, E-selectin), complement activation (C3a, C5a, complement factor H, C5b-9), and tubular injury (kidney injury molecule-1, urinary lipocalin-2) were quantified in 60 pregnant women with CKD including 15 women at the time of superimposed preeclampsia diagnosis and 45 women who did not develop superimposed preeclampsia, 18 women with preeclampsia, and 20 normal pregnancies. Correlation with placental growth factor was assessed. Results Plasma concentrations of hyaluronan (67.5 ng/ml vs. 27.5 ng/ml, P = 0.0017, receiver operating characteristic area 0.80) and VCAM (1132 ng/ml vs. 659 ng/ml, P < 0.0001, receiver operating characteristic area 0.86) distinguished women with CKD and superimposed preeclampsia from those without superimposed preeclampsia, and correlated with placental growth factor concentration. The diagnostic discrimination of markers of the renin-angiotensin system was reduced by adjustment for chronic hypertension, antihypertensive drug use, and black ethnicity. Other markers offered limited or no diagnostic discrimination for superimposed preeclampsia. Conclusion This study suggests that endothelial dysfunction contributes to the pathophysiology of superimposed preeclampsia and a diagnostic role for plasma hyaluronan and VCAM is hypothesized.
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Affiliation(s)
- Kate Wiles
- Department of Women and Children's Health, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Kate Bramham
- Department of Renal Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Paul T Seed
- Department of Women and Children's Health, King's College London, London, UK
| | - Lesia O Kurlak
- Division of Child Health, Obstetrics & Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Hiten D Mistry
- Division of Child Health, Obstetrics & Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Catherine Nelson-Piercy
- Guy's and St Thomas' NHS Foundation Trust and Imperial College Healthcare NHS Trust, London, UK
| | - Liz Lightstone
- Imperial College London and Imperial College Healthcare NHS Trust, London, UK
| | - Lucy C Chappell
- Department of Women and Children's Health, King's College London, London, UK
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Maternal Venous Hemodynamic Dysfunction in Proteinuric Gestational Hypertension: Evidence and Implications. J Clin Med 2019; 8:jcm8030335. [PMID: 30862007 PMCID: PMC6462953 DOI: 10.3390/jcm8030335] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 02/26/2019] [Accepted: 03/05/2019] [Indexed: 01/21/2023] Open
Abstract
This review summarizes current knowledge from experimental and clinical studies on renal function and venous hemodynamics in normal pregnancy, in gestational hypertension (GH) and in two types of preeclampsia: placental or early-onset preeclampsia (EPE) and maternal or late-onset (LPE) preeclampsia, presenting at <34 weeks and ≥34 weeks respectively. In addition, data from maternal venous Doppler studies are summarized, showing evidence for (1) the maternal circulation functioning closer to the upper limits of capacitance than in non-pregnant conditions, with intrinsic risks for volume overload, (2) abnormal venous Doppler measurements obtainable in preeclampsia, more pronounced in EPE than LPE, however not observed in GH, and (3) abnormal venous hemodynamic function installing gradually from first to third trimester within unique pathways of general circulatory deterioration in GH, EPE and LPE. These associations have important clinical implications in terms of screening, diagnosis, prevention and management of gestational hypertensive diseases. They invite for further hypothesis-driven research on the role of retrograde venous congestion in the etiology of preeclampsia-related organ dysfunctions and their absence in GH, and also challenge the generally accepted view of abnormal placentation as the primary cause of preeclampsia. The striking similarity between abnormal maternal venous Doppler flow patterns and those observed at the ductus venosus and other abdominal veins of the intra-uterine growth restricted fetus, also invites to explore the role of venous congestion in the intra-uterine programming of some adult diseases.
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Valdés G, Acuña S, Schneider D, Ortíz R, Padilla O. Bradykinin Exerts Independent Effects on Trophoblast Invasion and Blood Pressure in Pregnant Guinea Pigs. Reprod Sci 2019:1933719119833494. [PMID: 30836849 DOI: 10.1177/1933719119833494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION: The pleiotropic kininogen-kallikrein-kinin system is upregulated in pregnancy and localizes in the uteroplacental unit. To identify the systemic and local participation of the bradykinin type 2 receptor (B2R), this was antagonized by Bradyzide (BDZ) during 2 periods: from days 20 to 34 and from days 20 to 60 in pregnant guinea pigs. METHODS: Pregnant guinea pigs received subcutaneous infusions of saline or BDZ from gestational day 20 until sacrifice on day 34 (Short B2R Antagonism [SH-B2RA]) or on day 60 (Prolonged B2R Antagonism [PR-B2RA]). In SH-BDZA, systolic blood pressure was determined on day 34, while in PR-BDZA it was measured preconceptionally, at days 40 and 60. On gestational day 60, plasma creatinine, uricemia, proteinuria, fetal, placental and maternal kidney weight, and the extent of trophoblast invasion were evaluated. RESULTS: The SH-B2RA increased systolic blood pressure on day 34 and reduced trophoblast myometrial invasion, spiral artery remodeling, and placental sufficiency. The PR-B2RA suppressed the normal blood pressure fall observed on days 40 and 60; vascular transformation, placental efficiency, urinary protein, serum creatinine, and uric acid did not differ between the groups. The proportion of all studied mothers with lost fetuses was greater under BDZ infusion than in controls. CONCLUSION: The increased systolic blood pressure and transient reduction in trophoblast invasion and fetal/placental weight in the SH-B2R blockade and the isolated impact on blood pressure in the PR-B2R blockade indicate that bradykinin independently modulates systemic hemodynamics and the uteroplacental unit through cognate vascular and local B2R receptors.
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Affiliation(s)
- Gloria Valdés
- 1 Centro de Investigaciones Médicas, Facultad de Medicina, Pontificia Universidad Católica, Santiago, Chile
- 2 Departamento de Nefrología, Facultad de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Stephanie Acuña
- 1 Centro de Investigaciones Médicas, Facultad de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Daniela Schneider
- 1 Centro de Investigaciones Médicas, Facultad de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Rita Ortíz
- 1 Centro de Investigaciones Médicas, Facultad de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Oslando Padilla
- 3 Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica, Santiago, Chile
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Fu Z, Hu J, Zhou L, Chen Y, Deng M, Liu X, Su J, Lu A, Fu X, Yang T. (Pro)renin receptor contributes to pregnancy-induced sodium-water retention in rats via activation of intrarenal RAAS and α-ENaC. Am J Physiol Renal Physiol 2019; 316:F530-F538. [PMID: 30379098 PMCID: PMC6459302 DOI: 10.1152/ajprenal.00411.2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/11/2018] [Accepted: 10/24/2018] [Indexed: 02/07/2023] Open
Abstract
The (pro)renin receptor (PRR) is a new component of the renin-angiotensin-aldosterone system (RAAS) and regulates renin activity. The objective of the present study was to test potential roles of the renal PRR and intrarenal RAAS in the physiological status of late pregnancy. Late pregnant Sprague-Dawley rats were studied 19-21 days after sperm was observed in vaginal smears. Experiments were performed using age-matched virgin rats and late pregnant rats treated with the specific PRR inhibitor PRO20 (700 μg·kg-1·day-1 sc for 14 days, 3 times/day for every 8 h) or vehicle. The indices of RAAS, including PRR, renin, angiotensin II, and aldosterone levels, were examined by immunoblotting, qRT-PCR, or ELISA. Further analyses of renal epithelial sodium channel (ENaC) expression, sodium-water retention, and plasma volume were performed. We first present evidence for the activation of intrarenal RAAS in late pregnant rats, including increases in urinary renin activity, active and total renin content, and prorenin content, angiotensin II and aldosterone excretion, in parallel with increased renal PRR expression and urinary soluble PRR excretion. Functional evidence demonstrated that PRR antagonism with PRO20 effectively suppressed the indices of intrarenal RAAS in late pregnant rats. In addition, our results revealed that renal α-ENaC expression, sodium-water retention, and plasma volume were elevated during late pregnancy, which were all attenuated by PRO20. In summary, the present study examined the renal mechanism of sodium-water retention and plasma volume expansion in late pregnant rats and identified a novel role of PRR in regulation of intrarenal RAAS and α-ENaC and thus sodium and fluid retention associated with pregnancy.
