201
|
Peng S, Sun M, Sun X, Wang X, Jin T, Wang H, Han C, Meng T, Li C. Plasma levels of TAM receptors and ligands in severe preeclampsia. Pregnancy Hypertens 2018; 13:116-120. [DOI: 10.1016/j.preghy.2018.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 05/24/2018] [Accepted: 05/26/2018] [Indexed: 12/24/2022]
|
202
|
Nagarajappa C, Rangappa SS, Suryanarayana R, Balakrishna S. Urinary congophilia in preeclampsia: Experience from a rural tertiary-care hospital in India. Pregnancy Hypertens 2018; 13:83-86. [DOI: 10.1016/j.preghy.2018.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/28/2018] [Accepted: 05/13/2018] [Indexed: 12/13/2022]
|
203
|
Nahum Sacks K, Friger M, Shoham-Vardi I, Spiegel E, Sergienko R, Landau D, Sheiner E. Prenatal exposure to preeclampsia as an independent risk factor for long-term cardiovascular morbidity of the offspring. Pregnancy Hypertens 2018; 13:181-186. [PMID: 30177050 DOI: 10.1016/j.preghy.2018.06.013] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 06/13/2018] [Accepted: 06/16/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Preeclampsia is a leading cause of maternal and fetal morbidity and mortality. Regarding the offspring, little is known about the long-term complications. The objective of the current study is to assess whether in utero exposure to preeclampsia increases the risk of long-term cardiovascular morbidity in the offspring. MATERIALS AND METHODS A population-based cohort study compared the incidence of cardiovascular disease between singletons exposed and unexposed to preeclampsia. Deliveries occurred between 1991 and 2014 in a regional tertiary medical center. A Cox proportional hazard model was used to control for confounders. RESULTS During the study period 231,298 deliveries met the inclusion criteria; 4.1% of the births were to mothers diagnosed with preeclampsia, of which 3.2% with mild preeclampsia (n = 7286), 0.9% with severe preeclampsia (n = 2174) and 0.03% with eclampsia (n = 73). A significant linear association was noted between preeclampsia (no preeclampsia, mild preeclampsia, severe preeclampsia and eclampsia) and cardiovascular disease of the offspring (0.24%, vs. 0.33% vs. 0.51% vs. 2.73% respectively, p < 0.001 using the chi-square test for trends). In the offspring born at term, severe preeclampsia was found to be an independent risk factor for cardiovascular morbidity (adjusted HR = 2.32; 95% CI 1.15-4.67). In offspring born preterm, neither severe preeclampsia (adjusted HR = 1.36; 95% CI 0.53-3.48) nor mild preeclampsia (adjusted HR = 0.37; 95% CI 0.52-2.71) were associated with cardiovascular morbidity of the offspring. CONCLUSION Exposure to severe maternal preeclampsia is an independent risk factor for long-term cardiovascular morbidity in the offspring born at term.
Collapse
Affiliation(s)
- Kira Nahum Sacks
- Department of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Israel
| | - Michael Friger
- Department of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Israel
| | - Ilana Shoham-Vardi
- Department of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Israel
| | - Efrat Spiegel
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Israel
| | - Ruslan Sergienko
- Department of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Israel
| | - Daniella Landau
- Department of Pediatrics, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Israel.
| |
Collapse
|
204
|
Eastabrook G, Aksoy T, Bedell S, Penava D, de Vrijer B. Preeclampsia biomarkers: An assessment of maternal cardiometabolic health. Pregnancy Hypertens 2018; 13:204-213. [PMID: 30177053 DOI: 10.1016/j.preghy.2018.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/09/2018] [Accepted: 06/09/2018] [Indexed: 12/15/2022]
Abstract
Preeclampsia is a serious pregnancy condition defined as new-onset hypertension and proteinuria, commonly characterized as either early, 'placental', or late onset, 'maternal', using a cut-off of 34 weeks gestation. However, it may be more useful to differentiate between the vascular remodelling and placental invasion vs. inflammation and metabolic pathophysiology that underlie these forms of preeclampsia. Due to rising rates of obesity, the late-onset, maternal form is increasingly occurring earlier in pregnancy. Predictive tests for preeclampsia typically include biophysical markers such as maternal body mass index and mean arterial pressure, indicating the importance of cardiovascular and metabolic health in its pathophysiology. In contrast, the placental, inflammatory, endothelial and/or metabolic biomarkers used in these tests are generally thought to indicate an abnormal response to placentation and predict the disease. However, many of these non-placental biomarkers are known to predict impaired metabolic health in non-pregnant subjects with obesity (metabolically unhealthy obesity) and coronary artery disease or stroke in people at risk for cardiovascular events. Similarities between the performance of these markers in the prediction of cardiovascular and metabolic health outside of pregnancy suggests that they may be more indicative of maternal health than predictive for preeclampsia. This paper reviews the biophysical and biochemical markers in preeclampsia prediction and compares their performance to tests assessing metabolic health and risk of cardiovascular disease, particularly in the obese population.
Collapse
Affiliation(s)
- Genevieve Eastabrook
- Department of Obstetrics and Gynaecology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Children's Health Research Institute and Lawson Health Research Institute, London, Ontario, Canada.
| | - Tuba Aksoy
- Department of Obstetrics and Gynecology, Mackenzie Richmond Hill Hospital, Richmond Hill, Ontario, Canada.
| | - Samantha Bedell
- Department of Obstetrics and Gynaecology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.
| | - Debbie Penava
- Department of Obstetrics and Gynaecology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Children's Health Research Institute and Lawson Health Research Institute, London, Ontario, Canada.
| | - Barbra de Vrijer
- Department of Obstetrics and Gynaecology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Children's Health Research Institute and Lawson Health Research Institute, London, Ontario, Canada.
| |
Collapse
|
205
|
Sande AK, Torkildsen EA, Sande RK, Morken NH. Maternal allergy as an isolated risk factor for early-onset preeclampsia: An epidemiological study. J Reprod Immunol 2018; 127:43-47. [PMID: 29758487 DOI: 10.1016/j.jri.2018.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 12/16/2022]
Abstract
Immunological mechanisms underlying the development of preeclampsia are well known, but no association to allergy has yet been demonstrated. The aim of this study was to assess the correlation between maternal pre-gestational allergy, and early-onset and late-onset preeclampsia, respectively. It was a retrospective cohort study including all women giving birth in the Norwegian cities of Stavanger (1996-2014) and Bergen (2009-2014). Pre-gestational asthma, allergy, other known risk factors for preeclampsia, maternal age and parity were obtained from the electronic medical record system. The main outcome variables were early-onset and late-onset preeclampsia (before and after 34 completed weeks of gestation, respectively). We used multinomial logistic regression to estimate odds ratios (OR) with 95% confidence intervals (95% CI) for early and late-onset preeclampsia in women with pre-gestational allergy when compared to women without allergy, adjusting for covariates. Predicted probabilities for the outcomes were also calculated. Of the 110 064 included pregnancies, 2 799 developed late-onset preeclampsia (2.5%) and 348 developed early-onset preeclampsia (0.3%). Pre-gestational allergy increased the risk of early-onset preeclampsia (OR 1.7, 95% CI 1.3-2.4), and reduced the risk of late-onset preeclampsia (OR 0.8, 95% CI 0.7-0.9). These findings add valuable information on preeclampsia as an immunological complication of pregnancy and corroborate the understanding of early- and late-onset preeclampsia as two different entities.
Collapse
Affiliation(s)
- Anne Kvie Sande
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway.
| | | | - Ragnar Kvie Sande
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Nils-Halvdan Morken
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
206
|
Abstract
Preeclampsia (PE) is one of the leading causes of maternal morbidity and mortality worldwide. This disease is believed to occur in two stages with placental dysfunction in early pregnancy leading to maternal clinical findings after 20 weeks of gestation, as consequence of systemic inflammation, oxidative stress, and endothelial dysfunction. Much evidence suggests that PE women display an overshooting inflammatory response throughout pregnancy due to an unbalanced regulation of innate and adaptive immune responses. Recently, it has been suggested that dysregulation of endogenous protective pathways might be associated with PE etiopathogenesis. Resolution of inflammation is an active process coordinated by mediators from diverse nature that regulate key cellular events to restore tissue homeostasis. Inadequate or insufficient resolution of inflammation is believed to play an important role in the development of chronic inflammatory diseases, like PE. In this narrative review, we discuss possible pro-resolution pathways that might be compromised in PE women, which could be targets to novel therapeutic strategies in this disease.
Collapse
|
207
|
Borges VTM, Zanati SG, Peraçoli MTS, Poiati JR, Romão-Veiga M, Peraçoli JC, Thilaganathan B. Maternal left ventricular hypertrophy and diastolic dysfunction and brain natriuretic peptide concentration in early- and late-onset pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:519-523. [PMID: 28436119 DOI: 10.1002/uog.17495] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/01/2017] [Accepted: 04/07/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Pre-eclampsia (PE) is associated with maternal cardiac remodeling and diastolic dysfunction. The aim of this study was to assess and compare maternal left ventricular structure and diastolic function and levels of brain natriuretic peptide (BNP) in women with early-onset (< 34 weeks' gestation) vs those with late-onset (≥ 34 weeks' gestation) PE. METHODS This was a prospective, cross-sectional, observational study of 30 women with early-onset PE, 32 with late-onset PE and 23 normotensive controls. Maternal cardiac structure and diastolic function were assessed by echocardiography and plasma levels of BNP were measured by enzyme immunoassay. RESULTS Early- and late-onset PE were associated with increased left ventricular mass index and relative wall thickness compared with normotensive controls. In women with early-onset PE, the prevalence of concentric hypertrophy (40%) and diastolic dysfunction (23%) was also significantly higher (both P < 0.05) compared with women with late-onset PE (16% for both). Maternal serum BNP levels were significantly higher (P < 0.05) in women with early-onset PE and correlated with relative wall thickness and left ventricular mass index. CONCLUSIONS Early-onset PE is associated with more severe cardiac impairment than is late-onset PE, as evidenced by an increased prevalence of concentric hypertrophy, diastolic dysfunction and higher levels of BNP. These findings suggest that early-onset PE causes greater myocardial damage, increasing the risk of both peripartum and postpartum cardiovascular morbidity. Although these cardiovascular effects are easily identified by echocardiographic parameters and measuring BNP, further studies are needed to assess their clinical utility. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- V T M Borges
- Department of Obstetrics and Gynaecology, Botucatu Medical School, São Paulo State University - UNESP, São Paulo, Brazil
| | - S G Zanati
- Department of Clinical Medicine, Botucatu Medical School, São Paulo State University - UNESP, São Paulo, Brazil
| | - M T S Peraçoli
- Institute of Biosciences - UNESP, Botucatu, São Paulo, Brazil
| | - J R Poiati
- Department of Obstetrics and Gynaecology, Botucatu Medical School, São Paulo State University - UNESP, São Paulo, Brazil
| | - M Romão-Veiga
- Institute of Biosciences - UNESP, Botucatu, São Paulo, Brazil
| | - J C Peraçoli
- Department of Obstetrics and Gynaecology, Botucatu Medical School, São Paulo State University - UNESP, São Paulo, Brazil
| | - B Thilaganathan
- Fetal Maternal Medicine Unit, St George's University of London, London, UK
| |
Collapse
|
208
|
Marshall SA, Hannan NJ, Jelinic M, Nguyen TP, Girling JE, Parry LJ. Animal models of preeclampsia: translational failings and why. Am J Physiol Regul Integr Comp Physiol 2018; 314:R499-R508. [DOI: 10.1152/ajpregu.00355.2017] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Preeclampsia affects up to 8% of pregnancies worldwide and is a leading cause of both maternal and fetal morbidity and mortality. Our current understanding of the cause(s) of preeclampsia is far from complete, and the lack of a single reliable animal model that recapitulates all aspects of the disease further confounds our understanding. This is partially due to the heterogeneous nature of the disease, coupled with our evolving understanding of its etiology. Nevertheless, animal models are still highly relevant and useful tools that help us better understand the pathophysiology of specific aspects of preeclampsia. This review summarizes the various types and characteristics of animal models used to study preeclampsia, highlighting particular features of these models relevant to clinical translation. This review points out the strengths and limitations of these models to illustrate the importance of using the appropriate model depending on the research question.
