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Løset M, Mundal SB, Johnson MP, Fenstad MH, Freed KA, Lian IA, Eide IP, Bjørge L, Blangero J, Moses EK, Austgulen R. A transcriptional profile of the decidua in preeclampsia. Am J Obstet Gynecol 2011; 204:84.e1-27. [PMID: 20934677 DOI: 10.1016/j.ajog.2010.08.043] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 07/09/2010] [Accepted: 08/24/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We sought to obtain insight into possible mechanisms underlying preeclampsia using genomewide transcriptional profiling in decidua basalis. STUDY DESIGN Genomewide transcriptional profiling was performed on decidua basalis tissue from preeclamptic (n = 37) and normal (n = 58) pregnancies. Differentially expressed genes were identified and merged into canonical pathways and networks. RESULTS Of the 26,504 expressed transcripts detected, 455 were differentially expressed (P < .05; false discovery rate, P < .1). Both novel (ARL5B, SLITRK4) and previously reported preeclampsia-associated (PLA2G7, HMOX1) genes were identified. Pathway analysis revealed that tryptophan metabolism, endoplasmic reticulum stress, linoleic acid metabolism, notch signaling, fatty acid metabolism, arachidonic acid metabolism, and NRF2-mediated oxidative stress response were overrepresented canonical pathways. CONCLUSION In the present study single genes, canonical pathways, and gene-gene networks that are likely to play an important role in the pathogenesis of preeclampsia have been identified. Future functional studies are needed to accomplish a greater understanding of the mechanisms involved.
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353
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Abstract
Relaxin is an approximately 6-kilodalton peptide hormone secreted by the corpus luteum, and circulates in the maternal blood during pregnancy. Relaxin administration to awake, chronically instrumented, nonpregnant rats mimics the vasodilatory phenomena of pregnancy. Furthermore, immunoneutralization of relaxin or its elimination from the circulation during midterm pregnancy in awake rats prevents maternal systemic and renal vasodilation, and the increase in global arterial compliance. Human investigation, albeit limited through 2010, also reveals vasodilatory effects of relaxin in the nonpregnant condition and observations consistent with a role for relaxin in gestational renal hyperfiltration. Evidence suggests that the vasodilatory responses of relaxin are mediated by its major receptor, the relaxin/insulin-like family peptide 1 receptor, RFXP1. The molecular mechanisms of relaxin vasodilation depend on the duration of hormone exposure (ie, there are rapid and sustained vasodilatory responses). Newly emerging data support the role of Gα(i/o) protein coupling to phosphatidylinositol-3 kinase/Akt (protein kinase B)-dependent phosphorylation and activation of endothelial nitric oxide synthase in the rapid vasodilatory responses of relaxin. Sustained vasodilatory responses critically depend on vascular endothelial and placental growth factors, and increases in arterial gelatinase(s) activity. Gelatinases hydrolyze big endothelin (ET) at a gly-leu bond to form ET(1-32), which activates the endothelial ET(B)/nitric oxide vasodilatory pathway. Although the relevance of relaxin biology to preeclampsia is largely speculative at this time, there are potential tantalizing links that are discussed in the context of our current understanding of the etiology and pathophysiology of the disease.
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Affiliation(s)
- Kirk P Conrad
- Department of Physiology and Functional Genomics, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610, USA.