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Affiliation(s)
- Ziwei Fu
- Institute of Hypertension, Zhongshan School of Medicine, Sun Yat-sen University , Guangzhou , China
| | - Jiajia Hu
- Institute of Hypertension, Zhongshan School of Medicine, Sun Yat-sen University , Guangzhou , China
| | - Li Zhou
- Institute of Hypertension, Zhongshan School of Medicine, Sun Yat-sen University , Guangzhou , China
| | - Yanting Chen
- Institute of Hypertension, Zhongshan School of Medicine, Sun Yat-sen University , Guangzhou , China
| | - Mokan Deng
- Institute of Hypertension, Zhongshan School of Medicine, Sun Yat-sen University , Guangzhou , China
| | - Xiyang Liu
- Institute of Hypertension, Zhongshan School of Medicine, Sun Yat-sen University , Guangzhou , China
| | - Jiahui Su
- Institute of Hypertension, Zhongshan School of Medicine, Sun Yat-sen University , Guangzhou , China
| | - Aihua Lu
- Institute of Hypertension, Zhongshan School of Medicine, Sun Yat-sen University , Guangzhou , China
| | - Xiaodong Fu
- Guangzhou Institute of Cardiovascular Diseases, The Second Affiliated Hospital; Key Laboratory of Cardiovascular Diseases, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China
| | - Tianxin Yang
- Institute of Hypertension, Zhongshan School of Medicine, Sun Yat-sen University , Guangzhou , China
- Department of Internal Medicine, University of Utah and Veterans Affairs Medical Center , Salt Lake City, Utah
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Nonn O, Güttler J, Forstner D, Maninger S, Zadora J, Balogh A, Frolova A, Glasner A, Herse F, Gauster M. Placental CX3CL1 is Deregulated by Angiotensin II and Contributes to a Pro-Inflammatory Trophoblast-Monocyte Interaction. Int J Mol Sci 2019; 20:ijms20030641. [PMID: 30717334 PMCID: PMC6387455 DOI: 10.3390/ijms20030641] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 01/23/2019] [Accepted: 01/29/2019] [Indexed: 02/07/2023] Open
Abstract
CX3CL1, which is a chemokine involved in many aspects of human pregnancy, is a membrane-bound chemokine shed into circulation as a soluble isoform. Placental CX3CL1 is induced by inflammatory cytokines and is upregulated in severe early-onset preeclampsia. In this study, the hypothesis was addressed whether angiotensin II can deregulate placental CX3CL1 expression, and whether CX3CL1 can promote a pro-inflammatory status of monocytes. qPCR analysis of human placenta samples (n = 45) showed stable expression of CX3CL1 and the angiotensin II receptor AGTR1 throughout the first trimester, but did not show a correlation between both or any influence of maternal age, BMI, and gestational age. Angiotensin II incubation of placental explants transiently deregulated CX3CL1 expression, while the angiotensin II receptor antagonist candesartan reversed this effect. Overexpression of recombinant human CX3CL1 in SGHPL-4 trophoblasts increased adhesion of THP-1 monocytes and significantly increased IL8, CCL19, and CCL13 in co-cultures with human primary monocytes. Incubation of primary monocytes with CX3CL1 and subsequent global transcriptome analysis of CD16+ subsets revealed 81 upregulated genes, including clusterin, lipocalin-2, and the leptin receptor. Aldosterone synthase, osteopontin, and cortisone reductase were some of the 66 downregulated genes present. These data suggest that maternal angiotensin II levels influence placental CX3CL1 expression, which, in turn, can affect monocyte to trophoblast adhesion. Release of placental CX3CL1 could promote the pro-inflammatory status of the CD16+ subset of maternal monocytes.
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Affiliation(s)
- Olivia Nonn
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Centre for Cell Signaling, Metabolism and Ageing, Medical University of Graz, 8010 Graz, Austria.
| | - Jacqueline Güttler
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Centre for Cell Signaling, Metabolism and Ageing, Medical University of Graz, 8010 Graz, Austria.
| | - Désirée Forstner
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Centre for Cell Signaling, Metabolism and Ageing, Medical University of Graz, 8010 Graz, Austria.
| | - Sabine Maninger
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Centre for Cell Signaling, Metabolism and Ageing, Medical University of Graz, 8010 Graz, Austria.
| | - Julianna Zadora
- Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, 13125 Berlin, Germany.
- Max-Delbrueck Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany.
| | - András Balogh
- Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, 13125 Berlin, Germany.
- Berlin Institute of Health (BIH), 13125 Berlin, Germany.
| | - Alina Frolova
- Institute of Molecular Biology and Genetic of National Academy of Sciences of Ukraine, 03680 Kyiv, Ukraine.
| | | | - Florian Herse
- Experimental and Clinical Research Center, A Joint Cooperation Between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, 13125 Berlin, Germany.
- Max-Delbrueck Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany.
- Berlin Institute of Health (BIH), 13125 Berlin, Germany.
| | - Martin Gauster
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Centre for Cell Signaling, Metabolism and Ageing, Medical University of Graz, 8010 Graz, Austria.
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McKeating DR, Fisher JJ, Perkins AV. Elemental Metabolomics and Pregnancy Outcomes. Nutrients 2019; 11:E73. [PMID: 30609706 PMCID: PMC6356574 DOI: 10.3390/nu11010073] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/26/2018] [Accepted: 01/01/2019] [Indexed: 01/22/2023] Open
Abstract
Trace elements are important for human health and development. The body requires specific micronutrients to function, with aberrant changes associated with a variety of negative health outcomes. Despite this evidence, the status and function of micronutrients during pregnancy are relatively unknown and more information is required to ensure that women receive optimal intakes for foetal development. Changes in trace element status have been associated with pregnancy complications such as gestational diabetes mellitus (GDM), pre-eclampsia (PE), intrauterine growth restriction (IUGR), and preterm birth. Measuring micronutrients with methodologies such as elemental metabolomics, which involves the simultaneous quantification and characterisation of multiple elements, could provide insight into gestational disorders. Identifying unique and subtle micronutrient changes may highlight associated proteins that are affected underpinning the pathophysiology of these complications, leading to new means of disease diagnosis. This review will provide a comprehensive summary of micronutrient status during pregnancy, and their associations with gestational disorders. Furthermore, it will also comment on the potential use of elemental metabolomics as a technique for disease characterisation and prediction.
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Affiliation(s)
- Daniel R McKeating
- School of Medical Science, Menzies Health Institute Queensland, Griffith University, Southport 9726, Queensland, Australia.
| | - Joshua J Fisher
- School of Medical Science, Menzies Health Institute Queensland, Griffith University, Southport 9726, Queensland, Australia.
| | - Anthony V Perkins
- School of Medical Science, Menzies Health Institute Queensland, Griffith University, Southport 9726, Queensland, Australia.
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Lumbers ER, Delforce SJ, Arthurs AL, Pringle KG. Causes and Consequences of the Dysregulated Maternal Renin-Angiotensin System in Preeclampsia. Front Endocrinol (Lausanne) 2019; 10:563. [PMID: 31551925 PMCID: PMC6746881 DOI: 10.3389/fendo.2019.00563] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/02/2019] [Indexed: 12/11/2022] Open
Abstract
A healthy pregnancy outcome depends on the activation of the renin-angiotensin-aldosterone system (RAAS) as a regulated, integrated response to the growing demands of the conceptus. Both the circulating RAAS and the intrarenal renin-angiotensin system (iRAS) play major roles in cardiovascular function and fluid and electrolyte homeostasis. The circulating RAAS becomes dysfunctional in preeclampsia and we propose that dysregulation of the iRAS plays a role in development of the clinical syndrome known as preeclampsia. Experimental studies in animals have shown that placental renin, when released into the maternal circulation, can cause hypertension. We postulate that abnormal placental development is associated with over-secretion of renin and other RAS proteins/angiotensin (Ang) peptides by the placenta/decidua into the maternal circulation. We hypothesise that this is because of increased shedding of exosomes and other placental particles into the maternal circulation that not only contain RAS proteins and peptides but also microRNAs (miRNAs) that target RAS mRNAs, and Ang II type 1 receptor autoantibodies (AT1R-AAs), that are agonists for, and have the same actions as, Ang II. As a result, there is both suppression of the circulating RAAS that is responsible for maintaining maternal homeostasis and activation of the iRAS. Together with altered vascular reactivity to Ang peptides, the iRAS causes hypertension, renal damage and secondary changes in the neurohumoral control of the maternal circulation and fluid and electrolyte balance, which contribute to the pathophysiology of preeclampsia.
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Affiliation(s)
- Eugenie R. Lumbers
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle upon Tyne, NSW, Australia
- Priority Research Centre for Reproductive Sciences, University of Newcastle, Newcastle upon Tyne, NSW, Australia
- Pregnancy and Reproduction Program, Hunter Medical Research Institute, Newcastle upon Tyne, NSW, Australia
- *Correspondence: Eugenie R. Lumbers
| | - Sarah J. Delforce
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle upon Tyne, NSW, Australia
- Priority Research Centre for Reproductive Sciences, University of Newcastle, Newcastle upon Tyne, NSW, Australia
- Pregnancy and Reproduction Program, Hunter Medical Research Institute, Newcastle upon Tyne, NSW, Australia
| | - Anya L. Arthurs
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, SA, Australia
| | - Kirsty G. Pringle
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle upon Tyne, NSW, Australia
- Priority Research Centre for Reproductive Sciences, University of Newcastle, Newcastle upon Tyne, NSW, Australia
- Pregnancy and Reproduction Program, Hunter Medical Research Institute, Newcastle upon Tyne, NSW, Australia
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Cappell MS, Stavropoulos SN, Friedel D. Systematic review of safety and efficacy of therapeutic endoscopic-retrograde-cholangiopancreatography during pregnancy including studies of radiation-free therapeutic endoscopic-retrograde-cholangiopancreatography. World J Gastrointest Endosc 2018; 10:308-321. [PMID: 30364767 PMCID: PMC6198312 DOI: 10.4253/wjge.v10.i10.308] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 07/13/2018] [Accepted: 08/27/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To systematically review safety/efficacy of therapeutic endoscopic-retrograde-cholangiopancreatography (ERCP) performed during pregnancy, considering fetal viability, fetal teratogenicity, premature delivery, and future postpartum development of the infant.
METHODS Systematic computerized literature search performed using PubMed with the key words “ERCP” and “pregnancy”. Two clinicians independently reviewed the literature, and decided on which articles to incorporate in this review based on consensus and preassigned priorities. Large clinical trials, meta-analyses, systematic reviews, and controlled trials were assigned higher priority than review articles or small clinical series, and individual case reports were assigned lowest priority. Dr. Cappell has formal training and considerable experience in conducting systematic reviews, with 4 published systematic reviews in peer-reviewed journals indexed in PubMed during the last 2 years, and with a PhD in neurophysiology that involved 5 years of training and research in biomedical statistics.