Collapse
Affiliation(s)
- Sarah A. Marshall
- School of BioSciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Natalie J. Hannan
- The Translational Obstetrics Group, Mercy Hospital for Women, Department of Obstetrics and Gynaecology, The University of Melbourne, Victoria, Australia
| | - Maria Jelinic
- School of BioSciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Thy P.H. Nguyen
- School of BioSciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Jane E. Girling
- Gynaecology Research Centre, Department of Obstetrics and Gynaecology, The University of Melbourne and Royal Women’s Hospital, Parkville, Victoria, Australia
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Laura J. Parry
- School of BioSciences, The University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
209
|
Alahari S, Post M, Rolfo A, Weksberg R, Caniggia I. Compromised JMJD6 Histone Demethylase Activity Affects VHL Gene Repression in Preeclampsia. J Clin Endocrinol Metab 2018; 103:1545-1557. [PMID: 29373688 DOI: 10.1210/jc.2017-02197] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/09/2018] [Indexed: 12/16/2022]
Abstract
CONTEXT The von Hippel Lindau (VHL) protein is a key executor of the cellular hypoxic response that is compromised in preeclampsia, a serious disorder complicating 5% to 7% of pregnancies. To date, the mechanisms controlling VHL gene expression in the human placenta remain elusive. OBJECTIVE We examined VHL epigenetic regulation in normal pregnancy and in preeclampsia, a pathology characterized by placental hypoxia. DESIGN, SETTING, AND PARTICIPANTS Placentae were obtained from early-onset preeclampsia (n = 56; <34 weeks of gestation) and late-onset preeclampsia (n = 19; ≥34 weeks of gestation). Placentae from healthy normotensive age-matched preterm control (n = 43) and term control (n = 23) pregnancies were included as controls. MAIN OUTCOME MEASURE(S) We measured the activity of Jumonji domain containing protein 6 (JMJD6), a ferrous iron (Fe2+)- and oxygen-dependent histone demethylase, and examined its function in the epigenetic control of VHL. RESULTS JMJD6 regulates VHL gene expression in the human placenta. VHL downregulation in preeclampsia is dependent on decreased JMJD6 demethylase activity due to hypoxia and reduced Fe2+ bioavailability. Chromatin immunoprecipitation assays revealed decreased association of JMJD6 and its histone targets with the VHL promoter. Findings in preeclampsia were corroborated in a murine model of pharmacological hypoxia using FG-4592. Placentae from FG-4592-treated mice exhibited reduced VHL levels, accompanied by placental morphological alterations and reduced pup weights. Notably, Fe2+ supplementation rescued JMJD6 histone demethylase activity in histone from E-PE and FG-4592-treated mice. CONCLUSIONS Our study uncovers epigenetic regulation of VHL and its functional consequences for altered oxygen and iron homeostasis in preeclampsia.
Collapse
Affiliation(s)
- Sruthi Alahari
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Martin Post
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Program in Translational Medicine, Peter Gilgan Centre for Research and Learning, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alessandro Rolfo
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Rosanna Weksberg
- Genetics & Genome Biology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Isabella Caniggia
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
210
|
Pregnancy Outcome in Women with Obstetric and Thrombotic Antiphospholipid Syndrome-A Retrospective Analysis and a Review of Additional Treatment in Pregnancy. Clin Rev Allergy Immunol 2018; 53:54-67. [PMID: 27395067 DOI: 10.1007/s12016-016-8569-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Antiphospholipid syndrome (APS) is associated with pregnancy complications such as recurrent early fetal loss (RFL), fetal death, preeclampsia (PE), and intrauterine growth restriction (obstetric APS/OAPS). Other clinical manifestations are venous and/or arterial thromboses (thrombotic APS/TAPS). The data of 37 pregnancies with OAPS and 37 pregnancies with TAPS were analyzed and compared. Overall, the most frequent APS antibodies (aPl) were LA as well as "triple-positivity"; LA antibodies were significantly more frequent in women with TAPS (67.6 % TAPS vs. 29.7 % OAPS, p < 0.010), whereas "triple-positivity" was significantly more seen in women with OAPS (40.5 % OAPS vs. 13.5 % TAPS, p < 0.010). Adequate therapy has been administered in nearly all pregnancies with TAPS, whereas in 18.9 % of pregnancies with OPS, no therapy has been given at all. One woman in OAPS and four women in TAPS were treated with plasmapheresis and immunoadsorption. There was no significant association between adverse obstetric outcome and therapy. The most frequent pregnancy complications were RFL in the OAPS group (32.4 vs. 13.5 % in TAPS) and PE in the TAPS group (18.9 % in OAPS and TAPS, respectively). The data of our study showed that pregnancies with OAPS and TAPS have a similar rate of pregnancy complications. However, pregnancies with OAPS tend to have rather RFL. Although we were not able to reveal a significant association with adverse obstetric outcome, it seems that the current adequate therapy for APS in pregnancy, consisting of LDA and LMWH, might rather prevent the development of RFL. Additionally, it might be considered to divide the obstetric APS into obstetric APS with early pregnancy complications and obstetric APS with late pregnancy complications. The division into two groups of obstetric APS might facilitate the choice of additional therapy in these women.
Collapse
|
211
|
Wang X, Chen Y, Du L, Li X, Li X, Chen D. Evaluation of circulating placenta-related long noncoding RNAs as potential biomarkers for preeclampsia. Exp Ther Med 2018; 15:4309-4317. [PMID: 29725373 PMCID: PMC5920431 DOI: 10.3892/etm.2018.5968] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 10/23/2017] [Indexed: 12/12/2022] Open
Abstract
Increasing evidence has indicated that circulating placental RNAs may reflect the pathophysiology of the placenta. In the current study, circulating placenta-related long noncoding RNAs (lncRNAs) were evaluated as potential biomarkers for preeclampsia (PE). Two parts of the case-control study were simultaneously executed, including the following sets: 52 patients with late-onset PE (LOPE) (diagnosed after 34 weeks) and 52 gestational age (GA)-matched controls; 58 patients with early-onset PE (EOPE) (diagnosed before 34 weeks) and 58 GA-matched controls. LncRNA expression was detected in the placenta analysis part, and the participants were delivered by caesarean sections. The levels of circulating placenta-associated lncRNAs were measured in the plasma analysis part and all pregnant women were included. Using microarray analysis, 163 differentially expressed lncRNAs were identified in placental samples from patients with LOPE, some of which were also detected in plasma samples from pregnant women. There were significant positive correlations between plasma, and placental expression levels of NONHSAT116812 and NONHSAT145880, which in plasma provided high diagnostic efficiencies for LOPE and EOPE. The present study demonstrated that circulating placenta-associated lncRNAs, paticularly NONHSAT116812 and NONHSAT145880 have potential as biomarkers for PE.
Collapse
Affiliation(s)
- Xin Wang
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, P.R. China.,Department of Obstetrics and Gynecology, Affiliated Hangzhou Hospital (Hangzhou First People's Hospital), Nanjing Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Yanhong Chen
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, P.R. China
| | - Lili Du
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, P.R. China
| | - Xiaomei Li
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, P.R. China
| | - Xiuying Li
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, P.R. China
| | - Dunjin Chen
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, P.R. China
| |
Collapse
|
212
|
Are There Differences in the Anthropometric, Hemodynamic, Hematologic, and Biochemical Profiles between Late- and Early-Onset Preeclampsia? Obstet Gynecol Int 2018; 2018:9628726. [PMID: 29686709 PMCID: PMC5852893 DOI: 10.1155/2018/9628726] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/13/2017] [Accepted: 01/04/2018] [Indexed: 12/19/2022] Open
Abstract
Preeclampsia (PE) is classified as early-onset PE (EOPE) and late-onset PE (LOPE) when present before or after 34 weeks of gestation, respectively. This transversal study aimed to investigate the differences and possible associations existing in the anthropometric, hemodynamic, hematologic, and biochemical profiles of late- and early-onset preeclampsia. The study included 65 volunteers admitted to a tertiary hospital in Brazil: 29 normotensive and 36 with preeclampsia (13 with EOPE and 23 with LOPE). Pregnant women with LOPE presented greater weight gain and borderline increase in body mass index at the end of gestation in relation to the other groups, which is compatible with the metabolic origin, associated with obesity, attributed to this form of the disease. Pregnant women with EOPE presented a borderline reduction in the number of erythrocytes and a significant decrease in the number of platelets, in addition to a significant increase in reticulocytes, serum iron, and ferritin when compared to normotensive pregnant women and pregnant women with LOPE. A significant increase in osmotic stability of erythrocytes was observed in the EOPE group in relation to other groups. Hemodynamic analysis by Doppler ultrasonography of the ophthalmic artery showed that both groups of pregnant women with PE presented alterations compatible with the occurrence of hyperflow in the orbital territory. These hemodynamic changes were associated with changes in hematimetric indices.
Collapse
|
213
|
Nizyaeva NV, Sukhacheva TV, Serov RA, Kulikova GV, Nagovitsyna MN, Kan NE, Tyutyunnik VL, Pavlovich SV, Poltavtseva RA, Yarotskaya EL, Shchegolev AI, Sukhikh GT. Ultrastructural and Immunohistochemical Features of Telocytes in Placental Villi in Preeclampsia. Sci Rep 2018; 8:3453. [PMID: 29472628 PMCID: PMC5823867 DOI: 10.1038/s41598-018-21492-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 02/06/2018] [Indexed: 11/09/2022] Open
Abstract
A new cell type, interstitial Cajal-like cell (ICLC), was recently described in different organs. The name was recently changed to telocytes (TCs), and their typical thin, long processes have been named telopodes (Tp). TCs regulate the contractile activity of smooth muscle cells and play a role in regulating vessel contractions. Although the placenta is not an innervated organ, we believe that TCs are present in the placenta. We studied placenta samples from physiological pregnancies and in different variants of preeclampsia (PE). We examined these samples using light microscopy of semi-thin sections, transmission electron microscopy, and immunohistochemistry. Immunohistochemical examination was performed with primary antibodies to CD34, CD117, SMA, and vimentin, and TMEM16a (DOG-1), the latter was used for the diagnosis of gastrointestinal stromal tumours (GIST) consisting of TCs. We have identified a heterogenetic population of ТСs in term placentas, as these cell types differed in their localization, immunophenotype and ultrastructural characteristics. We assume TMEM16a could be used as the marker for identification of TCs. In PE we have revealed telocyte-like cells with ultrastructural signs of fibrocytes (significant process thickening and the granular endoplasmic reticulum content was increased) and a loss of TMEM16a immunohistochemical staining.