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354
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Poston L, Chappell L, Seed P, Shennan A. Biomarkers of oxidative stress in pre-eclampsia. Pregnancy Hypertens 2011; 1:22-7. [DOI: 10.1016/j.preghy.2010.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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355
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Tsai S, Hardison NE, James AH, Motsinger-Reif AA, Bischoff SR, Thames BH, Piedrahita JA. Transcriptional profiling of human placentas from pregnancies complicated by preeclampsia reveals disregulation of sialic acid acetylesterase and immune signalling pathways. Placenta 2010; 32:175-82. [PMID: 21183218 DOI: 10.1016/j.placenta.2010.11.014] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 10/09/2010] [Accepted: 11/19/2010] [Indexed: 02/08/2023]
Abstract
The placenta plays an important role as a regulator of fetal nutrition and growth throughout development and placental factors contribute to gestational abnormalities such as preeclampsia. This study describes the genome-wide gene expression profiles of a large (n = 60) set of human placentas in order to uncover gene expression patterns associated with preeclampsia. In addition to confirming changes in expression of soluble factors associated with preeclampsia such as sFLT1 (soluble fms-like tyrosine kinase-1), sENG (soluble endoglin), and INHA (inhibin alpha), we also find changes in immune-associated signaling pathways, offering a potential upstream explanation for the shallow trophoblast invasion and inadequate uterine remodeling typically observed in pathogenesis of preeclampsia. Notably, we also find evidence of preeclampsia-associated placental upregulation of sialic acid acetylesterase (SIAE), a gene functionally associated with autoimmune diseases.
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Affiliation(s)
- S Tsai
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
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356
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Best LG, Nadeau M, Bercier S, Dauphinais S, Davis J, Davis K, Poitra S, Anderson CM. Genetic variants, endothelial function, and risk of preeclampsia among American Indians. Hypertens Pregnancy 2010; 31:1-10. [PMID: 21174581 PMCID: PMC6097880 DOI: 10.3109/10641955.2010.525276] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the prevalence in an American Indian population of genetic variants with putative effects on endothelial function and determine whether they are associated with preeclampsia. METHODS Five genetic polymorphisms potentially related to endothelial function in the NOS3, GNB3, and DDAH1 genes were genotyped from a total of 101 cases, 198 controls, and an additional 110 population-based controls among an American Indian population. RESULTS The minor allele frequencies for NOS3 (rs1799983, rs3918227), GNB3 (rs5442), and DDAH1 (rs10158674, rs233115) among those with and without PE in this population were 25, 10, 5, 11, and 30%, respectively. Although not statistically significant, the maximum risk associated with any of these SNPs was 2.22 (0.734-6.73, 95% CI, p = 0.156) in a multivariate analysis of the A allele of the rs233115 SNP incorporated in a recessive model. CONCLUSION Although endothelial dysfunction likely plays a role in the pathophysiology of PE, this study was unable to find evidence for an association between these five SNPs on three genes influencing endothelial function and PE. This may be due to insufficient power to detect an association, investigation of SNPs without linkage to risk of PE in this population or other factors. Investigation of additional SNPs in these or related genes and other populations seems warranted.
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Affiliation(s)
- Lyle G Best
- Department of Natural Sciences, Turtle Mountain Community College, Belcourt, ND, USA.
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357
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Negre-Salvayre A, Auge N, Ayala V, Basaga H, Boada J, Brenke R, Chapple S, Cohen G, Feher J, Grune T, Lengyel G, Mann GE, Pamplona R, Poli G, Portero-Otin M, Riahi Y, Salvayre R, Sasson S, Serrano J, Shamni O, Siems W, Siow RCM, Wiswedel I, Zarkovic K, Zarkovic N. Pathological aspects of lipid peroxidation. Free Radic Res 2010; 44:1125-71. [PMID: 20836660 DOI: 10.3109/10715762.2010.498478] [Citation(s) in RCA: 474] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Lipid peroxidation (LPO) product accumulation in human tissues is a major cause of tissular and cellular dysfunction that plays a major role in ageing and most age-related and oxidative stress-related diseases. The current evidence for the implication of LPO in pathological processes is discussed in this review. New data and literature review are provided evaluating the role of LPO in the pathophysiology of ageing and classically oxidative stress-linked diseases, such as neurodegenerative diseases, diabetes and atherosclerosis (the main cause of cardiovascular complications). Striking evidences implicating LPO in foetal vascular dysfunction occurring in pre-eclampsia, in renal and liver diseases, as well as their role as cause and consequence to cancer development are addressed.