RESULTS Advances in imaging modalities, including abdominal ultrasound, MRCP, and endoscopic ultrasound, have generally obviated the need for diagnostic ERCP in non-pregnant and pregnant patients. Clinical experience with performing ERCP during pregnancy is burgeoning, with > 500 cases of therapeutic ERCP reported in the literature, aside from a national registry study of 58 patients. These studies show that therapeutic ERCP has a very high rate of technical success in clearing the bile duct of gallstones, and has a relatively low and acceptable rate of maternal and fetal complications. The great majority of births after therapeutic ERCP are full-term, have normal birth weights, and are healthy. A recent trend is performing ERCP without radiation to eliminate radiation teratogenicity. Systematic literature review reveals 147 cases of ERCP without fluoroscopy in 8 clinical series. These studies demonstrate extremely high technical success in endoscopically removing choledocholithiasis, favorable maternal outcomes with rare maternal ERCP complications, and excellent fetal outcomes. ERCP without fluoroscopy generally confirms proper biliary cannulation by aspiration of yellow bile per sphincterotome or leakage of yellow bile around an inserted guide-wire.
CONCLUSION This systematic literature review reveals ERCP is relatively safe and efficacious during pregnancy, with relatively favorable maternal and fetal outcomes after ERCP. Recommendations are provided about ERCP indications, special ERCP techniques during pregnancy, and prospects for future research.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology and Hepatology, William Beaumont Hospital, Royal Oak, MI 48073, United States
- Oakland University William Beaumont School of Medicine, Royal Oak, MI 48073, United States
| | | | - David Friedel
- Division of Gastroenterology, New York University Winthrop Medical Center, Mineola, NY 11501, United States
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Zitouni H, Raguema N, Gannoun MBA, Hebert-Stutter M, Zouari I, Maleh W, Faleh R, Letaifa DB, Almawi WY, Fournier T, Mahjoub T, Guibourdenche J. Impact of obesity on the association of active renin and plasma aldosterone concentrations, and aldosterone-to-renin ratio with preeclampsia. Pregnancy Hypertens 2018; 14:139-144. [DOI: 10.1016/j.preghy.2018.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 09/03/2018] [Accepted: 09/26/2018] [Indexed: 02/06/2023]
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Zitouni H, Ben Ali Gannoum M, Raguema N, Maleh W, Zouari I, Faleh RE, Guibourdenche J, Almawi WY, Mahjoub T. Contribution of angiotensinogen M235T and T174M gene variants and haplotypes to preeclampsia and its severity in (North African) Tunisians. J Renin Angiotensin Aldosterone Syst 2018; 19:1470320317753924. [PMID: 29366364 PMCID: PMC5843851 DOI: 10.1177/1470320317753924] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Preeclampsia (PE) is a pregnancy-associated hypertensive disorder and a leading cause of maternal and neonatal morbidity and mortality. While its pathogenesis remains ill defined, several candidate genes for PE have been identified, but results remain inconclusive. We investigated the association of the angiotensinogen ( AGT) gene variants M235T and T174M with PE, and we analyzed the contribution of both variants to the severity of PE. METHODS This case-control study enrolled 550 Tunisian pregnant women: 272 with PE, of whom 147 presented with mild, and 125 with severe PE, along with 278 unrelated age- and ethnically matched control women. AGT genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism. RESULTS Significantly higher M235T minor allele frequency (MAF) was associated with increased risk of PE ( p < 0.001). Decreased frequency of heterozygous T174M genotype carriers were found in control women ( p = 0.015), suggesting a protective effect of this genotype (odds ratio (95% confidence interval) = 0.51 (0.29-0.89)). Two-locus haplotype analysis demonstrated MM and TT haplotypes to be negatively and positively associated with PE, respectively. MAF of M253T, but not T174M, was higher in the severe PE group, and carrying M235T or T174M minor allele was associated with increased body mass index ( p < 0.001) among unselected PE women. CONCLUSIONS AGT M235T and T174M variants contribute to an increased risk of developing PE, and for M235T to PE severity.
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Affiliation(s)
- Hedia Zitouni
- 1 Laboratory of Human Genome and Multifactorial Diseases (LR12ES07), College of Pharmacy, University of Monastir, Tunisia.,2 Faculty of Science of Bizerte, University of Carthage, Tunisia.,3 INSERM UMR-S1139 College of Pharmacy, Paris Descartes University, France
| | - Marwa Ben Ali Gannoum
- 1 Laboratory of Human Genome and Multifactorial Diseases (LR12ES07), College of Pharmacy, University of Monastir, Tunisia.,2 Faculty of Science of Bizerte, University of Carthage, Tunisia
| | - Nozha Raguema
- 1 Laboratory of Human Genome and Multifactorial Diseases (LR12ES07), College of Pharmacy, University of Monastir, Tunisia.,2 Faculty of Science of Bizerte, University of Carthage, Tunisia
| | - Wided Maleh
- 4 Centre of Maternity and Neonatology, Tunisia
| | - Ines Zouari
- 4 Centre of Maternity and Neonatology, Tunisia
| | | | - Jean Guibourdenche
- 3 INSERM UMR-S1139 College of Pharmacy, Paris Descartes University, France
| | - Wassim Y Almawi
- 5 Faculty of Science of Tunis, University of Tunis El Manar, Tunisia
| | - Touhami Mahjoub
- 1 Laboratory of Human Genome and Multifactorial Diseases (LR12ES07), College of Pharmacy, University of Monastir, Tunisia
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Leaños-Miranda A, Inova Campos-Galicia, Méndez-Aguilar F, Molina-Pérez CJ, Ramírez-Valenzuela KL, Sillas-Pardo LJ, Uraga-Camacho NC, Isordia-Salas I, Berumen-Lechuga MG. Lower circulating angiotensin II levels are related to the severity of preeclampsia and its risk as disclosed by a specific bioassay. Medicine (Baltimore) 2018; 97:e12498. [PMID: 30278540 PMCID: PMC6181462 DOI: 10.1097/md.0000000000012498] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Preeclampsia is characterized by an increased sensitivity to angiotensin II (Ang II). We herein assessed whether serum Ang II levels measured by a new developed bioassay are associated with preeclampsia, its severity, and the risk for developing this disease.Using a cross-sectional design, we studied 90 pregnant women (30 healthy pregnant and 60 with preeclampsia [30 with- and 30 without severe features]). We also used a nested case-control study with 30 women who eventually developed preeclampsia and 31 normotensive controls. Serum samples were collected at diagnosis of preeclampsia or at 4-week intervals (from weeks 12th to 36th). Ang II was measured using a bioassay.At diagnosis of preeclampsia, serum Ang II concentrations were significantly lower in preeclampsia without and with severe features (P = .001 and P < .001, respectively) than in healthy pregnancy. In addition, Ang II was different in preeclampsia with severe features than in those without severe features (P = .048). Women who subsequently developed preeclampsia had lower Ang II levels than women with normal pregnancies, and these changes became significant at 24 weeks onward. The risk to developing preeclampsia was higher among women with Ang II concentration values in the lowest quartile of the control distribution from 12 weeks onward (odds ratio ranging from 3.8 [95% CI 1.3-11.1] to 6.5 [95% CI 1.6-26.9]).We concluded that concentrations of Ang II are markedly diminished at diagnosis of preeclampsia and are closely associated with the severity of disease. Changes in circulating levels of Ang II precede the clinical presentation of preeclampsia.
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Affiliation(s)
| | | | - Francisco Méndez-Aguilar
- Division of Maternal-Fetal Medicine, UMAE-Hospital de Ginecología y Obstetricia “Luis Castelazo Ayala,” Instituto Mexicano del Seguro Social (IMSS), Ciudad de México
| | - Carlos José Molina-Pérez
- Department of Obstetrics and Gynecology, Hospital General Regional No. 251 Metepec, IMSS, Estado de México
| | - Karla Leticia Ramírez-Valenzuela
- Division of Maternal-Fetal Medicine, UMAE-Hospital de Ginecología y Obstetricia “Luis Castelazo Ayala,” Instituto Mexicano del Seguro Social (IMSS), Ciudad de México
| | - Liliana Janet Sillas-Pardo
- Division of Maternal-Fetal Medicine, UMAE-Hospital de Ginecología y Obstetricia “Luis Castelazo Ayala,” Instituto Mexicano del Seguro Social (IMSS), Ciudad de México
| | - Navid Claudian Uraga-Camacho
- Division of Maternal-Fetal Medicine, UMAE-Hospital de Ginecología y Obstetricia “Luis Castelazo Ayala,” Instituto Mexicano del Seguro Social (IMSS), Ciudad de México
| | - Irma Isordia-Salas
- Medical Research Unit in Thrombosis, Hemostasia and Atherogenesis, H.G.R. No. 1 “Dr Carlos Mac Gregor,” IMSS. Ciudad de México, México, Mexico
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Napso T, Yong HEJ, Lopez-Tello J, Sferruzzi-Perri AN. The Role of Placental Hormones in Mediating Maternal Adaptations to Support Pregnancy and Lactation. Front Physiol 2018; 9:1091. [PMID: 30174608 PMCID: PMC6108594 DOI: 10.3389/fphys.2018.01091] [Citation(s) in RCA: 245] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/23/2018] [Indexed: 12/12/2022] Open
Abstract
During pregnancy, the mother must adapt her body systems to support nutrient and oxygen supply for growth of the baby in utero and during the subsequent lactation. These include changes in the cardiovascular, pulmonary, immune and metabolic systems of the mother. Failure to appropriately adjust maternal physiology to the pregnant state may result in pregnancy complications, including gestational diabetes and abnormal birth weight, which can further lead to a range of medically significant complications for the mother and baby. The placenta, which forms the functional interface separating the maternal and fetal circulations, is important for mediating adaptations in maternal physiology. It secretes a plethora of hormones into the maternal circulation which modulate her physiology and transfers the oxygen and nutrients available to the fetus for growth. Among these placental hormones, the prolactin-growth hormone family, steroids and neuropeptides play critical roles in driving maternal physiological adaptations during pregnancy. This review examines the changes that occur in maternal physiology in response to pregnancy and the significance of placental hormone production in mediating such changes.