Collapse
Affiliation(s)
- Natalia V Nizyaeva
- National Medical Research Center for Obstetrics Gynecology and Perinatology, Moscow, 117997, Russia.
| | - Tatiana V Sukhacheva
- A.N. Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow, 119991, Russia
| | - Roman A Serov
- A.N. Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow, 119991, Russia
| | - Galina V Kulikova
- National Medical Research Center for Obstetrics Gynecology and Perinatology, Moscow, 117997, Russia
| | - Marina N Nagovitsyna
- National Medical Research Center for Obstetrics Gynecology and Perinatology, Moscow, 117997, Russia
| | - Natalia E Kan
- National Medical Research Center for Obstetrics Gynecology and Perinatology, Moscow, 117997, Russia.,I.M. Sechenov First Moscow State Medical University, Moscow, 121552, Russia
| | - Victor L Tyutyunnik
- National Medical Research Center for Obstetrics Gynecology and Perinatology, Moscow, 117997, Russia.,I.M. Sechenov First Moscow State Medical University, Moscow, 121552, Russia
| | - Stanislav V Pavlovich
- National Medical Research Center for Obstetrics Gynecology and Perinatology, Moscow, 117997, Russia.,I.M. Sechenov First Moscow State Medical University, Moscow, 121552, Russia
| | - Rimma A Poltavtseva
- National Medical Research Center for Obstetrics Gynecology and Perinatology, Moscow, 117997, Russia
| | - Ekaterina L Yarotskaya
- National Medical Research Center for Obstetrics Gynecology and Perinatology, Moscow, 117997, Russia
| | - Aleksandr I Shchegolev
- National Medical Research Center for Obstetrics Gynecology and Perinatology, Moscow, 117997, Russia
| | - Gennadiy T Sukhikh
- National Medical Research Center for Obstetrics Gynecology and Perinatology, Moscow, 117997, Russia.,I.M. Sechenov First Moscow State Medical University, Moscow, 121552, Russia
| |
Collapse
|
214
|
Ozel A, Davutoglu EA, Firat A, Erenel H, Karslı MF, Korkmaz SÖ, Madazli R. Maternal serum irisin levels in early and late-onset pre-eclamptic and healthy pregnancies. J OBSTET GYNAECOL 2018; 38:642-646. [DOI: 10.1080/01443615.2017.1399260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Aysegul Ozel
- Department of Obstetrics and Gynecology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Ebru Alici Davutoglu
- Department of Obstetrics and Gynecology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Asuman Firat
- Department of Biochemistry, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Hakan Erenel
- Department of Obstetrics and Gynecology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Fatih Karslı
- Department of Obstetrics and Gynecology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Sevim Özge Korkmaz
- Department of Obstetrics and Gynecology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Riza Madazli
- Department of Obstetrics and Gynecology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| |
Collapse
|
215
|
Palmer KR, Tong S, Kaitu'u-Lino TJ. Placental-specific sFLT-1: role in pre-eclamptic pathophysiology and its translational possibilities for clinical prediction and diagnosis. Mol Hum Reprod 2018; 23:69-78. [PMID: 27986932 DOI: 10.1093/molehr/gaw077] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/09/2016] [Indexed: 11/12/2022] Open
Abstract
Pre-eclampsia is a common obstetric complication globally responsible for a significant burden of maternal and perinatal morbidity and mortality. Central to its pathophysiology is the anti-angiogenic protein, soluble fms-like tyrosine kinase-1 (sFLT-1). sFLT-1 is released from a range of tissues into the circulation, where it antagonizes the activity of vascular endothelial growth factor and placental growth factor leading to endothelial dysfunction. It is this widespread endothelial dysfunction that produces the clinical features of pre-eclampsia including hypertension and proteinuria. There are multiple splice variants of sFLT-1. One, known as sFLT-1 e15a, evolved quite recently and is only present in humans and higher order primates. This sFLT-1 variant is also the main sFLT-1 secreted from the placenta. Recent work has shown that sFLT-1 e15a is significantly elevated in the placenta and circulation of women with pre-eclampsia. It is also biologically active, capable of causing endothelial dysfunction and the end-organ dysfunction seen in pre-eclampsia. Indeed, the over-expression of sFLT-1 e15a in mice recapitulates the pre-eclamptic phenotype in pregnancy. Therefore, here we propose that sFLT-1 e15a may be the sFLT-1 variant primarily responsible for pre-eclampsia, a uniquely human disease. Furthermore, this placental-specific sFLT-1 variant provides promise for use as an accurate biomarker in the prediction or diagnosis of pre-eclampsia.
Collapse
Affiliation(s)
- K R Palmer
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, 246 Clayton Rd, Clayton, 3168 Victoria, Australia.,Translational Obstetric Group, University of Melbourne, Mercy Hospital for Women, 163 Studley Rd, Heidelberg, 3084 Victoria, Australia
| | - S Tong
- Translational Obstetric Group, University of Melbourne, Mercy Hospital for Women, 163 Studley Rd, Heidelberg, 3084 Victoria, Australia
| | - T J Kaitu'u-Lino
- Translational Obstetric Group, University of Melbourne, Mercy Hospital for Women, 163 Studley Rd, Heidelberg, 3084 Victoria, Australia
| |
Collapse
|
216
|
Combination of serum histidine-rich glycoprotein and uterine artery Doppler to predict preeclampsia. Hypertens Res 2018; 41:275-281. [PMID: 29416108 DOI: 10.1038/s41440-018-0013-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/10/2017] [Accepted: 05/27/2017] [Indexed: 01/06/2023]
Abstract
The primary aim of this study is to determine the value of using a combination of serum histidine-rich glycoprotein (HRG) level and uterine artery pulsatility index (PI) in pregnant women at 11-13+6 weeks' gestation to predict preeclampsia. The secondary aim is to determine the association between other pregnancy complications with the use of these combined tests. Transabdominal uterine artery PI and serum HRG level were measured at the time of first-trimester aneuploidy screening at 11-13+6 weeks' gestation in 327 pregnant women. The primary outcome was preeclampsia. The predictive values of this combination test were calculated. Eighteen cases developed preeclampsia (5.5%) and four of these preeclamptic cases were early-onset preeclampsia (1.2%). The sensitivity, specificity, positive predictive value, and negative predictive value of uterine artery PI combined with serum HRG level to predict preeclampsia were 11.1%, 96.8%, 16.7%, and 94.9%, respectively. For the prediction of early-onset preeclampsia, the sensitivity, specificity, positive predictive value, and negative predictive value were 25%, 97.1%, 10%, and 99%, respectively. An abnormal uterine artery PI and abnormal serum HRG level were associated with preterm delivery and intrauterine growth restriction. Our findings reveal that the combination of uterine artery PI and serum HRG level at 11-13+6 weeks of gestation is not an effective method for predicting preeclampsia at the time of first-trimester screening.
Collapse
|
217
|
Vuniqi-Krasniqi M, Paçarada M, Daka Q, Dervishi Z, Bimbashi A, Dakaj K. Hypertensive disorders of in-vitro fertilization pregnancies: A study from Kosovo. Int J Reprod Biomed 2018. [DOI: 10.29252/ijrm.16.2.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
|
218
|
Lan PG, Gillin AG, Pelosi M, Tooher J, Sandager P, Hyett J. Effect of early use of low-dose aspirin therapy on late-onset preeclampsia. J Matern Fetal Neonatal Med 2018; 32:2137-2142. [DOI: 10.1080/14767058.2018.1427718] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Patrick G. Lan
- School of Medicine, University of Sydney, Sydney, Australia
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Adrian G. Gillin
- School of Medicine, University of Sydney, Sydney, Australia
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Marilena Pelosi
- RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Jane Tooher
- RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Puk Sandager
- Department of Obstetrics and Gyanecology, Aarhus University Hospital, Aarhus, Denmark
| | - Jon Hyett
- RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, Australia
- Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, Australia
| |
Collapse
|
219
|
González-González NL, González Dávila E, Padrón E, Armas Gonzalez M, Plasencia W. Value of Placental Volume and Vascular Flow Indices as Predictors of Early and Late Preeclampsia at First Trimester. Fetal Diagn Ther 2018; 44:256-263. [PMID: 29393218 DOI: 10.1159/000481433] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 08/07/2017] [Indexed: 12/28/2022]
Abstract
INTRODUCTION We evaluated the utility of placental volume and three-dimensional (3D) vascular flow indices to predict early and late preeclampsia. MATERIAL AND METHODS In 1,004 pregnancies attending routine care, we recorded first-trimester screening program for aneuploidy (FTSA) parameter and measured uterine artery pulsatility index (uterine-a PI). Placental volume and vascular flow indices were obtained using 3D power Doppler and VOCAL techniques. RESULTS Placental volume was lower and uterine-a PI was higher in both early and late preeclampsia groups versus nonaffected pregnancies. The prediction rate of placental volume in late preeclampsia was higher than that of uterine-a PI (AUROC 0.707 vs. 0.581, p < 0.011). The inclusion of placental volume improved significantly the prediction rate of total and late preeclampsia in the models constructed with maternal characteristics, FTSA, and uterine-a PI (AUROC 0.745 vs. 0.818, p < 0.004, and 0.740 vs. 0.812, p < 0.012, respectively). The inclusion of vascular indices did not improve the predictive value of these models. DISCUSSION Placental volume was an independent predictor of total, early, and late preeclampsia and its inclusion in combined predictive models significantly improved prediction rates. Reduced placental volume observed at first trimester in women with early and late preeclampsia suggests that these entities are the clinical expression of a similar pathophysiological process.
Collapse
Affiliation(s)
- Nieves L González-González
- Departamento de Obstetricia y Ginecología, Hospital Universitario de Canarias, Universidad de La Laguna, La Laguna,
| | - Enrique González Dávila
- Departamento de Matemáticas, Estadística e Investigación Operativa, Universidad de La Laguna, La Laguna, Spain
| | - Erika Padrón
- Departamento de Obstetricia y Ginecología, Hospital Universitario de Canarias, Universidad de La Laguna, La Laguna, Spain
| | - Marina Armas Gonzalez
- Departamento de Obstetricia y Ginecología, Hospital Universitario de Canarias, Universidad de La Laguna, La Laguna, Spain
| | | |
Collapse
|
220
|
Kenny LC, Kell DB. Immunological Tolerance, Pregnancy, and Preeclampsia: The Roles of Semen Microbes and the Father. Front Med (Lausanne) 2018; 4:239. [PMID: 29354635 PMCID: PMC5758600 DOI: 10.3389/fmed.2017.00239] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 12/12/2017] [Indexed: 12/18/2022] Open
Abstract
Although it is widely considered, in many cases, to involve two separable stages (poor placentation followed by oxidative stress/inflammation), the precise originating causes of preeclampsia (PE) remain elusive. We have previously brought together some of the considerable evidence that a (dormant) microbial component is commonly a significant part of its etiology. However, apart from recognizing, consistent with this view, that the many inflammatory markers of PE are also increased in infection, we had little to say about immunity, whether innate or adaptive. In addition, we focused on the gut, oral and female urinary tract microbiomes as the main sources of the infection. We here marshall further evidence for an infectious component in PE, focusing on the immunological tolerance characteristic of pregnancy, and the well-established fact that increased exposure to the father's semen assists this immunological tolerance. As well as these benefits, however, semen is not sterile, microbial tolerance mechanisms may exist, and we also review the evidence that semen may be responsible for inoculating the developing conceptus (and maybe the placenta) with microbes, not all of which are benign. It is suggested that when they are not, this may be a significant cause of PE. A variety of epidemiological and other evidence is entirely consistent with this, not least correlations between semen infection, infertility and PE. Our view also leads to a series of other, testable predictions. Overall, we argue for a significant paternal role in the development of PE through microbial infection of the mother via insemination.
Collapse
Affiliation(s)
- Louise C. Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- Department of Obstetrics and Gynecology, University College Cork, Cork, Ireland
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Douglas B. Kell
- School of Chemistry, The University of Manchester, Manchester, United Kingdom
- The Manchester Institute of Biotechnology, The University of Manchester, Manchester, United Kingdom
| |
Collapse
|
221
|
|
222
|
Razak A, Florendo-Chin A, Banfield L, Abdul Wahab MG, McDonald S, Shah PS, Mukerji A. Pregnancy-induced hypertension and neonatal outcomes: a systematic review and meta-analysis. J Perinatol 2018; 38:46-53. [PMID: 29095432 DOI: 10.1038/jp.2017.162] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/08/2017] [Accepted: 08/29/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Pregnancy-induced hypertension (PIH) is associated with preterm delivery but its independent impact on neonatal outcomes remains unclear. We sought to systematically review and meta-analyze clinical outcomes of preterm infants <37 weeks' gestation born to mothers with and without PIH. STUDY DESIGN Medline, Embase, PsychINFO and CINAHL were searched from January 2000 to October 2016. Studies with low-moderate risk of bias reporting neonatal outcomes based on PIH as primary exposure variable were included. Data were extracted independently by two co-authors. RESULTS PIH was associated with lower mortality (3 studies; adjusted odds ratio (aOR) 0.65; 95% confidence interval (CI) 0.54 to 0.79), lower severe retinopathy of prematurity (ROP) (2 studies; aOR 0.83; 0.72 to 0.96) and lower severe brain injury (2 studies; unadjusted OR (uOR) 0.57; 0.49 to 0.66). No association between PIH and short-term respiratory outcomes, bronchopulmonary dysplasia (BPD) or necrotizing enterocolitis (NEC) was identified. In subgroup analysis among infants <29 weeks' gestation, BPD odds were higher (3 studies; aOR 1.15; 1.06 to 1.26), whereas mortality lower (2 studies; aOR 0.73; 0.69 to 0.77). In subgroup analysis limited to severe PIH, odds of mortality (3 studies; uOR 2.36; 1.07 to 5.22) and invasive ventilation (3 studies; uOR 3.26; 1.11 to 9.61) were higher. In subgroup analysis limited to preeclampsia, odds of BPD (3 studies; uOR 1.21; 95% CI:1.03 to 1.43) and NEC were higher (3 studies; uOR 2.79; 95% CI:1.57 to 4.96). CONCLUSION PIH was associated with reduced odds of mortality and ROP (all infants), but higher odds for BPD (<29 weeks' gestation). The paradoxical reduction in mortality may be due to survival bias and deserves further exploration in future studies.