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358
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Burton GJ, Jauniaux E. Oxidative stress. Best Pract Res Clin Obstet Gynaecol 2010; 25:287-99. [PMID: 21130690 PMCID: PMC3101336 DOI: 10.1016/j.bpobgyn.2010.10.016] [Citation(s) in RCA: 647] [Impact Index Per Article: 46.2] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 10/22/2010] [Indexed: 02/07/2023]
Abstract
Considerable evidence implicates oxidative stress in the pathophysiology of many complications of human pregnancy, and this topic has now become a major focus of both clinical and basic science research. Oxidative stress arises when the production of reactive oxygen species overwhelms the intrinsic anti-oxidant defences. Reactive oxygen species play important roles as second messengers in many intracellular signalling cascades aimed at maintaining the cell in homeostasis with its immediate environment. At higher levels, they can cause indiscriminate damage to biological molecules, leading to loss of function and even cell death. In this chapter, we will review how reactive oxygen species are generated and detoxified in the human placenta, and what roles they may play at homeostatic concentrations. We will then consider their involvement in normal placental development, and in complications ranging from miscarriage to pre-eclampsia and premature rupture of the membranes.
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Affiliation(s)
- Graham J Burton
- Centre for Trophoblast Research, University of Cambridge, Cambridge, UK.
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359
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Ramaesh T, Logie JJ, Roseweir AK, Millar RP, Walker BR, Hadoke PWF, Reynolds RM. Kisspeptin-10 inhibits angiogenesis in human placental vessels ex vivo and endothelial cells in vitro. Endocrinology 2010; 151:5927-34. [PMID: 20926586 DOI: 10.1210/en.2010-0565] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Recent studies suggest that kisspeptin (a neuropeptide central to the regulation of gonadotrophin secretion) has diverse roles in human physiology, including a putative role in implantation and placental function. Kisspeptin and its receptor are present in human blood vessels, where they mediate vasoconstriction, and kisspeptin is known to inhibit tumor metastasis and trophoblast invasion, both processes involving angiogenesis. We hypothesized that kisspeptin contributes to the regulation of angiogenesis in the reproductive system. The presence of the kisspeptin receptor was confirmed in human placental blood vessels and human umbilical vein endothelial cells (HUVEC) using immunochemistry. The ability of kisspeptin-10 (KP-10) (a shorter biologically active processed peptide) to inhibit angiogenesis was tested in explanted human placental arteries and HUVEC using complementary ex vivo and in vitro assays. KP-10 inhibited new vessel sprouting from placental arteries embedded in Matrigel and tube-like structure formation by HUVEC, in a concentration-dependent manner. KP-10 had no effect on HUVEC viability or apoptosis but induced concentration-dependent inhibition of proliferation and migration. In conclusion, KP-10 has antiangiogenic effects and, given its high expression in the placenta, may contribute to the regulation of angiogenesis in this tissue.
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Affiliation(s)
- Thayalini Ramaesh
- Jennifer Brown Research Laboratory, Centre for Cardiovascular Science, Queen's Medical Research Institute, Edinburgh, UK
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360
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Southcombe J, Redman C, Sargent I. Peripheral blood invariant natural killer T cells throughout pregnancy and in preeclamptic women. J Reprod Immunol 2010; 87:52-9. [PMID: 20850184 PMCID: PMC2995212 DOI: 10.1016/j.jri.2010.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 07/29/2010] [Accepted: 07/30/2010] [Indexed: 01/14/2023]
Abstract
Invariant natural killer T (iNKT) cells are implicated in the pathogenesis of several diseases. They influence both innate and adaptive immune responses through their capacity to rapidly produce large quantities of cytokines upon activation. During pregnancy maternal immunity is biased towards type 2 cytokine production to regulate type 1 cytokines that could be harmful for the developing fetus. This shift to type 2 cytokines does not occur in preeclamptic women and there is an exaggerated maternal inflammatory response which is dangerous for both mother and baby. We have therefore investigated the numbers, phenotype and functional activity of iNKT cells throughout pregnancy and in women diagnosed with preeclampsia. We demonstrate that the numbers of iNKT cells in the peripheral blood do not change between the first, second and third trimesters of pregnancy, but the cells become activated and less able to produce the type 1 cytokine IFNγ. However, iNKT cells are unchanged in preeclamptic women, when compared to normal pregnancy, suggesting that these cells are not primary players in the pathogenesis of the disease.