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Affiliation(s)
- Tina Napso
- Department of Physiology, Development and Neuroscience, Centre for Trophoblast Research, University of Cambridge, Cambridge, United Kingdom
| | - Hannah E J Yong
- Department of Physiology, Development and Neuroscience, Centre for Trophoblast Research, University of Cambridge, Cambridge, United Kingdom
| | - Jorge Lopez-Tello
- Department of Physiology, Development and Neuroscience, Centre for Trophoblast Research, University of Cambridge, Cambridge, United Kingdom
| | - Amanda N Sferruzzi-Perri
- Department of Physiology, Development and Neuroscience, Centre for Trophoblast Research, University of Cambridge, Cambridge, United Kingdom
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76
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The regulation of aldosterone secretion by leptin: implications in obesity-related cardiovascular disease. Curr Opin Nephrol Hypertens 2018; 27:63-69. [PMID: 29135585 DOI: 10.1097/mnh.0000000000000384] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Although it has been known for some time that increases in body mass enhance aldosterone secretion, particularly in women, the origin of this elevation in aldosterone production is not well defined. Adipocyte-derived factors have emerged as potential candidates to increase aldosterone production in obesity. RECENT FINDINGS Emerging evidence suggests the presence of a mechanistic link in which the adipocyte-derived hormone leptin stimulates aldosterone production in obesity, thereby creating a positive feedback loop for obesity-associated cardiovascular disease. In addition, recent reports give credence to the concept that this leptin-aldosterone stimulation pathway in obesity is an underlying mechanism for sex-discrepancies in obesity-associated cardiovascular disease. SUMMARY Leptin appears as a new direct regulator of adrenal aldosterone production and leptin-mediated aldosterone production is a novel candidate mechanism underlying obesity-associated hypertension, particularly in females.
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Pringle KG, de Meaultsart CC, Sykes SD, Weatherall LJ, Keogh L, Clausen DC, Dekker GA, Smith R, Roberts CT, Rae KM, Lumbers ER. Urinary angiotensinogen excretion in Australian Indigenous and non-Indigenous pregnant women. Pregnancy Hypertens 2018; 12:110-117. [PMID: 29674190 DOI: 10.1016/j.preghy.2018.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 02/12/2018] [Accepted: 04/11/2018] [Indexed: 12/28/2022]
Abstract
The intrarenal renin-angiotensin system (iRAS) is implicated in the pathogenesis of hypertension, chronic kidney disease and diabetic nephropathy. Urinary angiotensinogen (uAGT) levels reflect the activity of the iRAS and are altered in women with preeclampsia. Since Indigenous Australians suffer high rates and early onset of renal disease, we hypothesised that Indigenous Australian pregnant women, like non-Indigenous women with pregnancy complications, would have altered uAGT levels. The excretion of RAS proteins was measured in non-Indigenous and Indigenous Australian women with uncomplicated or complicated pregnancies (preeclampsia, diabetes/gestational diabetes, proteinuria/albuminuria, hypertension, small/large for gestational age, preterm birth), and in non-pregnant non-Indigenous women. Non-Indigenous pregnant women with uncomplicated pregnancies, had higher uAGT/creatinine levels than non-Indigenous non-pregnant women (P < 0.01), and levels increased as pregnancy progressed (P < 0.001). In non-Indigenous pregnant women with pregnancy complications, uAGT/creatinine was suppressed in the third trimester (P < 0.01). In Indigenous pregnant women with uncomplicated pregnancies, there was no change in uAGT/creatinine with gestational age and uAGT/creatinine was lower in the 2nd and 3rd trimesters than in non-Indigenous pregnant women with uncomplicated pregnancies (P < 0.03, P < 0.007, respectively). The uAGT/creatinine ratios of Indigenous women with uncomplicated or complicated pregnancies were the same. A decrease in uAGT/creatinine with advancing gestational age was associated with increased urinary albumin/creatinine, as is seen in preeclampsia, but it was not specific for this disorder. The reduced uAGT/creatinine in Indigenous pregnant women may reflect subclinical renal dysfunction which limits the ability of the kidney to maintain sodium balance and could indicate an increased risk of pregnancy complications and/or future renal disease.
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Affiliation(s)
- Kirsty G Pringle
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia; Priority Research Centre for Reproductive Science, University of Newcastle, Callaghan, New South Wales, Australia; Mothers and Babies Research Centre, Hunter Medical Research Institute, New Lambton, New South Wales, Australia.
| | - Celine Corbisier de Meaultsart
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia; Priority Research Centre for Reproductive Science, University of Newcastle, Callaghan, New South Wales, Australia; Mothers and Babies Research Centre, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Shane D Sykes
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia; Priority Research Centre for Reproductive Science, University of Newcastle, Callaghan, New South Wales, Australia; Mothers and Babies Research Centre, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Loretta J Weatherall
- Priority Research Centre for Reproductive Science, University of Newcastle, Callaghan, New South Wales, Australia; Gomeroi Gaaynggal Centre, Faculty of Health and Medicine, The University of Newcastle, Tamworth, New South Wales, Australia; University of Newcastle Department of Rural Health, Faculty of Health and Medicine, The University of Newcastle, Tamworth, New South Wales, Australia
| | - Lyniece Keogh
- Priority Research Centre for Reproductive Science, University of Newcastle, Callaghan, New South Wales, Australia; Gomeroi Gaaynggal Centre, Faculty of Health and Medicine, The University of Newcastle, Tamworth, New South Wales, Australia; University of Newcastle Department of Rural Health, Faculty of Health and Medicine, The University of Newcastle, Tamworth, New South Wales, Australia
| | - Don C Clausen
- Pathology North, New South Wales Health, Tamworth, New South Wales, Australia
| | - Gus A Dekker
- Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Roger Smith
- Priority Research Centre for Reproductive Science, University of Newcastle, Callaghan, New South Wales, Australia; Mothers and Babies Research Centre, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Claire T Roberts
- Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Kym M Rae
- Priority Research Centre for Reproductive Science, University of Newcastle, Callaghan, New South Wales, Australia; Gomeroi Gaaynggal Centre, Faculty of Health and Medicine, The University of Newcastle, Tamworth, New South Wales, Australia; University of Newcastle Department of Rural Health, Faculty of Health and Medicine, The University of Newcastle, Tamworth, New South Wales, Australia; Priority Research Centre for Generational Health and Aging, University of Newcastle, Callaghan, New South Wales, Australia
| | - Eugenie R Lumbers
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia; Priority Research Centre for Reproductive Science, University of Newcastle, Callaghan, New South Wales, Australia; Mothers and Babies Research Centre, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
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Pears S, Makris A, Hennessy A. The chronobiology of blood pressure in pregnancy. Pregnancy Hypertens 2018; 12:104-109. [DOI: 10.1016/j.preghy.2018.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/29/2018] [Accepted: 04/06/2018] [Indexed: 01/31/2023]
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Rodríguez-Lara SQ, García-Benavides L, Miranda-Díaz AG. The Renin-Angiotensin-Aldosterone System as a Therapeutic Target in Late Injury Caused by Ischemia-Reperfusion. Int J Endocrinol 2018; 2018:3614303. [PMID: 29849615 PMCID: PMC5904808 DOI: 10.1155/2018/3614303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 01/09/2018] [Accepted: 02/07/2018] [Indexed: 12/19/2022] Open
Abstract
Ischemia-reperfusion (I/R) injury is a well-known phenomenon that involves different pathophysiological processes. Connection in diverse systems of survival brings about cellular dysfunction or even apoptosis. One of the survival systems of the cells, to the assault caused by ischemia, is the activation of the renin-angiotensin-aldosterone system (also known as an axis), which is focused on activating diverse signaling pathways to favor adaptation to the decrease in metabolic supports caused by the hypoxia. In trying to adapt to the I/R event, great changes occur that unchain cellular dysfunction with the capacity to lead to cell death, which translates into a poor prognosis due to the progression of dysfunction of the cellular activity. The search for the understanding of the diverse therapeutic alternatives in molecular coupling could favor the prognosis and evolution of patients who are subject to the I/R process.