Collapse
Affiliation(s)
- A Razak
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - A Florendo-Chin
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - L Banfield
- Faculty of Health Science, Health Sciences Library, McMaster University, Hamilton, ON, Canada
| | - M G Abdul Wahab
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - S McDonald
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - P S Shah
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - A Mukerji
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
223
|
Paauw ND, Lely AT. Cardiovascular Sequels During and After Preeclampsia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:455-470. [PMID: 30051401 DOI: 10.1007/978-3-319-77932-4_28] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Preeclampsia is a pregnancy-specific disorder complicating 2%-8% of pregnancies worldwide and characterized by de novo development of hypertension and proteinuria. Current understanding of the pathophysiology of preeclampsia is limited. A main feature is disrupted spiral artery remodeling in the placenta, which restricts the blood flow to the placenta, which in turn leads to decreased uteroplacental perfusion. Impaired blood flow through the placenta might result in fetal growth restriction and secretion of several factors by the placenta-mainly pro-inflammatory cytokines and anti-angiogenic factors-which spread into the maternal circulation, leading to endothelial dysfunction, which subsequently results in disrupted maternal hemodynamics. To date, no treatment options are available apart from termination of pregnancy. Despite normalization of the maternal vascular disturbances after birth, it has become apparent that formerly preeclamptic women experience an increased risk to develop cardiovascular and kidney disease later in life. One well-accepted concept is that the development of preeclampsia is an indicator of maternal susceptibility to develop future cardiovascular conditions, although the increased risk might also be the result of organ damage caused during preeclampsia. Given the associations between preeclampsia and long-term complications, preeclampsia is acknowledged as woman-specific risk factor for cardiovascular disease. Current research focuses on finding effective screening and prevention strategies for the reduction of cardiovascular disease in women with a history of preeclampsia.
Collapse
Affiliation(s)
- Nina D Paauw
- Department of Obstetrics, Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - A Titia Lely
- Department of Obstetrics, Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands.
| |
Collapse
|
224
|
Shao Y, Qiu J, Huang H, Mao B, Dai W, He X, Cui H, Lin X, Lv L, Wang D, Tang Z, Xu S, Zhao N, Zhou M, Xu X, Qiu W, Liu Q, Zhang Y. Pre-pregnancy BMI, gestational weight gain and risk of preeclampsia: a birth cohort study in Lanzhou, China. BMC Pregnancy Childbirth 2017; 17:400. [PMID: 29191156 PMCID: PMC5709979 DOI: 10.1186/s12884-017-1567-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 11/06/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND To evaluate the independent and joint effects of maternal pre-pregnancy BMI and gestational weight gain (GWG) on the risk of preeclampsia and its subtypes. METHODS A birth cohort study was conducted from 2010 to 2012 in Lanzhou, China. Three hundred fourty seven pregnant women with preeclampsia and 9516 normotensive women at Gansu Provincial Maternity and Child Care Hospital were included in the present study. Unconditional logistic regression models were used to evaluate the associations between pre-pregnancy BMI, GWG, and risk of preeclampsia and its subtypes. RESULTS Compared to women with normal pre-pregnancy BMI, those who were overweight/obese had an increased risk of preeclampsia (OR = 1.81; 95%CI: 1.37-2.39). Women with excessive GWG had an increased risk of preeclampsia (OR = 2.28; 95%CI: 1.70-3.05) compared to women with adequate GWG. The observed increased risk was similar for mild-, severe- and late-onset preeclampsia. No association was found for early-onset preeclampsia. Overweight/obese women with excessive GWG had the highest risk of developing preeclampsia compared to normal weight women with no excessive weight gain (OR = 3.78; 95%CI: 2.65-5.41). CONCLUSIONS Our results suggested that pre-pregnancy BMI and GWG are independent risk factors for preeclampsia and that the risk might vary by preeclampsia subtypes. Our study also proposed a potential synergistic effect of pre-pregnancy BMI and GWG that warrants further investigation.
Collapse
Affiliation(s)
- Yawen Shao
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Jie Qiu
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Huang Huang
- Yale University School of Public Health, 60 College Street, New Haven, CT 06520 USA
| | - Baohong Mao
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Wei Dai
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Xiaochun He
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Hongmei Cui
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Xiaojuan Lin
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Ling Lv
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Dennis Wang
- Yale University School of Public Health, 60 College Street, New Haven, CT 06520 USA
| | - Zhongfeng Tang
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Sijuan Xu
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Nan Zhao
- Yale University School of Public Health, 60 College Street, New Haven, CT 06520 USA
| | - Min Zhou
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Xiaoying Xu
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Weitao Qiu
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Qing Liu
- Gansu Provincial Maternity and Child Care Hospital, 143 North Road, Qilihe District, Lanzhou, Gansu Province 730050 China
| | - Yawei Zhang
- Yale University School of Public Health, 60 College Street, New Haven, CT 06520 USA
- Yale School of Medicine, New Haven, CT USA
| |
Collapse
|
225
|
Egan K, O’Connor H, Kevane B, Malone F, Lennon A, Zadjali A, Cooley S, Monteith C, Maguire P, Szklanna P, Allen S, McCallion N, Áinle F. Elevated plasma TFPI activity causes attenuated TF-dependent thrombin generation in early onset preeclampsia. Thromb Haemost 2017; 117:1549-1557. [DOI: 10.1160/th16-12-0949] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/09/2017] [Indexed: 11/05/2022]
Abstract
SummaryEarly onset preeclampsia (EOP) is a pregnancy-specific proinflammatory disorder that is characterised by competing thrombotic and bleeding risks. It was the aim of this study to characterise thrombin generation, a major determinant of thrombotic and bleeding risk, in order to better understand the haemostatic balance in patients with EOP. Patients with EOP were recruited at the Rotunda Hospital, Dublin. Twenty-six cases of EOP were recruited over a 21-month period, out of 15,299 deliveries at the Rotunda. Blood samples were collected into sodium citrate plus corn trypsin inhibitor anticoagulated vacutainers, platelet-poor plasma was prepared, and calibrated automated thrombography was used to assess thrombin generation. Results were compared to age and sex-matched non-pregnant controls (n=13) and age-and gestation-matched pregnant controls (n=20). The rate and extent of thrombin generation triggered by low-dose tissue factor (TF) was significantly reduced in patients with EOP compared to pregnant controls, most significantly in cases of severe EOP. EOP patients displayed a trend towards an increased response to endogenous activated protein C and thrombomodulin relative to pregnant controls. Plasma tissue factor pathway inhibitor (TFPI) activity was increased in EOP patients. Inhibition of TFPI abolished the attenuation of thrombin generation stimulated by low-dose TF. In conclusion, patients with EOP are characterised by an attenuated coagulation response characterised by reduced thrombin generation stimulated by low-dose TF and elevated plasma TFPI activity. These changes in coagulation may modulate thrombotic risk and bleeding risk in patients with EOP.
Collapse
|
226
|
Polymorphism of ERCC1 rs3212986 in Chinese Han women with preeclampsia. Pregnancy Hypertens 2017; 10:192-195. [PMID: 29153678 DOI: 10.1016/j.preghy.2017.08.007] [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: 04/22/2017] [Revised: 08/13/2017] [Accepted: 08/26/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the association between polymorphism of rs3212986 in ERCC1 and susceptibility to preeclampsia in the Chinese Han population. STUDY DESIGN Samples of 642 preeclampsia patients and 877 controls were genotyped for rs3212986 using TaqMan allele discrimination assays. The genetic and allelic distributions between the groups were compared by Pearson's χ2 test. RESULT There was no difference in the genotypic and allelic distributions between cases and controls (P>0.05). Statistical difference in genotypic frequencies of rs3212986 was observed between early-onset and late-onset preeclampsia (χ2=6.985, P=0.030). When subdivided into TT/GG+GT groups, a significant difference was found between early-onset and late-onset preeclampsia (χ2=6.528, P=0.011, OR=2.011, 95%CI 1.167-3.465). CONCLUSION The polymorphisms of rs3212986 showed no association with the risk of preeclampsia in the Chinese Han population. However, the difference in the genotypic distribution between early-onset and late-onset preeclampsia suggest the need for future studies.
Collapse
|
227
|
Scoville CD, Leavitt GR, Rosales M, Tolley HD. A pilot study of the relationship between preeclampsia and anti-tetanus toxoid antibody levels. Pregnancy Hypertens 2017; 10:182-186. [PMID: 29153676 DOI: 10.1016/j.preghy.2017.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 07/30/2017] [Accepted: 08/13/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Craig D Scoville
- Institute of Arthritis Research, 2220 East 25th St, Idaho Falls, ID 83404, USA.
| | - Glenn R Leavitt
- Leavitt Womens Healthcare, 1550 Elk Creek Dr, Idaho Falls, ID 83404, USA
| | - Maritza Rosales
- Institute of Arthritis Research, 2220 East 25th St, Idaho Falls, ID 83404, USA
| | - H Dennis Tolley
- Department of Statistics, 223 TMCB, Brigham Young University, Provo, UT 84602, USA.
| |
Collapse
|
228
|
Zenerino C, Nuzzo AM, Giuffrida D, Biolcati M, Zicari A, Todros T, Rolfo A. The HMGB1/RAGE Pro-Inflammatory Axis in the Human Placenta: Modulating Effect of Low Molecular Weight Heparin. Molecules 2017; 22:molecules22111997. [PMID: 29149067 PMCID: PMC6150179 DOI: 10.3390/molecules22111997] [Citation(s) in RCA: 24] [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: 10/09/2017] [Revised: 11/10/2017] [Accepted: 11/14/2017] [Indexed: 01/11/2023] Open
Abstract
We evaluated whether physiological and pre-eclamptic (PE) placentae, characterized by exacerbated inflammation, presented alterations in pro-inflammatory High Mobility Group Box 1 (HMGB1) and its Receptor of Advanced Glycation End products (RAGE) expression. Moreover, we investigated, in physiological placental tissue, the ability of Low Molecular Weight Heparin (LMWH) to modify HMGB1 structural conformation thus inhibiting RAGE binding and HMGB1/RAGE axis inflammatory activity. HMGB1, RAGE, IL-6 and TNFα (HMGB1/RAGE targets) mRNA expression were assessed by Real Time PCR. HMGB1, RAGE protein levels were assessed by western blot assay. Physiological term placental explants were treated by 0.5 U LMWH for 24 or 48 h. HMGB1 and RAGE expression and association were evaluated in LMWH explants by RAGE immunoprecipitation followed by HMGB1 immunoblot. HMGB1 spatial localization was evaluated by immuofluorescent staining (IF). HMGB1 expression was increased in PE relative to physiological placentae while RAGE was unvaried. 24 h LMWH treatment significantly up-regulated HMGB1 expression but inhibited HMGB1/RAGE complex formation in physiological explants. RAGE expression decreased in treated relative to untreated explants at 48 h. IF showed HMGB1 localization in both cytoplasm and nucleus of mesenchymal and endothelial cells but not in the trophoblast. IL-6 and TNFα gene expression were significantly increased at 24 h relative to controls, while they were significantly down-regulated in 48 h vs. 24 h LMWH explants. Our data depicted a new molecular mechanism through which LMWH exerts its anti-inflammatory effect on PE placentae, underlying the importance of HMGB1/RAGE axis in PE inflammatory response.