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Affiliation(s)
- Jennifer Southcombe
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK.
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361
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Woods AK, Hoffmann DS, Weydert CJ, Butler SD, Zhou Y, Sharma RV, Davisson RL. Adenoviral delivery of VEGF121 early in pregnancy prevents spontaneous development of preeclampsia in BPH/5 mice. Hypertension 2010; 57:94-102. [PMID: 21079047 DOI: 10.1161/hypertensionaha.110.160242] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
An imbalance in circulating proangiogenic and antiangiogenic factors is postulated to play a causal role in preeclampsia (PE). We have described an inbred mouse strain, BPH/5, which spontaneously develops a PE-like syndrome including late-gestational hypertension, proteinuria, and poor feto-placental outcomes. Here we tested the hypothesis that an angiogenic imbalance during pregnancy in BPH/5 mice leads to the development of PE-like phenotypes in this model. Similar to clinical findings, plasma from pregnant BPH/5 showed reduced levels of free vascular endothelial growth factor (VEGF) and placental growth factor (PGF) compared to C57BL/6 controls. This was paralleled by a marked decrease in VEGF protein and Pgf mRNA in BPH/5 placentae. Surprisingly, antagonism by the soluble form of the FLT1 receptor (sFLT1) did not appear to be the cause of this reduction, as sFLT1 levels were unchanged or even reduced in BPH/5 compared to controls. Adenoviral-mediated delivery of VEGF(121) (Ad-VEGF) via tail vein at embryonic day 7.5 normalized both the plasma-free VEGF levels in BPH/5 and restored the in vitro angiogenic capacity of serum from these mice. Ad-VEGF also reduced the incidence of fetal resorptions and prevented the late-gestational spike in blood pressure and proteinuria observed in BPH/5. These data underscore the importance of dysregulation of angiogenic factors in the pathogenesis of PE and suggest the potential utility of early proangiogenic therapies in treating this disease.
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Affiliation(s)
- Ashley K Woods
- Department of Biomedical Sciences, Cornell University, Ithaca, NY 14853-6401, USA
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362
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Dahlstrøm B, Esbensen Y, Vollan H, Oian P, Bukholm G. Genome profiles in maternal blood during early onset preeclampsia and towards term. J Perinat Med 2010; 38:601-8. [PMID: 20807010 DOI: 10.1515/jpm.2010.095] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AIMS inflammatory processes are present during preeclampsia and in normal pregnancy. Maternal inflammatory reactions may change towards term. Our objective was to evaluate genome signaling in blood during preeclampsia and towards term using microarrays. METHODS RNA microarrays (Illumina) were conducted on blood from preeclamptic pregnancies delivered preterm, normal pregnancies at term and normal pregnancies at gestational week 31. Two statistical methods (Q-value cut-off 1%) identified data structures in the three groups and retrieved activated genes along a time axis and a diseased-healthy axis. Signaling genes were localized within known pathways and gene sets, and genes associated with inflammation were identified. RESULTS early onset preeclampsia and term pregnancies both showed distinct expression patterns when compared to normal pregnancy at gestational week 31. In preeclampsia, 19 genes were differentially expressed, including a down-regulation of CC-chemokine receptor 3 (CCR3). Among the 183 differentially expressed genes towards term, tumor necrosis factor superfamily member 15 (TNFSF15) was up-regulated and interferon-γ receptor 2 (IFNGR2) and CXC-chemokine receptor type 4 (CXCR4) were down-regulated. Seven of the genes were similarly changed during preeclampsia and towards term. CONCLUSIONS a possible type 1 immune response was identified both during preeclampsia and towards term. In pre-eclampsia a premature activation of leucocytes might be present.