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Affiliation(s)
- Simón Quetzalcóatl Rodríguez-Lara
- University of Guadalajara, Institute of Experimental and Clinical Therapeutics, Department of Physiology, University Health Sciences Centre, Guadalajara, JAL, Mexico
| | - Leonel García-Benavides
- University of Guadalajara, Institute of Experimental and Clinical Therapeutics, Department of Physiology, University Health Sciences Centre, Guadalajara, JAL, Mexico
| | - Alejandra Guillermina Miranda-Díaz
- University of Guadalajara, Institute of Experimental and Clinical Therapeutics, Department of Physiology, University Health Sciences Centre, Guadalajara, JAL, Mexico
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80
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Melo CFOR, Delafiori J, de Oliveira DN, Guerreiro TM, Esteves CZ, Lima EDO, Pando-Robles V, Catharino RR. Serum Metabolic Alterations upon Zika Infection. Front Microbiol 2017; 8:1954. [PMID: 29067015 PMCID: PMC5641361 DOI: 10.3389/fmicb.2017.01954] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 09/22/2017] [Indexed: 12/13/2022] Open
Abstract
Zika virus (ZIKV) infection has recently emerged as a major concern worldwide due to its strong association with nervous system malformation (microcephaly) of fetuses in pregnant women infected by the virus. Signs and symptoms of ZIKV infection are often mistaken with other common viral infections. Since transmission may occur through biological fluids exchange and coitus, in addition to mosquito bite, this condition is an important infectious disease. Thus, understanding the mechanism of viral infection has become an important research focus, as well as providing potential targets for assertive clinical diagnosis and quality screening for hemoderivatives. Within this context, the present work analyzed blood plasma from 79 subjects, divided as a control group and a ZIKV-infected group. Samples underwent direct-infusion mass spectrometry and statistical analysis, where eight markers related to the pathophysiological process of ZIKV infection were elected and characterized. Among these, Angiotensin (1-7) and Angiotensin I were upregulated under infection, showing an attempt to induce autophagy of the infected cells. However, this finding is concerning about hypertensive individuals under treatment with inhibitors of the Renin-Angiotensin System (RAS), which could reduce this response against the virus and exacerbate the symptoms of the infection. Moreover, one of the most abundant glycosphingolipids in the nervous tissue, Ganglioside GM2, was also elected in the present study as an infection biomarker. Considered an important pathogen receptor at membrane's outer layer, this finding represents the importance of gangliosides for ZIKV infection and its association with brain tropism. Furthermore, a series of phosphatidylinositols were also identified as biomarkers, implying a significant role of the PI3K-AKT-mTOR Pathway in this mechanism. Finally, these pathways may also be understood as potential targets to be considered in pharmacological intervention studies on ZIKV infection management.
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Affiliation(s)
- Carlos Fernando O R Melo
- INNOVARE Biomarkers Laboratory, School of Pharmaceutical Sciences, University of Campinas, Campinas, Brazil
| | - Jeany Delafiori
- INNOVARE Biomarkers Laboratory, School of Pharmaceutical Sciences, University of Campinas, Campinas, Brazil
| | - Diogo N de Oliveira
- INNOVARE Biomarkers Laboratory, School of Pharmaceutical Sciences, University of Campinas, Campinas, Brazil
| | - Tatiane M Guerreiro
- INNOVARE Biomarkers Laboratory, School of Pharmaceutical Sciences, University of Campinas, Campinas, Brazil
| | - Cibele Z Esteves
- INNOVARE Biomarkers Laboratory, School of Pharmaceutical Sciences, University of Campinas, Campinas, Brazil
| | - Estela de O Lima
- INNOVARE Biomarkers Laboratory, School of Pharmaceutical Sciences, University of Campinas, Campinas, Brazil
| | | | - Rodrigo R Catharino
- INNOVARE Biomarkers Laboratory, School of Pharmaceutical Sciences, University of Campinas, Campinas, Brazil
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Taylor J, Hicks CW, Heller JA. The hemodynamic effects of pregnancy on the lower extremity venous system. J Vasc Surg Venous Lymphat Disord 2017; 6:246-255. [PMID: 29454441 DOI: 10.1016/j.jvsv.2017.08.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 08/01/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Pregnancy has significant effects on the lower extremity venous system. Increasing venous pressure and blood volume, in combination with reduced flow rates within the deep veins, predisposes pregnant women to both primary and secondary chronic venous insufficiency (CVI). This review article highlights the specific physiologic and hemodynamic changes that occur during pregnancy and examines the nonpharmacologic, pharmacologic, and invasive interventions that are appropriate for both prophylaxis and treatment of CVI and venous thromboembolism (VTE). METHODS This study is a review article of the key literature related to VTE and CVI in pregnancy. RESULTS Significant hemodynamic changes occur in the lower extremities during pregnancy. Although well documented and essential to fetal development, these changes can have a negative impact on the maternal lower extremity venous circulation. Consequences of pregnancy can result in venous disease only during pregnancy or, particularly in the multiparous patient, can progress to CVI. An abundance of literature and guidelines exist for the management of VTE during pregnancy; however, the quality and extent of literature based around the management of primary CVI during pregnancy are modest at best. CONCLUSIONS The physiologic changes throughout the arterial and venous systems during pregnancy are well documented. However, there is a paucity of data available to construct guidelines for care, particularly in the pregnant patient with symptomatic superficial venous insufficiency. Further investigation in the form of prospective randomized trials is required to establish appropriate guidelines for treatment.
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Affiliation(s)
- James Taylor
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Md
| | - Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Hospital, Baltimore, Md
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82
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The influence of prenatal exercise and pre-eclampsia on maternal vascular function. Clin Sci (Lond) 2017; 131:2223-2240. [PMID: 28798074 DOI: 10.1042/cs20171036] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/03/2017] [Accepted: 07/06/2017] [Indexed: 01/10/2023]
Abstract
During healthy pregnancy, the cardiovascular system undergoes diverse adaptations to support adequate transfer of oxygen and nutrients from mother to fetus. In order to accommodate the large expansion of blood volume and associated cardiac output, the structure, mechanics, and function of the arteries are altered. Specifically, in healthy pregnancy there is a remodeling of arteries (increased angiogenesis and vasodilation), a generalized reduction in arterial stiffness (increased compliance), and an enhanced endothelial function. The development of pregnancy complications, specifically pre-eclampsia, is associated with poor placentation (decreased angiogenesis), increased arterial stiffness, and vascular dysfunction (reduced endothelial function). Many of the positive adaptations that occur in healthy pregnancy are enhanced in response to chronic exercise. Specifically, placental angiogenesis and endothelial function have been shown to improve to a greater extent in women who are active during their pregnancy compared with those who are not. Prenatal exercise may be important in helping to reduce the risk of vascular dysfunction in pregnancy. However, our knowledge of the vascular adaptations resulting from maternal exercise is limited. This review highlights maternal vascular adaptations occurring during healthy pregnancy, and contrasts the vascular maladaptation associated with pre-eclampsia. Finally, we discuss the role of prenatal exercise on vascular function in the potential prevention of vascular complications associated with pre-eclampsia.
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83
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Lee JM, Shin TJ. Use of local anesthetics for dental treatment during pregnancy; safety for parturient. J Dent Anesth Pain Med 2017; 17:81-90. [PMID: 28879335 PMCID: PMC5564152 DOI: 10.17245/jdapm.2017.17.2.81] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 05/29/2017] [Accepted: 05/30/2017] [Indexed: 11/15/2022] Open
Abstract
Pregnancy induces significant anatomical and physiological changes in the mother. Many pregnant women need dental treatment due to poor oral hygiene related to pregnancy. However, most dentists are reluctant to provide, and most pregnant women are reluctant to receive, dental treatment during pregnancy. Theoretically, maternally administered drugs are transferred to the fetus. Depending on the types of drugs and the stage of pregnancy, the effects of drugs on the mother, as well as the fetus, may vary. Local anesthetics are the most widely used in dental treatment. It is, therefore, important to understand the potential effects of local anesthetics during pregnancy. In this review, we will focus on the maternal and fetal effects of local anesthetics widely used in dental treatment with consideration of the use of local anesthetics during pregnancy.
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Affiliation(s)
- Ji Min Lee
- Department of Pediatric Dentistry and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Teo Jeon Shin
- Department of Pediatric Dentistry and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
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84
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Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovasc J Afr 2017; 27:89-94. [PMID: 27213856 PMCID: PMC4928162 DOI: 10.5830/cvja-2016-021] [Citation(s) in RCA: 642] [Impact Index Per Article: 91.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 03/04/2016] [Indexed: 11/13/2022] Open
Abstract
Physiological changes occur in pregnancy to nurture the developing foetus and prepare the mother for labour and delivery. Some of these changes influence normal biochemical values while others may mimic symptoms of medical disease. It is important to differentiate between normal physiological changes and disease pathology. This review highlights the important changes that take place during normal pregnancy.