Collapse
Affiliation(s)
- Cristian Zenerino
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy.
| | - Anna Maria Nuzzo
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy.
| | - Domenica Giuffrida
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy.
| | - Marilisa Biolcati
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy.
| | - Alessandra Zicari
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Rome, Italy.
| | - Tullia Todros
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy.
| | - Alessandro Rolfo
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy.
| |
Collapse
|
229
|
Verma S, Pillay P, Naicker T, Moodley J, Mackraj I. Placental hypoxia inducible factor -1α & CHOP immuno-histochemical expression relative to maternal circulatory syncytiotrophoblast micro-vesicles in preeclamptic and normotensive pregnancies. Eur J Obstet Gynecol Reprod Biol 2017; 220:18-24. [PMID: 29127866 DOI: 10.1016/j.ejogrb.2017.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 11/03/2017] [Accepted: 11/06/2017] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Preeclampsia (PE) occurs as a result placental hypoxia-induced oxidative and endoplasmic reticulum stress, and is associated with the activation of hypoxia inducible factor-1α (HIF-1α) and apoptotic CHOP pathways with the consequential shedding of syncytiotrophoblast microvesicles which may be central in mediating the maternal systemic immune response. The aim of this study was to immune-localise and morphometrically analyse CHOP and HIF-1α within the placenta of normotensive and pre-eclamptic pregnancies and concomitantly quantify syncytiotrophoblast released microvesicles in maternal circulation. STUDY DESIGN Placental tissue and plasma were obtained from normotensive and pre-eclamptic pregnant women. The expression of CHOP and HIF-1α was analysed using immunohistochemistry. Isolation and size distribution of the circulating maternal microvesicles was determined using nanoparticle tracking analysis. The concentration of syncytiotrophoblast microvesicles was determined using the placental alkaline phosphatase ELISA. RESULTS This study demonstrates a significant increase in immunohistochemical expression of HIF-1 α and CHOP in preeclampsia compared to the normotensive women (p<0.05). In keeping with this, a significant increase in the mean syncytiotrophoblast microvesicles concentration was observed in PE, compared to normotensives (p<0.05). A positive correlation between placental expression of CHOP and HIF-1α and STBMs was obtained. CONCLUSION This study demonstrates increased placental expression of HIF-1α and CHOP in preeclampsia compared to normotensive pregnancies which correlate to their increased syncytiotrophoblast microvesicles concentration in maternal circulation. These findings indicate that placental hypoxia and ER stress are interrelated contributory factors to the pathogenesis of PE and the consequential release of placental derived debris into the maternal circulation.
Collapse
Affiliation(s)
- S Verma
- Department of Physiology, University of KwaZulu-Natal, South Africa
| | - P Pillay
- Department of Physiology, University of KwaZulu-Natal, South Africa
| | - T Naicker
- Department of Optics and Imaging, University of KwaZulu-Natal, South Africa
| | - J Moodley
- Women's Health and HIV Research Group, University of KwaZulu-Natal, South Africa
| | - I Mackraj
- Department of Physiology, University of KwaZulu-Natal, South Africa.
| |
Collapse
|
230
|
Weber TM, Lackner HK, Roessler A, Papousek I, Kolovetsiou-Kreiner V, Lucovnik M, Schmid-Zalaudek K, Lang U, Moertl MG. Heart rate variability and baroreceptor reflex sensitivity in early- versus late-onset preeclampsia. PLoS One 2017; 12:e0186521. [PMID: 29053723 PMCID: PMC5650147 DOI: 10.1371/journal.pone.0186521] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 10/03/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To determine whether there are differences in autonomic nervous system function in early- versus late-onset preeclampsia. METHODS Matched case-control study. Cases were defined as singleton pregnancies with preeclampsia at < 34+0 weeks of gestation (early-onset preeclampsia) and ≥ 34+0 weeks of gestation (late-onset preeclampsia). For each case in each of the preeclampsia subgroups, three "control"uncomplicated singleton pregnancies were matched by maternal age, height, and week of gestation. Blood pressure and heart rate were measured continuously for 30 minutes in each participant. Baroreceptor reflex sensitivity (assessed using sequence technique), time and frequency domain heart rate variability measures, as SDNN, RMSSD, LFRRI, HFRRI and LF/HFRRI of R-R intervals, were compared between groups (p<0.05 significant). RESULTS 24 women with preeclampsia (10 with early-onset and 14 with late-onset preeclampsia) and 72 controls were included in the study. SDNN, RMSSD and HFRRI were significantly higher in the late-onset preeclampsia group compared to gestational age matched controls (p = 0.033, p = 0.002 and p = 0.018, respectively). No significant differences in SDNN RMSSD and HFRRI between early-onset preeclampsia group and gestational age matched controls were observed (p = 0.304, p = 0.325 and p = 0.824, respectively). Similarly, baroreceptor reflex sensitivity was higher in late-onset preeclampsia compared to controls at ≥ 34 weeks (p = 0.037), but not different between early-onset preeclampsia compared to controls at < 34 weeks (p = 0.50). CONCLUSIONS Heart rate variability and baroreceptor reflex sensitivity are increased in late- but not early-onset preeclampsia compared to healthy pregnancies. This indicates a better autonomic nervous system mediated adaptation to preeclampsia related cardiovascular changes in late-onset disease.
Collapse
Affiliation(s)
| | - Helmut Karl Lackner
- Department of Physiology, Medical University of Graz, Graz, Austria
- Department of Medical Engineering, Graz University of Technology, Graz, Austria
| | - Andreas Roessler
- Department of Physiology, Medical University of Graz, Graz, Austria
| | - Ilona Papousek
- Department of Psychology, Biological Psychology Unit, University of Graz, Graz, Austria
| | | | - Miha Lucovnik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Uwe Lang
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | | |
Collapse
|
231
|
Herzog EM, Eggink AJ, Willemsen SP, Slieker RC, Wijnands KP, Felix JF, Chen J, Stubbs A, van der Spek PJ, van Meurs JB, Steegers-Theunissen RP. Early- and late-onset preeclampsia and the tissue-specific epigenome of the placenta and newborn. Placenta 2017; 58:122-132. [DOI: 10.1016/j.placenta.2017.08.070] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/18/2017] [Accepted: 08/28/2017] [Indexed: 01/22/2023]
|
232
|
Vaddamani S, Keepanasseril A, Pillai AA, Kumar B. Maternal cardiovascular dysfunction in women with early onset preeclampsia and late onset preeclampsia: A cross-sectional study. Pregnancy Hypertens 2017; 10:247-250. [DOI: 10.1016/j.preghy.2017.10.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/09/2017] [Indexed: 11/30/2022]
|
233
|
Hung TH, Hsieh TT, Chen SF. Risk of abnormal fetal growth in women with early- and late-onset preeclampsia. Pregnancy Hypertens 2017; 12:201-206. [PMID: 29104027 DOI: 10.1016/j.preghy.2017.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/28/2017] [Accepted: 09/10/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To investigate the risks of delivering small-for-gestational-age (SGA) and large-for-gestational-age (LGA) infants in women with early- (delivered before 34weeks of gestation) and late-onset (delivered at or after 34weeks of gestation) preeclampsia. STUDY DESIGN We conducted a retrospective cohort study of 29,494 singleton deliveries after 24weeks' gestation, excluding pregnancies complicated by fetal anomalies, stillbirths, and prepregnancy diabetes mellitus. Univariate and multivariate logistic analyses adjusted for potential confounding factors, including prepregnancy body mass index (BMI), gestational weight gain (GWG), and gestational diabetes mellitus (GDM), were performed. RESULTS Among women who delivered before 34weeks, significantly more women with preeclampsia delivered SGA infants than women without preeclampsia (50.6% vs. 7.0%; adjusted odds ratio [OR] 16.3; 95% confidence interval [CI] 8.1-32.9). Among women who delivered at or after 34weeks, women with preeclampsia had higher rates of delivering SGA (25.5% vs. 7.0%) and LGA (13.7% vs. 9.9%) infants than women without preeclampsia. After adjustment for confounding factors, preeclampsia remained a significant risk factor for delivering SGA infants (adjusted OR 5.7; 95% CI 4.6-7.1), but the association between preeclampsia and the delivery of LGA infants was diminished (adjusted OR 0.8; 95% CI 0.6-1.1). CONCLUSIONS Our results confirm that preeclampsia is associated with SGA and that the association is stronger with early-onset disease. Although women with late-onset preeclampsia had a higher rate of delivering LGA infants, the association between late-onset preeclampsia and LGA is due to confounding factors, such as high prepregnancy BMI, excessive GWG, and GDM, related to maternal metabolic abnormalities.
Collapse
Affiliation(s)
- Tai-Ho Hung
- Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - T'sang-T'ang Hsieh
- Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Szu-Fu Chen
- Department of Physical Medicine and Rehabilitation, Cheng Hsin Rehabilitation Medical Center, Taipei, Taiwan
| |
Collapse
|
234
|
Ribeiro VR, Romao‐Veiga M, Romagnoli GG, Matias ML, Nunes PR, Borges VTM, Peracoli JC, Peracoli MTS. Association between cytokine profile and transcription factors produced by T-cell subsets in early- and late-onset pre-eclampsia. Immunology 2017; 152:163-173. [PMID: 28502089 PMCID: PMC5543493 DOI: 10.1111/imm.12757] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/18/2017] [Accepted: 05/06/2017] [Indexed: 01/04/2023] Open
Abstract
Pre-eclampsia (PE) is an obstetric pathology characterized by abnormal activation of the innate and adaptive immune systems dependent on the imbalance of T helper subsets. The present study aimed to evaluate the gene and protein expression of T helper type 1 (Th1)/Th2/Th17/regulatory T (Treg) cell transcription factors in peripheral blood lymphocytes from pregnant women with PE employing quantitative RT-PCR and flow cytometry techniques, as well as the cytokine profile produced by these CD4+ T-cell subsets in the plasma of pregnant women with PE, classified as early-onset PE (n = 20), late-onset PE (n = 20) and normotensive pregnant women (n = 20). Results showed a higher percentage of CD4+ T cells expressing the RORc transcription factor (Th17) and a lower percentage of cells expressing FoxP3 (Treg) in women with early-onset PE compared with late-onset PE and normotensive groups. A lower gene expression of GATA-3 transcription factor was detected in cells of women with early-onset PE compared with the late-onset PE group. Endogenous plasma levels of interleukin-6 (IL-6), IL-17 and tumour necrosis factor-α were significantly higher in the early-onset PE group than in the late-onset PE and normotensive groups, whereas IL-4 (Th2 profile) and IL-22 (Th17 profile), were not significantly different between the studied groups. The endogenous levels of transforming growth factor-β and IL-10 were significantly lower in the pre-eclamptic than in the normotensive groups of the same gestational age, with a significant difference between early- and late-onset PE. The results show that in women with PE there is an imbalance between inflammatory and anti-inflammatory profiles in CD4+ T-cell subsets, with polarization to Th17 profiles in the early-onset PE, considered as the severe form of PE.