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Affiliation(s)
- Berit Dahlstrøm
- Department of Obstetrics and Gynecology, Faculty Division Akershus University Hospital, University of Oslo, N-1474 Nordbyhagen, Norway.
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363
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Saftlas AF, Triche EW, Beydoun H, Bracken MB. Does chocolate intake during pregnancy reduce the risks of preeclampsia and gestational hypertension? Ann Epidemiol 2010; 20:584-91. [PMID: 20609337 DOI: 10.1016/j.annepidem.2010.05.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 05/07/2010] [Accepted: 05/10/2010] [Indexed: 01/12/2023]
Abstract
PURPOSE Chocolate consumption is associated with favorable levels of blood pressure and other cardiovascular disease risk markers. We analyzed a prospective cohort study to determine whether regular chocolate intake during pregnancy is associated with reduced risks of preeclampsia and gestational hypertension (GH). METHODS Subjects were recruited from 13 prenatal care practices in Connecticut (1988-1991). In-person interviews were administered at <16 weeks' gestation to ascertain risk factors for adverse pregnancy outcomes. Hospital delivery and prenatal records were abstracted to classify preeclampsia (n = 58), GH (n = 158), and normotensive pregnancies (n = 2351). Chocolate consumption (servings/week) during the first and third trimesters was ascertained at initial interview and immediately postpartum, respectively. Consumers of less than 1 serving/week comprised the referent group. Adjusted odds ratios (aORs) were estimated by the use of logistic regression. RESULTS Chocolate intake was more frequent among normotensive (80.7%) than preeclamptic (62.5%) or GH women (75.8%), and associated with reduced odds of preeclampsia (first trimester: aOR, 0.55; 95% confidence interval [95% CI], 0.32-0.95; third trimester: aOR, 0.56; 95% CI, 0.32-0.97). Only first trimester intake was associated with reduced odds of GH (aOR,0.65; 95% CI, 0.45-0.87). CONCLUSIONS These findings provide additional evidence of the benefits of chocolate. Prospective studies are needed to confirm and delineate protective effects of chocolate intake on risk of preeclampsia.
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Affiliation(s)
- Audrey F Saftlas
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, USA
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364
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Sammour RN, Nakhoul FM, Levy AP, Miller-Lotan R, Nakhoul N, Awad HR, Gonen R, Ohel G. Haptoglobin phenotype in women with preeclampsia. Endocrine 2010; 38:303-8. [PMID: 20972727 DOI: 10.1007/s12020-010-9392-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 07/26/2010] [Indexed: 11/26/2022]
Abstract
In pre-eclampsia, poor placentation causes both oxidative and endoplasmic reticulum stress of the placenta. The anti-oxidative protein Haptoglobin has three phenotypes: 1-1, 1-2, and 2-2. Haptoglobin 1-1 is a more potent antioxidant. Our objective was to determine whether haptoglobin 1-1 was less common in women with preeclampsia which is a disease with an oxidatives-stress component, compared to the healthy population. Haptoglobin phenotype was compared in 240 healthy and 120 preeclamptic gravida in a case-control study. Statistical analysis was performed using Chi square test. The prevalence of haptoglobin 1-1 was 13% among healthy women and 6% among preeclamptic women (P=0.049). Secondary analysis was also performed. The prevalence of haptoglobin 1-1 is higher in healthy compared to preeclamptic subjects, a finding compatible with a protective role. Haptoglobin 1-1 might have a protective role in preeclampsia. Further work is needed with more Hp 1-1 subjects before we can conclude on the possible use of Haptoglobin phenotype to assess the risk of preeclampsia.