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Affiliation(s)
- Priya Soma-Pillay
- Department of Obstetrics and Gynaecology, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa.
| | - Catherine Nelson-Piercy
- Department of Obstetric Medicine, Women's Health Academic Centre, King's Health Partners; Guy's and St Thomas' Foundation Trust, and Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare Trust, London, UK
| | | | - Alexandre Mebazaa
- INSERM UMRS 942, Paris, France; University Paris Diderot, Sorbonne Paris Cité, Paris; Department of Anesthesia and Critical Care, Hôpital Lariboisière, APHP, France
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de Haas S, Ghossein-Doha C, van Kuijk SMJ, van Drongelen J, Spaanderman MEA. Physiological adaptation of maternal plasma volume during pregnancy: a systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:177-187. [PMID: 28169502 DOI: 10.1002/uog.17360] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/21/2016] [Accepted: 11/07/2016] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To describe the physiological pattern of gestational plasma volume adjustments in normal singleton pregnancy and compare this with the pattern in pregnancies complicated by pregnancy-induced hypertension, pre-eclampsia or fetal growth restriction. METHODS We performed a meta-analysis of the current literature on plasma volume adjustments during physiological and complicated pregnancies. Literature was retrieved from PubMed (NCBI) and EMBASE (Ovid) databases. Included studies reported both reference plasma volume measurements (non-pregnant, prepregnancy or postpartum) and measurements obtained during predetermined gestational ages. Mean differences bet ween the reference and pregnancy plasma volume measurements were calculated for predefined intervals of gestational age using a random-effects model described by DerSimonian and Laird. RESULTS Thirty studies were included in the meta-analysis with publication dates ranging from 1934 to 2007. Plasma volume increased in the first weeks of pregnancy, with the steepest increase occurring during the second trimester. Plasma volume continued to increase in the third trimester with a pooled maximum increase of 1.13 L (95% CI, 1.07-1.19 L), an increase of 45.6% (95% CI, 43.0-48.1%) in physiological pregnancies compared with the reference value. The plasma volume expansion in gestational hypertensive and growth-restricted pregnancies was 0.80 L (95% CI, 0.59-1.02 L), an increase of 32.3% (95% CI, 23.6-41.1%) in the third trimester, a smaller increase than in physiological pregnancies (P < 0.0001). CONCLUSIONS During physiological pregnancy, plasma volume increases by, on average, more than 1 L as compared with non-pregnant conditions. In pregnancies complicated by pregnancy-induced hypertension, pre-eclampsia or fetal growth restriction, plasma volume increase in the third trimester is 13.3% lower than in normal pregnancy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Adaptación fisiológica del volumen del plasma materno durante el embarazo: una revisi\xF3n sistemática y metaanálisis RESUMEN OBJETIVO: Describir el patrón fisiológico de los cambios en el volumen del plasma gestacional en embarazos normales con feto único y compararlo con el patrón en los embarazos complicados por hipertensión gestacional, preeclampsia o restricción del crecimiento fetal. MÉTODOS: Se realizó un metaanálisis de la literatura actual sobre los cambios en el volumen de plasma durante embarazos complicados y fisiológicos. La literatura se obtuvo de las bases de datos PubMed (NCBI) y EMBASE (Ovid). Los estudios incluidos mencionaban tanto mediciones de referencia del volumen plasmático (no embarazada, antes del embarazo o después del parto) como mediciones tomadas a edades gestacionales predeterminadas. Se calcularon las medias de las diferencias entre las mediciones de referencia y las del embarazo para el volumen plasmático a intervalos predefinidos de la edad gestacional, utilizando un modelo de efectos aleatorios descrito por DerSimonian y Laird. RESULTADOS En el metaanálisis se incluyeron treinta estudios con fechas de publicación entre 1934 y 2007. El volumen plasmático aumentó en las primeras semanas de embarazo y el mayor incremento se produjo durante el segundo trimestre. El volumen de plasma continuó aumentando en el tercer trimestre con un aumento combinado máximo de 1,13L (IC 95%, 1,7-1,19 L), lo que supone un aumento del 45,6% (IC 95%, 43,0-48,1%) en embarazos fisiológicas en comparación con el valor de referencia. El aumento del volumen plasmático en los embarazos con hipertensión y con crecimiento intrauterino restringido fue de 0,80L (IC 95%, 0,59-1,02 L), lo que supone un aumento del 32,3% (IC 95%, 23,6-41,1%) en el tercer trimestre, y un incremento menor que en los embarazos fisiológicos (P <0,0001). CONCLUSIONES Durante el embarazo fisiológico el volumen de plasma aumenta, en promedio, más de 1L, en comparación con el de las no embarazadas. En los embarazos complicados por hipertensión gestacional, preeclampsia o restricción del crecimiento fetal, el aumento del volumen plasmático en el tercer trimestre es un 13,3% menor que en el embarazo normal. :meta : ,、。 : meta。PubMed(NCBI)EMBASE(Ovid)。(、)。DerSimonianLaird,。 : Meta30,19342007。,。,1.13 L(95% CI,1.07~1.19 L),,45.6%(95% CI,43.0%~48.1%)。0.80 L(95%CI,0.59~1.02 L),32.3%(95% CI,23.6%~41.1%),(P<0.0001)。 : ,,1 L。、,13.3%。.
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Affiliation(s)
- S de Haas
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - C Ghossein-Doha
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - J van Drongelen
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - M E A Spaanderman
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
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Canobbio MM, Warnes CA, Aboulhosn J, Connolly HM, Khanna A, Koos BJ, Mital S, Rose C, Silversides C, Stout K. Management of Pregnancy in Patients With Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation 2017; 135:e50-e87. [PMID: 28082385 DOI: 10.1161/cir.0000000000000458] [Citation(s) in RCA: 233] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Today, most female children born with congenital heart disease will reach childbearing age. For many women with complex congenital heart disease, carrying a pregnancy carries a moderate to high risk for both the mother and her fetus. Many such women, however, do not have access to adult congenital heart disease tertiary centers with experienced reproductive programs. Therefore, it is important that all practitioners who will be managing these women have current information not only on preconception counseling and diagnostic evaluation to determine maternal and fetal risk but also on how to manage them once they are pregnant and when to refer them to a regional center with expertise in pregnancy management.
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Salt, aldosterone and extrarenal Na + - sensitive responses in pregnancy. Placenta 2017; 56:53-58. [PMID: 28094006 PMCID: PMC5526786 DOI: 10.1016/j.placenta.2017.01.100] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/30/2016] [Accepted: 01/09/2017] [Indexed: 12/23/2022]
Abstract
Outside of pregnancy excessive salt consumption is known to be harmful being linked to increased blood pressure and cardiovascular disease. However, pregnancy represents a major change to a woman's physiology resulting in an intimate adaptation to environmental conditions. It is now becoming apparent that salt is essential for a number of these changes during pregnancy including haematological, cardiac adaptations as well as directly influencing placental development and the uteroplacental immune environment. The present review discusses the important role that salt has during normal pregnancy and evidence will also be presented to show how the placenta may act as a salt sensing organ temporarily, yet substantially regulating maternal blood pressure. The placenta may function as an extrarenal regulator of maternal blood pressure. Na+handling in pregnancy is completely different to the non-pregnant situation. Na+may actually lower blood pressure in pregnancy affected with pre-eclampsia. Aldosterone is an important regulator of placental and fetal development. Na+ may compensate for aldosterone deficiency in pregnancy.
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Ozer OF, Kacar O, Demirci O, Eren YS, Bilsel AS. PLASMA CONCENTRATIONS AND CORRELATIONS OF NATRIURETIC PEPTIDES AND OXYTOCIN DURING LABOR AND EARLY POSTPARTUM PERIOD. ACTA ENDOCRINOLOGICA-BUCHAREST 2017; 13:65-71. [PMID: 31149150 DOI: 10.4183/aeb.2017.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Context Natriuretic peptides (NP) and oxytocin (OT) play an important role in cardiovascular and hydro-electrolytic homeostasis. Changes in NP levels and their roles in cardiovascular adaptations in pregnancy and labor have not been clear. Objective The present study aimed to investigate the changes and correlations in plasma levels of atrial natriuretic peptide (ANP), C-type natriuretic peptide (CNP), B-type natriuretic peptide (BNP) and OT during labor and the postpartum period. Study design Blood samples were collected from 29 healthy pregnant women in the active phase of spontaneous labor, 15 minutes after delivery and 3 hours postpartum. Plasma levels of OT and the stable N-terminal fragments of NPs (NT-proANP, NT-proCNP, NT-proBNP) were measured using enzyme or electrochemiluminescence immunoassays. Results The plasma levels of NT-proANP and NT-proCNP significantly decrease 3 hours postpartum compared to the active phase of labor and to 15 minutes after delivery. The plasma NT-proBNP levels significantly higher after delivery and 3 hours postpartum compared to the active phase of labor. A significant correlation exists between OT and NT-proANP levels during the active phase of labor and 15 minutes after delivery. Conclusions The data show that during labor and postpartum, the plasma concentrations of the NPs change differently. Elevations in NT- proBNP after delivery suggest that BNP may be involved in postpartum adaptations. The correlations between OT and ANP levels indicate that OT may be partly responsible for the increased levels of ANP and may have a role in the modification of the cardiovascular system.
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Affiliation(s)
- O F Ozer
- Marmara Universty, Faculty of Medicine, Dept of Biochemistry, Istanbul, Turkey
| | - O Kacar
- TUBITAK Marmara Research Center, Genetic Engineering and Biotechnology Institute, Kocaeli, Turkey
| | - O Demirci
- Zeynep Kamil Women and Children's Diseases Education and Research Hospital, Istanbul, Turkey
| | - Y S Eren
- Zeynep Kamil Women and Children's Diseases Education and Research Hospital, Istanbul, Turkey
| | - A S Bilsel
- Marmara Universty, Faculty of Medicine, Dept of Biochemistry, Istanbul, Turkey
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89
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Im MJ, Cho DS. Salt Preference and Sodium Intake among Pregnant Women. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2016; 22:297-307. [PMID: 37684878 DOI: 10.4069/kjwhn.2016.22.4.297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/03/2016] [Accepted: 12/14/2016] [Indexed: 09/10/2023] Open
Abstract
PURPOSE This study was to estimate salt preference and sodium intake of pregnant women, and identify the relationship between salt preference and sodium intake. METHODS Research design was a cross sectional correlational survey with 197 pregnant women who visited outpatient clinics for antenatal care. The sodium intake levels were estimated by the amounts of sodium intake using the 24-hour recall method and sodium concentration in spot urine. The data were analyzed using descriptive statistics, t-test, ANOVA and Pearson's correlation. RESULTS Sodium intake using 24-hour recall method was 3,504±1,359 mg. Sodium intake levels had statistically significant differences depending on income. The average amount of sodium in spot urine was 2,882±878mg/day. Sodium excretion levels had statistically significant differences depending on whether participants had preexisting hypertension in their family history and Body Mass Index (BMI) pre-conception. Salt preference was 62.61±20.96 out of 180 points. Salt preference had significant differences depending on income, parity, gestational age, BMI pre-conception and showed negative correlation with sodium quantity in spot urine. CONCLUSION Sodium intake in pregnant women recommended by World Health Organization recommended is 175%. Salt preference was not significantly different between sodium intake levels, however it was negatively correlated with sodium quantity in spot urine among pregnant women.