Collapse
MESH Headings
- Adaptive Immunity
- Adolescent
- Adult
- Biomarkers/blood
- Case-Control Studies
- Cytokines/blood
- Cytokines/genetics
- Cytokines/immunology
- Female
- Forkhead Transcription Factors/blood
- Forkhead Transcription Factors/genetics
- Forkhead Transcription Factors/immunology
- GATA3 Transcription Factor/blood
- GATA3 Transcription Factor/genetics
- GATA3 Transcription Factor/immunology
- Gene Expression Regulation
- Humans
- Inflammation Mediators/blood
- Inflammation Mediators/immunology
- Nuclear Receptor Subfamily 1, Group F, Member 3/blood
- Nuclear Receptor Subfamily 1, Group F, Member 3/genetics
- Nuclear Receptor Subfamily 1, Group F, Member 3/immunology
- Phenotype
- Pre-Eclampsia/blood
- Pre-Eclampsia/diagnosis
- Pre-Eclampsia/genetics
- Pre-Eclampsia/immunology
- Pregnancy
- RNA, Messenger/blood
- RNA, Messenger/genetics
- Severity of Illness Index
- T-Lymphocytes, Regulatory/immunology
- T-Lymphocytes, Regulatory/metabolism
- Th1 Cells/immunology
- Th1 Cells/metabolism
- Th17 Cells/immunology
- Th17 Cells/metabolism
- Th2 Cells/immunology
- Th2 Cells/metabolism
- Transcription Factors/blood
- Transcription Factors/genetics
- Transcription Factors/immunology
- Young Adult
Collapse
Affiliation(s)
- Vanessa R. Ribeiro
- Department of Gynaecology and ObstetricsMedical SchoolBotucatu Sao Paulo State University (UNESP)BotucatuSao PauloBrazil
| | - Mariana Romao‐Veiga
- Department of Microbiology and ImmunologyInstitute of BiosciencesBotucatu Sao Paulo State University (UNESP)BotucatuSao PauloBrazil
| | - Graziela G. Romagnoli
- Department of Microbiology and ImmunologyInstitute of BiosciencesBotucatu Sao Paulo State University (UNESP)BotucatuSao PauloBrazil
| | - Mariana L. Matias
- Department of Gynaecology and ObstetricsMedical SchoolBotucatu Sao Paulo State University (UNESP)BotucatuSao PauloBrazil
| | - Priscila R. Nunes
- Department of Gynaecology and ObstetricsMedical SchoolBotucatu Sao Paulo State University (UNESP)BotucatuSao PauloBrazil
| | - Vera Therezinha M. Borges
- Department of Gynaecology and ObstetricsMedical SchoolBotucatu Sao Paulo State University (UNESP)BotucatuSao PauloBrazil
| | - Jose C. Peracoli
- Department of Gynaecology and ObstetricsMedical SchoolBotucatu Sao Paulo State University (UNESP)BotucatuSao PauloBrazil
| | - Maria Terezinha S. Peracoli
- Department of Microbiology and ImmunologyInstitute of BiosciencesBotucatu Sao Paulo State University (UNESP)BotucatuSao PauloBrazil
| |
Collapse
|
235
|
Sebire NJ. Placental histology findings in relation to pre-eclampsia: implications for interpretation of retrospective studies. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:291-292. [PMID: 28436063 DOI: 10.1002/uog.17498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 04/12/2017] [Indexed: 06/07/2023]
Affiliation(s)
- N J Sebire
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Trust and Institute of Child Health (UCL), London, UK
| |
Collapse
|
236
|
Lucovnik M, Lackner HK, Papousek I, Schmid-Zalaudek K, Schulter G, Roessler A, Moertl MG. Systemic vascular resistance and endogenous inhibitors of nitric oxide synthesis in early- compared to late-onset preeclampsia: preliminary findings. Hypertens Pregnancy 2017; 36:276-281. [DOI: 10.1080/10641955.2017.1364381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Miha Lucovnik
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Ilona Papousek
- Department of Psychology, Biological Psychology Unit, University of Graz, Graz, Austria
| | | | - Guenter Schulter
- Department of Psychology, Biological Psychology Unit, University of Graz, Graz, Austria
| | - Andreas Roessler
- Department of Physiology, Medical University of Graz, Graz, Austria
| | | |
Collapse
|
237
|
Güngör ZB, Tüten A, Ekmekçi H, Ekmekçi ÖB, Kucur M, Öncül M, Donma O, Madazlı R, Sönmez H. Possible effects of lipoprotein-associated phospholipase A2 single-nucleotide polymorphisms on cardiovascular risk in patients with preeclampsia. J Matern Fetal Neonatal Med 2017; 31:3119-3127. [DOI: 10.1080/14767058.2017.1365125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Zeynep B. Güngör
- Department of Medical Biochemistry, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| | - Abdullah Tüten
- Department of Obstetrics and Gynecology, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| | - Hakan Ekmekçi
- Department of Medical Biochemistry, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| | - Özlem B. Ekmekçi
- Department of Medical Biochemistry, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| | - Mine Kucur
- Department of Medical Biochemistry, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| | - Mahmut Öncül
- Department of Obstetrics and Gynecology, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| | - Orkide Donma
- Department of Medical Biochemistry, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| | - Rıza Madazlı
- Department of Obstetrics and Gynecology, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| | - Hüseyin Sönmez
- Department of Medical Biochemistry, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| |
Collapse
|
238
|
Labor therapeutics and BMI as risk factors for postpartum preeclampsia: A case-control study. Pregnancy Hypertens 2017; 10:177-181. [PMID: 29153674 DOI: 10.1016/j.preghy.2017.07.142] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 07/14/2017] [Accepted: 07/23/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study aims at identifying associations between therapeutics used during labor and the occurrence of postpartum preeclampsia (PPPE), a poorly understood entity. STUDY DESIGN AND MAIN OUTCOME MEASURES This is a case-control study of women who received an ICD-9 code for PPPE (cases) during the years 2009-2011, compared to women with a normotensive term pregnancy, delivery and postpartum period until discharge (controls), matched on age (±1year) and delivery date (±3months). Cases were defined as women having a normotensive term pregnancy, delivery and initial postpartum period (48h post-delivery) but developing hypertension between 48h and 6weeks postpartum. Single variable and multiple variable models were used to determine significant risk factors. RESULTS Forty-three women with PPPE were compared to 86 controls. Use of vasopressors and oxytocin did not differ between cases and controls, but rate of fluids administered during labor (OR=1.68 per 100cc/h; 95% CI: 1.09-2.59, p=0.02) and an elevated pre-pregnancy/first trimester BMI (OR=1.18 per kg/m2, 95% CI: 1.07-1.3, p=0.001) were identified as significant risk factors in multivariate analysis. CONCLUSIONS We identified two potentially modifiable risk factors for PPPE; further studies are needed to better define the role of these two variables in the development of PPPE.
Collapse
|
239
|
Yu M, Wang J, Liu S, Wang X, Yan Q. Novel function of pregnancy-associated plasma protein A: promotes endometrium receptivity by up-regulating N-fucosylation. Sci Rep 2017; 7:5315. [PMID: 28706275 PMCID: PMC5509645 DOI: 10.1038/s41598-017-04735-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 05/19/2017] [Indexed: 12/27/2022] Open
Abstract
Glycosylation of uterine endometrial cells plays important roles to determine their receptive function to blastocysts. Trophoblast-derived pregnancy-associated plasma protein A (PAPPA) is specifically elevated in pregnant women serum, and is known to promote trophoblast cell proliferation and adhesion. However, the relationship between PAPPA and endometrium receptivity, as well as the regulation of N-fucosylation remains unclear. We found that rhPAPPA and PAPPA in the serum samples from pregnant women or conditioned medium of trophoblast cells promoted endometrium receptivity in vitro. Moreover, rhPAPPA increased α1,2-, α1,3- and α1,6-fucosylation levels by up-regulating N-fucosyltransferases FUT1, FUT4 and FUT8 expression, respectively, through IGF-1R/PI3K/Akt signaling pathway in human endometrial cells. Additionally, α1,2-, α1,3- and α1,6-fucosylation of integrin αVβ3, a critical endometrium receptivity biomarker, was up-regulated by PAPPA, thereby enhanced its adhesive functions. Furthermore, PAPPA blockage with antibody inhibited embryo implantation in vivo, mouse embryo adhesion and spreading in vitro, as well as N-fucosylation level of the endometrium in pregnant mice. In summary, this study suggests that PAPPA is essential to maintain a receptive endometrium by up-regulating N-fucosylation, which is a potential useful biomarker to evaluate the receptive functions of the endometrium.
Collapse
Affiliation(s)
- Ming Yu
- Department of Biochemistry and Molecular Biology, Dalian Medical University, Liaoning Provincial Core Lab of Glycobiology and Glycoengineering, Dalian, 116044, China
| | - Jiao Wang
- Departmentof Hematology, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, China
| | - Shuai Liu
- Department of Biochemistry and Molecular Biology, Dalian Medical University, Liaoning Provincial Core Lab of Glycobiology and Glycoengineering, Dalian, 116044, China
| | - Xiaoqi Wang
- Departmentof Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Qiu Yan
- Department of Biochemistry and Molecular Biology, Dalian Medical University, Liaoning Provincial Core Lab of Glycobiology and Glycoengineering, Dalian, 116044, China.
| |
Collapse
|
240
|
Namugowa A, Iputo J, Wandabwa J, Meeme A, Buga GAB. Comparison of arterial stiffness in preeclamptic and normotensive pregnant women from a semi-rural region of South Africa. Clin Exp Hypertens 2017; 39:277-283. [DOI: 10.1080/10641963.2016.1254227] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
241
|
Boyd HA, Basit S, Behrens I, Leirgul E, Bundgaard H, Wohlfahrt J, Melbye M, Øyen N. Association Between Fetal Congenital Heart Defects and Maternal Risk of Hypertensive Disorders of Pregnancy in the Same Pregnancy and Across Pregnancies. Circulation 2017; 136:39-48. [PMID: 28424221 DOI: 10.1161/circulationaha.116.024600] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 04/12/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Both pregnant women carrying fetuses with heart defects and women with hypertensive disorders of pregnancy often exhibit angiogenic imbalances, suggesting that the same mechanisms are involved in the pathogenesis of the former and the pathophysiology of the latter. We conducted a register-based cohort study to determine whether offspring congenital heart defects are associated with an increased risk of hypertensive disorders of pregnancy and whether the mechanisms driving any association are primarily maternal or fetal. METHODS Among singleton pregnancies without chromosomal abnormalities lasting ≥20 weeks in Denmark from 1978 to 2011 (n= 1 972 857), we identified pregnancies complicated by offspring congenital heart defects or early preterm preeclampsia, late preterm preeclampsia, term preeclampsia, and gestational hypertension. We used polytomous logistic regression to estimate odds ratios (ORs) for associations between offspring congenital heart defects and maternal hypertensive disorders of pregnancy overall and for specific heart defects. RESULTS Offspring congenital heart defects were strongly associated with early preterm preeclampsia (OR, 7.00; 95% confidence interval [CI], 6.11-8.03) and late preterm preeclampsia (OR, 2.82; 95% CI, 2.38-3.34) in the same pregnancy and weakly associated with term preeclampsia (OR, 1.16; 95% CI, 1.06-1.27), but they were not associated with gestational hypertension (OR, 1.07; 95% CI, 0.92-1.25). Association strengths were consistent across heart defect types. Offspring congenital heart defects in a previous pregnancy were also strongly associated with preterm preeclampsia in subsequent pregnancies (early preterm preeclampsia: OR, 2.37; 95% CI, 1.68-3.34; late preterm preeclampsia: OR, 2.04; 95% CI, 1.52-2.75) but were only modestly associated with term preeclampsia and not associated with gestational hypertension. Similarly, preterm preeclampsia in a previous pregnancy, but not term preeclampsia or gestational hypertension, was associated with offspring congenital heart defects in later pregnancies (early preterm preeclampsia: OR, 7.91; 95% CI, 6.06-10.3; late preterm preeclampsia: OR, 2.83; 95% CI, 2.11-3.79; term preeclampsia: OR, 0.98; 95% CI, 0.88-1.10; gestational hypertension: OR, 1.13; 95% CI, 0.92-1.38). CONCLUSIONS Linked pathophysiological mechanisms may be involved in some congenital heart defects and preterm preeclampsia. The strong associations across pregnancies support a predominantly maternal origin of effect.