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Affiliation(s)
- Mi Jeung Im
- Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Dong Sook Cho
- Nowon Eulji Medical Center, Eulji University, Seoul, Korea
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90
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Afolabi BB, Oladipo OO, Akanmu AS, Abudu OO, Sofola OA, Broughton Pipkin F. Volume regulatory hormones and plasma volume in pregnant women with sickle cell disorder. J Renin Angiotensin Aldosterone Syst 2016; 17:17/3/1470320316670444. [PMID: 27678389 PMCID: PMC5843859 DOI: 10.1177/1470320316670444] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 08/18/2016] [Indexed: 12/15/2022] Open
Abstract
Background: Sickle cell disease (haemoglobin SS (HbSS)) mainly affects those of West African origin and is associated with hypervolaemia. Plasma volume rises by up to 50% in normal pregnancy but was previously found to be paradoxically contracted in late sickle cell pregnancy. The renin–angiotensin–aldosterone system is activated very early in human pregnancy to support the plasma volume expansion. We hypothesised that activation of the renin–angiotensin–aldosterone system would be blunted in pregnant women with sickle cell disease. Materials and methods: We measured plasma volume and concentrations of plasma renin, angiotensinogen, aldosterone and other volume-related hormones in a cross-sectional study of pregnant and non-pregnant Nigerian women with HbSS or HbAA. Results: Plasma volume was higher in non-pregnant HbSS than HbAA women, but had not risen by 16 weeks, unlike plasma volume in HbAA women. The concentration of plasma renin also rose significantly less by 16 weeks in HbSS; angiotensinogen and aldosterone concentrations increased. Conclusions: The lower plasma renin concentration at 16 weeks with HbSS could be either primary or secondary to vasoconstriction related to inadequate vasodilator activity. The contracted plasma volume might then stimulate aldosterone synthesis by non-angiotensin II dependent stimulation. Studies of vasodilators such as nitric oxide, vasodilator eicosanoids or the PlGF/VEGF/sFlT-1 axis in pregnant HbSS and HbAA women will test this hypothesis.
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Affiliation(s)
- Bosede B Afolabi
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Nigeria
| | | | - Alani S Akanmu
- Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Nigeria
| | - Olalekan O Abudu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Nigeria
| | - Olusoga A Sofola
- Department of Physiology, College of Medicine, University of Lagos, Nigeria
| | - Fiona Broughton Pipkin
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Nottingham, UK
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91
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Nagel C, Trenk L, Aurich J, Wulf M, Aurich C. Changes in blood pressure, heart rate, and blood profile in mares during the last 3 months of gestation and the peripartum period. Theriogenology 2016; 86:1856-64. [PMID: 27393220 DOI: 10.1016/j.theriogenology.2016.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/01/2016] [Accepted: 06/03/2016] [Indexed: 10/21/2022]
Abstract
In this study, peripartum changes in complete blood count, plasma electrolyte concentrations, blood pressure, heart rate, and heart rate variability (HRV) were determined in pregnant Warmblood mares (n = 10). Blood was collected from Days 245 to 330 of gestation (phase A), 2Days 3 to 1 before foaling (phase B), repeatedly within 12 hours after foaling (phase C), and on Days 1 to 3 postpartum (phase D). On the same days as blood collection, blood pressure and cardiac beat-to-beat intervals were measured and time domain HRV variables were calculated. Blood pressure decreased during the past 3 months of gestation, reached a nadir at foaling and increased rapidly thereafter (P < 0.001). Heart rate increased in phase A, reached a maximum in phase B, and decreased directly after foaling (P < 0.001) while HRV increased transiently after foaling (P < 0.001). The number of polymorphonuclear granulocytes was higher during phases B, C, and D than that during phase A (P < 0.001) and total leukocyte numbers peaked in phase C (P < 0.001). Erythrocyte counts and hematocrit increased immediately after foaling with a rapid decrease thereafter (P < 0.001), while plasma total protein was highest 1 hour after foaling (P < 0.001). Sodium and chloride concentrations increased from phases A to C and decreased in phase D (P < 0.001). Calcium concentrations were lowest immediately after foaling. In conclusion, changes in cardiovascular function and a transient hemoconcentration occur in peripartum mares. These changes may favor adequate uterine perfusion.
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Affiliation(s)
- Christina Nagel
- Graf Lehndorff Institute for Equine Science, Vetmeduni Vienna, Neustadt/Dosse, Germany.
| | - Lisa Trenk
- Centre for Artificial Insemination and Embryo Transfer, Department for Small Animals and Horses, Vetmeduni Vienna, Vienna, Austria
| | - Jörg Aurich
- Section for Obstetrics, Gynecology and Andrology, Department for Small Animals and Horses, Vetmeduni Vienna, Vienna, Austria
| | - Manuela Wulf
- Graf Lehndorff Institute for Equine Science, Vetmeduni Vienna, Neustadt/Dosse, Germany
| | - Christine Aurich
- Centre for Artificial Insemination and Embryo Transfer, Department for Small Animals and Horses, Vetmeduni Vienna, Vienna, Austria
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92
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Pereza N, Ostojić S, Zdravčević M, Volk M, Kapović M, Peterlin B. Insertion/deletion polymorphism in intron 16 of ACE gene in idiopathic recurrent spontaneous abortion: case-control study, systematic review and meta-analysis. Reprod Biomed Online 2015; 32:237-46. [PMID: 26673102 DOI: 10.1016/j.rbmo.2015.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 11/03/2015] [Accepted: 11/04/2015] [Indexed: 11/19/2022]
Abstract
The insertion/deletion (I/D) polymorphism in intron 16 of the angiotensin I-converting enzyme gene (ACE) has been extensively studied as a predisposing factor for idiopathic recurrent spontaneous abortion (IRSA). A case-control study including 149 women with ≥3 spontaneous abortions and 149 controls was performed to test the association of ACE I/D polymorphism with IRSA. A systematic review was conducted of previous case-control studies, with strict selection criteria for meta-analyses. We also aimed to evaluate the potential differences in summary estimates between studies defining IRSA as ≥2 and ≥3 spontaneous abortions. Genotyping was performed by PCR, and systematic review conducted using PubMed and Scopus. There was no association of the polymorphism with IRSA in Slovenian women. Sixteen case-control studies, showing substantial differences regarding IRSA definition and selection criteria for women were identified. Meta-analysis was performed and included four studies defining IRSA as ≥2 spontaneous abortions and the current study, which defined IRSA as ≥3 spontaneous abortions. Based on random effects model, meta-analysis conducted on 1192 patients and 736 controls showed no association with IRSA under dominant(DD+IDvsII) and recessive(DDvsID+II) genetic models. Well-designed studies are needed to evaluate the role of ACE I/D polymorphism in IRSA defined as ≥3 spontaneous abortions.
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Affiliation(s)
- Nina Pereza
- Department of biology and medical genetics, Faculty of medicine, University of Rijeka, B. Branchetta 20, 51000 Rijeka, Croatia.
| | - Saša Ostojić
- Department of biology and medical genetics, Faculty of medicine, University of Rijeka, B. Branchetta 20, 51000 Rijeka, Croatia
| | - Matea Zdravčević
- Department of biology and medical genetics, Faculty of medicine, University of Rijeka, B. Branchetta 20, 51000 Rijeka, Croatia
| | - Marija Volk
- Clinical Institute of Medical Genetics, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Miljenko Kapović
- Department of biology and medical genetics, Faculty of medicine, University of Rijeka, B. Branchetta 20, 51000 Rijeka, Croatia
| | - Borut Peterlin
- Clinical Institute of Medical Genetics, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
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93
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Yamaleyeva LM, Chappell MC, Brosnihan KB, Anton L, Caudell DL, Shi S, McGee C, Pirro N, Gallagher PE, Taylor RN, Merrill DC, Mertz HL. Downregulation of apelin in the human placental chorionic villi from preeclamptic pregnancies. Am J Physiol Endocrinol Metab 2015; 309:E852-60. [PMID: 26394665 DOI: 10.1152/ajpendo.00272.2015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/16/2015] [Indexed: 12/31/2022]
Abstract
The role of the endogenous apelin system in pregnancy is not well understood. Apelin's actions in pregnancy are further complicated by the expression of multiple forms of the peptide. Using radioimmunoassay (RIA) alone, we established the expression of apelin content in the chorionic villi of preeclamptic (PRE) and normal pregnant women (NORM) at 36-38 wk of gestation. Total apelin content was lower in PRE compared with NORM chorionic villi (49.7±3.4 vs. 72.3±9.8 fmol/mg protein; n=20-22) and was associated with a trend for lower preproapelin mRNA in the PRE. Further characterization of apelin isoforms by HPLC-RIA was conducted in pooled samples from each group. The expression patterns of apelin peptides in NORM and PRE villi revealed little or no apelin-36 or apelin-17. Pyroglutamate apelin-13 [(Pyr1)-apelin-13] was the predominant form of the peptide in NORM and PRE villi. Angiotensin-converting enzyme 2 (ACE2) activity was higher in PRE villi (572.0±23.0 vs. 485.3±24.8 pmol·mg(-1)·min(-1); n=18-22). A low dose of ANG II (1 nM; 2 h) decreased apelin release in NORM villous explants that was blocked by the ANG II receptor 1 (AT1) antagonist losartan. Moreover, losartan enhanced apelin release above the 2-h baseline levels in both NORM and PRE villi (P<0.05). In summary, these studies are the first to demonstrate the lower apelin content in human placental chorionic villi of PRE subjects using quantitative RIA. (Pyr1)-apelin-13 is the predominant form of endogenous apelin in the chorionic villi of NORM and PRE. The potential mechanism of lower apelin expression in the PRE villi may involve a negative regulation of apelin by ANG II.