Collapse
Affiliation(s)
- Heather Allison Boyd
- From Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark (H.A.B., S.B., I.B., J.W., M.M.); Department of Global Public Health and Primary Care, University of Bergen, Norway (E.L., N.Ø.); Department of Cardiology (E.L.) and Center for Medical Genetics and Molecular Medicine (N.Ø.), Haukeland University Hospital, Bergen, Norway; Unit for Inherited Cardiac Diseases, Heart Centre, Copenhagen University Hospital (Rigshospitalet), Denmark (H.B.); Department of Clinical Medicine, Copenhagen University, Denmark (M.M.); and Department of Medicine, Stanford University School of Medicine, CA (M.M.).
| | - Saima Basit
- From Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark (H.A.B., S.B., I.B., J.W., M.M.); Department of Global Public Health and Primary Care, University of Bergen, Norway (E.L., N.Ø.); Department of Cardiology (E.L.) and Center for Medical Genetics and Molecular Medicine (N.Ø.), Haukeland University Hospital, Bergen, Norway; Unit for Inherited Cardiac Diseases, Heart Centre, Copenhagen University Hospital (Rigshospitalet), Denmark (H.B.); Department of Clinical Medicine, Copenhagen University, Denmark (M.M.); and Department of Medicine, Stanford University School of Medicine, CA (M.M.)
| | - Ida Behrens
- From Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark (H.A.B., S.B., I.B., J.W., M.M.); Department of Global Public Health and Primary Care, University of Bergen, Norway (E.L., N.Ø.); Department of Cardiology (E.L.) and Center for Medical Genetics and Molecular Medicine (N.Ø.), Haukeland University Hospital, Bergen, Norway; Unit for Inherited Cardiac Diseases, Heart Centre, Copenhagen University Hospital (Rigshospitalet), Denmark (H.B.); Department of Clinical Medicine, Copenhagen University, Denmark (M.M.); and Department of Medicine, Stanford University School of Medicine, CA (M.M.)
| | - Elisabeth Leirgul
- From Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark (H.A.B., S.B., I.B., J.W., M.M.); Department of Global Public Health and Primary Care, University of Bergen, Norway (E.L., N.Ø.); Department of Cardiology (E.L.) and Center for Medical Genetics and Molecular Medicine (N.Ø.), Haukeland University Hospital, Bergen, Norway; Unit for Inherited Cardiac Diseases, Heart Centre, Copenhagen University Hospital (Rigshospitalet), Denmark (H.B.); Department of Clinical Medicine, Copenhagen University, Denmark (M.M.); and Department of Medicine, Stanford University School of Medicine, CA (M.M.)
| | - Henning Bundgaard
- From Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark (H.A.B., S.B., I.B., J.W., M.M.); Department of Global Public Health and Primary Care, University of Bergen, Norway (E.L., N.Ø.); Department of Cardiology (E.L.) and Center for Medical Genetics and Molecular Medicine (N.Ø.), Haukeland University Hospital, Bergen, Norway; Unit for Inherited Cardiac Diseases, Heart Centre, Copenhagen University Hospital (Rigshospitalet), Denmark (H.B.); Department of Clinical Medicine, Copenhagen University, Denmark (M.M.); and Department of Medicine, Stanford University School of Medicine, CA (M.M.)
| | - Jan Wohlfahrt
- From Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark (H.A.B., S.B., I.B., J.W., M.M.); Department of Global Public Health and Primary Care, University of Bergen, Norway (E.L., N.Ø.); Department of Cardiology (E.L.) and Center for Medical Genetics and Molecular Medicine (N.Ø.), Haukeland University Hospital, Bergen, Norway; Unit for Inherited Cardiac Diseases, Heart Centre, Copenhagen University Hospital (Rigshospitalet), Denmark (H.B.); Department of Clinical Medicine, Copenhagen University, Denmark (M.M.); and Department of Medicine, Stanford University School of Medicine, CA (M.M.)
| | - Mads Melbye
- From Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark (H.A.B., S.B., I.B., J.W., M.M.); Department of Global Public Health and Primary Care, University of Bergen, Norway (E.L., N.Ø.); Department of Cardiology (E.L.) and Center for Medical Genetics and Molecular Medicine (N.Ø.), Haukeland University Hospital, Bergen, Norway; Unit for Inherited Cardiac Diseases, Heart Centre, Copenhagen University Hospital (Rigshospitalet), Denmark (H.B.); Department of Clinical Medicine, Copenhagen University, Denmark (M.M.); and Department of Medicine, Stanford University School of Medicine, CA (M.M.)
| | - Nina Øyen
- From Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark (H.A.B., S.B., I.B., J.W., M.M.); Department of Global Public Health and Primary Care, University of Bergen, Norway (E.L., N.Ø.); Department of Cardiology (E.L.) and Center for Medical Genetics and Molecular Medicine (N.Ø.), Haukeland University Hospital, Bergen, Norway; Unit for Inherited Cardiac Diseases, Heart Centre, Copenhagen University Hospital (Rigshospitalet), Denmark (H.B.); Department of Clinical Medicine, Copenhagen University, Denmark (M.M.); and Department of Medicine, Stanford University School of Medicine, CA (M.M.)
| |
Collapse
|
242
|
Adu-Bonsaffoh K, Antwi DA, Gyan B, Obed SA. Endothelial dysfunction in the pathogenesis of pre-eclampsia in Ghanaian women. BMC PHYSIOLOGY 2017; 17:5. [PMID: 28356151 PMCID: PMC5372282 DOI: 10.1186/s12899-017-0029-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 02/09/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pre-eclampsia (PE) remains a disease of theories despite extensive research into its etiology. Alteration in the production of vascular endothelial growth factor (VEGF), a biomarker of endothelial dysfunction, is associated with pre-eclampsia although conflicting reports have been reported. The aim of the study was to determine and compare maternal serum levels of VEGF among pre-eclamptics, normotensive non pregnant and pregnant women. This was a cross-sectional study involving 100 women with pre-eclampsia, 102 women with normotensive pregnancy and 75 normotensives who were not pregnant. The study was carried out at Korle Bu Teaching Hospital (KBTH) from April to June in 2011. Basic socio-demographic and obstetric data were obtained by means of structured questionnaire. Following venesection, about 5mls of blood was sampled from the participants for the various tests. Enzyme Linked Immunosorbent Assay was used to determine the maternal serum levels of free VEGF. Data analysis was performed using SPSS version 20. RESULTS Significant reduction in median serum levels of free VEGF was seen in both, normal pregnant [84.06 pg/ml (IQR: 78.90-99.67)] and pre-eclamptic women [4.71 pg/ml, (IQR: 3.41-7.93)] compared to the non-pregnant (395.85 pg/ml, IQR 234.93-625) with p < 0.001; the reduction was far greater in the pre-eclamptic group compared to that of normotensive pregnant group (p < 0.001). Early-onset pre-eclampsia had significantly more severe reduction in free VEGF levels (3.89, IQR: 2.60-5.67 pg/ml) compared to that of late onset PE (5.23, IQR: 3.78-16.97 pg/ml) with p<0.001 indicating a severer endothelial damage in former. CONCLUSIONS Endothelial dysfunction contributes significantly to the pathogenesis of pre-eclampsia as demonstrated by profound decrease in maternal serum VEGF levels in PE compared to normotensive pregnancy and non-pregnancy state. The pathophysiology of early-onset pre-eclampsia may be partly explained by marked reduction in free serum VEGF levels with resultant severe endothelial dysfunction.
Collapse
Affiliation(s)
- Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra, Ghana.
- Department of Physiology, School of Biomedical and Allied Sciences, College of Health Sciences, University of Ghana, Accra, Ghana.
| | - Daniel Ansong Antwi
- Department of Physiology, School of Biomedical and Allied Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ben Gyan
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Samuel Amenyi Obed
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| |
Collapse
|
243
|
Hypertension in CKD Pregnancy: a Question of Cause and Effect (Cause or Effect? This Is the Question). Curr Hypertens Rep 2016; 18:35. [PMID: 27072828 DOI: 10.1007/s11906-016-0644-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Chronic kidney disease (CKD) is increasingly encountered in pregnancy, and hypertension is frequently concomitant. In pregnancy, the prevalence of CKD is estimated to be about 3%, while the prevalence of chronic hypertension is about 5-8%. The prevalence of hypertension and CKD in pregnancy is unknown. Both are independently related to adverse pregnancy outcomes, and the clinical picture merges with pregnancy-induced hypertension and preeclampsia. Precise risk quantification is not available, but risks linked to CKD stage, hypertension, and proteinuria are probably multiplicative, each at least doubling the rates of preterm and early preterm delivery, small for gestational age babies, and related outcomes. Differential diagnosis (based upon utero-placental flows, fetal growth, and supported by serum biomarkers) is important for clinical management. In the absence of guidelines for hypertension in CKD pregnancies, the ideal blood pressure goal has not been established; we support a tailored approach, depending on compliance, baseline control, and CKD stages, with strict blood pressure monitoring. The choice of antihypertensive drugs and the use of diuretics and of erythropoiesis-stimulating agents (ESAs) are still open questions which only future studies may clarify.
Collapse
|
244
|
Yang W, Wang A, Zhao C, Li Q, Pan Z, Han X, Zhang C, Wang G, Ji C, Wang G, Jia G, Ju J, Gao W, Yu W, Liu X, Chen X, Feng W, Gao Z, Li J, Ren C. miR-125b Enhances IL-8 Production in Early-Onset Severe Preeclampsia by Targeting Sphingosine-1-Phosphate Lyase 1. PLoS One 2016; 11:e0166940. [PMID: 27935985 PMCID: PMC5147846 DOI: 10.1371/journal.pone.0166940] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/17/2016] [Indexed: 02/06/2023] Open
Abstract
Preeclampsia (PE) is one of the leading causes of maternal and perinatal mortality and morbidity. One of the main hallmarks observed in PE is impaired inflammation state. In the current study, we found that miR-125b was deregulated in placental tissues and plasma derived from PE patients, which suggest a potential association between this miRNA and the pathogenesis of PE. Overexpression of miR-125b significantly reduced SGPL1 expression, and luciferase assays confirmed that SGPL1 is a direct target of miR-125b. We also found that miR-125b enhanced IL-8 production by directly targeting sphingosine-1-phosphate lyase 1 (SGPL1), and this effect could be reversed by SGPL1 overexpression. In placentas derived from PE patients, a negative correlation of miR-125b and SGPL1 was observed, and IL-8 was validated to be increased in the circulation of PE patients. Our data demonstrated a critical role of miR-125b in IL-8 production and the development of PE.