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Affiliation(s)
- Liliya M Yamaleyeva
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina;
| | - Mark C Chappell
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - K Bridget Brosnihan
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lauren Anton
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David L Caudell
- Department of Pathology/Comparative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Sara Shi
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Carolynne McGee
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Nancy Pirro
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Patricia E Gallagher
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Robert N Taylor
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
| | - David C Merrill
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
| | - Heather L Mertz
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
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94
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Vaswani K, Chan HW, Verma P, Dekker Nitert M, Peiris HN, Wood-Bradley RJ, Armitage JA, Rice GE, Mitchell MD. The rat placental renin-angiotensin system - a gestational gene expression study. Reprod Biol Endocrinol 2015; 13:89. [PMID: 26260700 PMCID: PMC4532142 DOI: 10.1186/s12958-015-0088-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/03/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The placenta is an essential organ that provides nutrients and oxygen to the developing fetus and removes toxic waste products from the fetal circulation. Maintaining placental blood osmotic pressure and blood flow is crucial for viable offspring. The renin-angiotensin system (RAS) in the placenta is a key player in the regulation of maternal-fetal blood flow during pregnancy. Therefore, the aim of this study was to determine if RAS genes are differentially expressed in mid to late gestation in rat placenta. METHODS Whole placental tissue samples from pregnant Sprague Dawley rats at embryonic (E) days 14.25, 15.25, 17.25 and 20 (n = 6 for each gestational age) were used for genome-wide gene expression by microarray. RAS genes with expression differences of >2 fold were further analyzed. Quantitative Real-Time PCR (qPCR) was performed on independent samples to confirm and validate microarray data. Immunohistochemisty and Western blotting were performed on a differentially expressed novel RAS pathway gene (ANPEP). RESULTS Six out of 17 genes of the RAS pathway were differentially expressed at different gestational ages. Gene expression of four genes (Angiotensin converting enzyme (Ace), angiotensin converting enzyme 2 (Ace2), membrane metalloendopeptidase (Mme) and angiotensin II receptor 1A (Agtr1a)) were significantly upregulated at E20 whereas two others (Thimet oligopeptidase 1 (Thop1) and Alanyl aminopeptidase (Anpep)) were downregulated at E20 prior to the onset of labour. These changes were confirmed by qPCR. Western blots revealed no overall differences in ANPEP protein expression in the placentae. Immunohistochemical studies, however, indicated that the localization of ANPEP differed at E17.25 and E20 as ANPEP localization in the giant trophoblast cell of the junctional zone was no longer detectable at E20. CONCLUSIONS The current study investigated the expression of members of the RAS pathway in rat placentae and observed significantly altered expression of 6 RAS genes at 4 gestational ages. These findings present the need for further comprehensive investigation of RAS genes in normal and complicated pregnancies.
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Affiliation(s)
- Kanchan Vaswani
- Centre for Clinical Diagnostics, University of Queensland Centre for Clinical Research Royal Brisbane and Women's Hospital Campus, Building 71/918, Royal Brisbane Hospital, Herston, QLD, 4029, Australia.
| | - Hsiu-Wen Chan
- Centre for Clinical Diagnostics, University of Queensland Centre for Clinical Research Royal Brisbane and Women's Hospital Campus, Building 71/918, Royal Brisbane Hospital, Herston, QLD, 4029, Australia.
| | - Pali Verma
- Centre for Clinical Diagnostics, University of Queensland Centre for Clinical Research Royal Brisbane and Women's Hospital Campus, Building 71/918, Royal Brisbane Hospital, Herston, QLD, 4029, Australia.
| | - Marloes Dekker Nitert
- Centre for Clinical Diagnostics, University of Queensland Centre for Clinical Research Royal Brisbane and Women's Hospital Campus, Building 71/918, Royal Brisbane Hospital, Herston, QLD, 4029, Australia.
| | - Hassendrini N Peiris
- Centre for Clinical Diagnostics, University of Queensland Centre for Clinical Research Royal Brisbane and Women's Hospital Campus, Building 71/918, Royal Brisbane Hospital, Herston, QLD, 4029, Australia.
| | - Ryan J Wood-Bradley
- Department of Anatomy & Developmental Biology Monash University, Clayton, VIC, 3800, Australia.
- School of Medicine (Optometry), Deakin University, Pigdons Road, Waurn Ponds, VIC, 3800, Australia.
| | - James A Armitage
- Department of Anatomy & Developmental Biology Monash University, Clayton, VIC, 3800, Australia.
- School of Medicine (Optometry), Deakin University, Pigdons Road, Waurn Ponds, VIC, 3800, Australia.
| | - Gregory E Rice
- Centre for Clinical Diagnostics, University of Queensland Centre for Clinical Research Royal Brisbane and Women's Hospital Campus, Building 71/918, Royal Brisbane Hospital, Herston, QLD, 4029, Australia.
| | - Murray D Mitchell
- Centre for Clinical Diagnostics, University of Queensland Centre for Clinical Research Royal Brisbane and Women's Hospital Campus, Building 71/918, Royal Brisbane Hospital, Herston, QLD, 4029, Australia.
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95
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Eshriqui I, Vilela AAF, Rebelo F, Farias DR, Castro MBT, Kac G. Gestational dietary patterns are not associated with blood pressure changes during pregnancy and early postpartum in a Brazilian prospective cohort. Eur J Nutr 2014; 55:21-32. [DOI: 10.1007/s00394-014-0819-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 12/09/2014] [Indexed: 12/31/2022]
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Affiliation(s)
- Monika Sanghavi
- From the Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - John D. Rutherford
- From the Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
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97
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Valdés G, Schneider D, Corthorn J, Ortíz R, Acuña S, Padilla O. Administration of angiotensin II and a bradykinin B2 receptor blocker in midpregnancy impairs gestational outcome in guinea pigs. Reprod Biol Endocrinol 2014; 12:49. [PMID: 24893657 PMCID: PMC4062647 DOI: 10.1186/1477-7827-12-49] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 05/25/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The opposing renin-angiotensin system (RAS) and kallikrein-kinin system (KKS) are upregulated in pregnancy and localize in the utero-placental unit. To test their participation as counter-regulators, circulating angiotensin II (AII) was exogenously elevated and the bradykinin B2 receptor (B2R) was antagonized in pregnant guinea-pigs. We hypothesized that disrupting the RAS/KKS balance during the period of maximal trophoblast invasion and placental development would provoke increased blood pressure, defective trophoblast invasion and a preeclampsia-like syndrome. METHODS Pregnant guinea-pigs received subcutaneous infusions of AII (200 μg/kg/day), the B2R antagonist Bradyzide (BDZ; 62.5 microg/kg/day), or both (AII + BDZ) from gestational day 20 to 34. Non-pregnant cycling animals were included in a control group (C NP) or received AII + BDZ (AII + BDZ NP) during 14 days. Systolic blood pressure was determined during cycle in C NP, and on the last day of infusion, and 6 and 26 days thereafter in the remaining groups. Twenty six days after the infusions blood and urine were extracted, fetuses, placentas and kidneys were weighed, and trophoblast invasion of spiral arteries was defined in the utero-placental units by immunocytochemistry. RESULTS Systolic blood pressure transiently rose in a subgroup of the pregnant females while receiving AII + BDZ infusion, but not in AII + BDZ NP. Plasma creatinine was higher in AII- and BDZ-treated dams, but no proteinuria or hyperuricemia were observed. Kidney weight increased in AII + BDZ-treated pregnant and non-pregnant females. Aborted and dead fetuses were increased in dams that received AII and AII + BDZ. The fetal/placental weight ratio was reduced in litters of AII + BDZ-treated mothers. All groups that received interventions during pregnancy showed reduced replacement of endothelial cells by extravillous trophoblasts in lateral and myometrial spiral arteries. CONCLUSIONS The acute effects on fetal viability, and the persistently impaired renal/placental sufficiency and incomplete arterial remodeling implicate the RAS and KKS in the adaptations in pregnancy. The results partially confirm our hypothesis, as a preeclampsia-like syndrome was not induced. We demonstrate the feasibility of characterizing systemic and local modifications in pregnant guinea-pig, supporting its use to study normal placentation and related disorders.
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Affiliation(s)
- Gloria Valdés
- Centro de Investigaciones Médicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
- Departamento de Nefrología, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Daniela Schneider
- Centro de Investigaciones Médicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Jenny Corthorn
- Centro de Investigaciones Médicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
- Departamento de Nefrología, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Rita Ortíz
- Centro de Investigaciones Médicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Stephanie Acuña
- Centro de Investigaciones Médicas, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
| | - Oslando Padilla
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile
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