Collapse
Affiliation(s)
- Weiwei Yang
- School of Biological Sciences, Weifang Medical University, Weifang, China
- Biopharmaceutical Laboratory of Health and Family Planning Commission of Shandong Province, Weifang Medical University, Weifang, China
| | - Anning Wang
- Department of Cardiology, Weifang People’s Hospital, Weifang, China
| | - Chunling Zhao
- School of Biological Sciences, Weifang Medical University, Weifang, China
- Biopharmaceutical Laboratory of Health and Family Planning Commission of Shandong Province, Weifang Medical University, Weifang, China
| | - Qinghua Li
- Public Health College, Weifang Medical University, Weifang, China
| | - Zhifang Pan
- School of Biological Sciences, Weifang Medical University, Weifang, China
| | - Xuefu Han
- Department of Cardiology, Weifang People’s Hospital, Weifang, China
| | - Cuijuan Zhang
- Department of Obstetrics, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Guohui Wang
- School of Biological Sciences, Weifang Medical University, Weifang, China
| | - Chao Ji
- School of Biological Sciences, Weifang Medical University, Weifang, China
| | - Guili Wang
- Center for Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Guangtao Jia
- School of Biological Sciences, Weifang Medical University, Weifang, China
| | - Jiyu Ju
- School of Biological Sciences, Weifang Medical University, Weifang, China
| | - Wei Gao
- School of Biological Sciences, Weifang Medical University, Weifang, China
| | - Wenjing Yu
- School of Biological Sciences, Weifang Medical University, Weifang, China
| | - Xiaoying Liu
- School of Biological Sciences, Weifang Medical University, Weifang, China
| | - Xi Chen
- Department of Dentistry, Weifang Maternity and Child Care Hospital, Weifang, China
| | - Weiguo Feng
- School of Biological Sciences, Weifang Medical University, Weifang, China
| | - Zhiqin Gao
- School of Biological Sciences, Weifang Medical University, Weifang, China
- Biopharmaceutical Laboratory of Health and Family Planning Commission of Shandong Province, Weifang Medical University, Weifang, China
- * E-mail:
| | - Jie Li
- Department of Obstetrics, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Chune Ren
- Center for Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Weifang, China
| |
Collapse
|
245
|
Soobryan N, Murugesan S, Phoswa W, Gathiram P, Moodley J, Mackraj I. The effects of sildenafil citrate on uterine angiogenic status and serum inflammatory markers in an L-NAME rat model of pre-eclampsia. Eur J Pharmacol 2016; 795:101-107. [PMID: 27940055 DOI: 10.1016/j.ejphar.2016.12.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/01/2016] [Accepted: 12/06/2016] [Indexed: 11/29/2022]
Abstract
Pre-eclampsia (PE), a hypertensive disorder of pregnancy, is detrimental to both mother and foetus. There is currently no effective treatment, but we have shown that Sildenafil Citrate (SC) improve various foetal outcomes in Nω-nitro-L arginine methyl ester (L-NAME) rat model of PE. Therefore, we aimed to investigate the effects of SC on a uterine angiogenic status and serum inflammatory markers in an L-NAME rat model of PE. One hundred and twenty adult nulliparous pregnant female Sprague-Dawley rats were used for the study. These were divided into five equal groups; the pregnant control, early and late onset PE and respective SC treated animals. Hypertension was manifested by considerably increased systolic blood pressure and placental lipid peroxidative marker (thiobarbituric acid reactive substances) and also we assessed the activities of plasma nitric oxide level, serum inflammatory marker (TGF-β and IFN-γ) and uterine angiogenic status (VEGF and sFlt-1) at two stages of PE. The administration of SC decreased systolic blood pressure, placental lipid peroxidation product and altered uterine angiogenic status; increased plasma nitric oxide levels in an early and late onset L-NAME model of PE. In addition, histological findings of SC treated preeclamptic rat placenta support the biochemical findings of this study. Our findings revealed that SC enhanced plasma NO levels and uterine angiogenic status in an L-NAME model of PE at two gestational stages.
Collapse
Affiliation(s)
- Nerolen Soobryan
- Department of Human Physiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Saravanakumar Murugesan
- Department of Human Physiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Wendy Phoswa
- Department of Human Physiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Prem Gathiram
- Department of Family Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Jagidesa Moodley
- Department of Obstetrics and Gynaecology and Women's Health and HIV Research Unit, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Irene Mackraj
- Department of Human Physiology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.
| |
Collapse
|
246
|
Miyazaki J, Nishizawa H, Kambayashi A, Ito M, Noda Y, Terasawa S, Kato T, Miyamura H, Shiogama K, Sekiya T, Kurahashi H, Fujii T. Increased levels of soluble corin in pre-eclampsia and fetal growth restriction. Placenta 2016; 48:20-25. [DOI: 10.1016/j.placenta.2016.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 09/12/2016] [Accepted: 10/03/2016] [Indexed: 10/20/2022]
|
247
|
Spradley FT. Metabolic abnormalities and obesity's impact on the risk for developing preeclampsia. Am J Physiol Regul Integr Comp Physiol 2016; 312:R5-R12. [PMID: 27903516 DOI: 10.1152/ajpregu.00440.2016] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/11/2016] [Accepted: 11/29/2016] [Indexed: 02/07/2023]
Abstract
Preeclampsia (PE), a hypertensive disorder of pregnancy, is increasing as a major contributor to perinatal and long-term morbidity of mother and offspring. PE is thought to originate from ischemic insults in the placenta driving the release of prohypertensive anti-angiogenic [soluble fms-like tyrosine kinase-1 (sFlt-1)] and proinflammatory [tumor necrosis factor-α (TNF-α)] factors into the maternal circulation. Whereas the increased incidence of PE is hypothesized to be largely due to the obesity pandemic, the mechanisms whereby obesity increases this risk are unknown. The maternal endothelium is targeted by placental and adipose tissue-derived factors like sFlt-1 and TNF-α that promote hypertension during pregnancy, resulting in vascular dysfunction and hypertension. Interestingly, not all obese pregnant women develop PE. Data suggest that obese pregnant women with the greatest metabolic abnormalities have the highest incidence of PE. Identifying obesity-related mechanisms driving hypertension in some obese pregnant women and pathways that protect normotensive obese pregnant women, may uncover novel protocols to treat PE. Metabolic abnormalities, such as increased circulating leptin, glucose, insulin, and lipids, are likely to increase the risk for PE in obese women. It is not only important to understand whether each of these metabolic factors contribute to the increased risk for PE in obesity, but also their cumulative effects. This is particularly relevant to obese pregnant women with gestational diabetes mellitus (GDM) where all of these factors are increased and the risk for PE is highest. It is speculated that these factors potentiate the anti-angiogenic and proinflammatory mechanisms of placental ischemia-induced vascular dysfunction thereby contributing to the increasing incidence of PE.
Collapse
Affiliation(s)
- Frank T Spradley
- Department of Surgery, Department of Physiology and Biophysics, Cardiovascular-Renal Research Center, Women's Health Research Center, The University of Mississippi Medical Center, Jackson, Mississippi
| |
Collapse
|
248
|
Herzog EM, Eggink AJ, Reijnierse A, Kerkhof MAM, de Krijger RR, Roks AJM, Reiss IKM, Nigg AL, Eilers PHC, Steegers EAP, Steegers-Theunissen RPM. Impact of early- and late-onset preeclampsia on features of placental and newborn vascular health. Placenta 2016; 49:72-79. [PMID: 28012458 DOI: 10.1016/j.placenta.2016.11.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/16/2016] [Accepted: 11/25/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Offspring exposed to preeclampsia (PE) show an increased risk of cardiovascular disease in adulthood. We hypothesize that this is mediated by a disturbed vascular development of the placenta, umbilical cord and fetus. Therefore, we investigated associations between early-onset PE (EOPE), late-onset PE (LOPE) and features of placental and newborn vascular health. METHODS We performed a nested case-control study in The Rotterdam Periconceptional Cohort, including 30 PE pregnancies (15 EOPE, 15 LOPE) and 218 control pregnancies (164 uncomplicated controls, 54 complicated controls including 28 fetal growth restriction, 26 preterm birth) and assessed macroscopic and histomorphometric outcomes of the placenta and umbilical cord. RESULTS A significant association was observed between PE and a smaller umbilical vein area and wall thickness, independent of gestational age and birth weight. In EOPE we observed significant associations with a lower weight, length and width of the placenta, length of the umbilical cord, and thickness and wall area of the umbilical vein and artery. These associations attenuated after gestational age and birth weight adjustment. In LOPE a significant association with a larger placental width and smaller umbilical vein wall thickness was shown, independent of gestational age and birth weight. DISCUSSION Our study suggests that PE is associated with a smaller umbilical cord vein area and wall thickness, independent of gestational age and birth weight, which may serve as a proxy of disturbed cardiovascular development in the newborn. Follow-up studies are needed to ultimately predict and lower the risk of cardiovascular disease in offspring exposed to PE.
Collapse
Affiliation(s)
- Emilie M Herzog
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | - Alex J Eggink
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | - Anniek Reijnierse
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | - Martina A M Kerkhof
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | - Ronald R de Krijger
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands; Department of Pathology, Reinier de Graaf Hospital, Reinier de Graafweg 5, 2625 AD Delft, The Netherlands
| | - Anton J M Roks
- Department of Internal Medicine, Section of Vascular Medicine and Pharmacology, Erasmus MC, University Medical Centre Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Department of Neonatology, Erasmus MC, University Medical Centre Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | - Alex L Nigg
- Erasmus Optical Imaging Centre (OIC), Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | - Paul H C Eilers
- Department of Biostatistics, Erasmus MC, University Medical Centre Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | - Régine P M Steegers-Theunissen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands.
| |
Collapse
|
249
|
Long W, Rui C, Song X, Dai X, Xue X, Lu Y, Shen R, Li J, Li J, Ding H. Distinct expression profiles of lncRNAs between early-onset preeclampsia and preterm controls. Clin Chim Acta 2016; 463:193-199. [PMID: 27816668 DOI: 10.1016/j.cca.2016.10.036] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 10/31/2016] [Accepted: 10/31/2016] [Indexed: 12/13/2022]
Abstract
Early-onset preeclampsia (EOPE), which is the most severe form of the syndrome, confers a high risk of neonatal morbidity and perinatal death. We aim to study the roles of long non-coding RNAs (lncRNAs) in the pathogenesis of early-onset preeclampsia (EOPE). Therefore, we examined the expression profiles of lncRNAs between early-onset preeclampsia and preterm controls using microarray analysis. Quantitative real-time PCR (qRT-PCR) was performed to verify the selected differentially expressed lncRNAs. In total, we identified 15,646 upregulated and 13,178 downregulated lncRNAs in the placenta of EOPE patients compared to the preterm controls. Gene ontology and pathway analysis revealed that compared to the preterm controls, many of the processes over-represented in the EOPE patients were related to cell migration and cell motility. A selection of the differentially expressed lncRNA transcripts was confirmed using qRT-PCR, particularly RP11-465L10.10, which is associated with the MMP9 gene. These data may offer a background/reference resource for future functional studies of lncRNAs related to EOPE.
Collapse
Affiliation(s)
- Wei Long
- Department of Obstetrics, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, China
| | - Can Rui
- Department of Obstetrics, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, China
| | - Xuejing Song
- Department of Obstetrics, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, China
| | - Xiaonan Dai
- Department of Obstetrics, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, China
| | - Xuan Xue
- Department of Obstetrics, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, China
| | - Yuanqing Lu
- Department of Obstetrics, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, China
| | - Rong Shen
- Department of Obstetrics, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, China
| | - Jun Li
- Maternal and Child Health Medical Institute, Department of Plastic & Cosmetic Surgery, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, China
| | - Jingyun Li
- Maternal and Child Health Medical Institute, Department of Plastic & Cosmetic Surgery, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, China.
| | - Hongjuan Ding
- Department of Obstetrics, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, China.
| |
Collapse
|
250
|
Suman P, Gandhi S, Kumar P, Garg K. Prospects of electrochemical immunosensors for early diagnosis of preeclampsia. Am J Reprod Immunol 2016; 77. [PMID: 27666125 DOI: 10.1111/aji.12584] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 08/30/2016] [Indexed: 12/18/2022] Open
Abstract
Preeclampsia is a vascular multisystem disorder that accounts for varying degree of morbidity and mortality of mother and the fetus. This can be significantly averted if diagnosed at an early (18-20 weeks) stage of gestation, as there is no known way to prevent preeclampsia. In spite of extensive work on biomarker discovery, the existing method for its detection is mostly based on colorimetric immunoassays whose sensitivity is ranging in nanomolar range. Further, it has also been observed that change in the expression of a single biomarker is not sufficient to diagnose this condition. So, for early diagnosis (by 18-20 weeks), an immuno-diagnostic platform with detection limits in picomolar range and beyond along with the ability to do simultaneous detection of multiple analyte would be of great importance. A nano-immunosensors with an electrochemical readout system can be a potential alternative that promises for the ultrasensitive detection of analyte with high specificity as well as suitability for on-site analysis. Coupling the lateral flow technology with immunosensors would make it feasible to detect more than one biomarker simultaneously on a microchip. This review intends to summarize the potential preeclampsia biomarkers, limitations of existing diagnostic methods along with the recent advancements, and prospects to develop electrochemical immunosensors for early clinical diagnosis.
Collapse
Affiliation(s)
- Pankaj Suman
- Veterianry Hospital Dhanarua, Animal and Fishery Resources Department (Govt. of Bihar), Patna, Bihar, India
| | - Sonu Gandhi
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, Uttar Pradesh, India
| | - Prabhanshu Kumar
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, Uttar Pradesh, India
| | - Kirti Garg
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, Uttar Pradesh, India
| |
Collapse
|