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Affiliation(s)
- Rami N Sammour
- Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Haifa, Israel
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365
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Tskitishvili E, Nakamura H, Kinugasa-Taniguchi Y, Kanagawa T, Shimoya K, Tomimatsu T, Kimura T. The effect of tumor-associated protein RCAS1 gene silencing on blood pressure and urinary protein excretion in pregnant mouse: a pilot study. Am J Obstet Gynecol 2010; 203:364.e6-364.e12. [PMID: 20579953 DOI: 10.1016/j.ajog.2010.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 04/14/2010] [Accepted: 05/01/2010] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The level of tumor-associated receptor-binding cancer antigen that is expressed on SiSo cells (RCAS1) is decreased significantly in preeclamptic pregnancies. We hypothesized that RCAS1 protein gene silencing might affect blood pressure and proteinuria in pregnant mice. STUDY DESIGN On postcoital day 7.5, pregnant imprinting control region mice were subjected to the transfer of small interfering RNA (siRNA) against RCAS1 protein into the uterine cavity with the use of a hemagglutinating virus Japan envelope. Scramble siRNA was used as a negative control. Blood pressure and urine albumin/creatinine measurements were performed. The effect of the transferred siRNA was examined in uterine samples on postcoital day 8.5 with the use of Western blotting and immunohistochemistry analyses. RESULTS In the RCAS1 siRNA group, blood pressure significantly raised on postcoital days 9.5, 10.5, 11.5, and 15.5, whereas urine albumin/creatinine ratio was significantly increased on postcoital day 9.5 CONCLUSION Our results suggest the importance of RCAS1 protein in the pathophysiologic condition of preeclampsia.
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Affiliation(s)
- Ekaterine Tskitishvili
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan.
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366
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Patel J, Landers K, Mortimer RH, Richard K. Regulation of hypoxia inducible factors (HIF) in hypoxia and normoxia during placental development. Placenta 2010; 31:951-7. [PMID: 20869770 DOI: 10.1016/j.placenta.2010.08.008] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 08/13/2010] [Accepted: 08/17/2010] [Indexed: 01/14/2023]
Abstract
During the first trimester of pregnancy the human placenta develops in an hypoxic environment caused by the occlusion of uterine spiral arterioles by extravillous trophoblasts (EVT). This period of low oxygen tension is crucial for successful pregnancy. In low oxygen environments, Hypoxia Inducible Factors (HIF) are the main regulators in the transcription of a number of genes. Target genes can induce anaerobic processes, reducing oxygen consumption, or promote angiogenesis, which establishes and enhances the vascular environment. The HIFs can function throughout all stages of placental differentiation and growth both in normal and pathological pregnancies (compromised by hypoxia/ischemia). Interestingly, HIFs respond to a multitude of changes during pregnancy, including 1) low oxygen, 2) renin-angiotensin system (RAS), 3) cytokines, and 4) growth factors, all of which regulate placental function. This review explores oxygen-dependent and oxygen-independent regulation and the role of HIF in placental development and differentiation.
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Affiliation(s)
- J Patel
- School of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Herston, Queensland 4029, Australia.
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367
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Ahn H, Park J, Gilman-Sachs A, Kwak-Kim J. Immunologic Characteristics of Preeclampsia, a Comprehensive Review. Am J Reprod Immunol 2010; 65:377-94. [DOI: 10.1111/j.1600-0897.2010.00913.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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368
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Abstract
Pre-eclampsia remains a leading cause of maternal and perinatal mortality and morbidity. It is a pregnancy-specific disease characterised by de-novo development of concurrent hypertension and proteinuria, sometimes progressing into a multiorgan cluster of varying clinical features. Poor early placentation is especially associated with early onset disease. Predisposing cardiovascular or metabolic risks for endothelial dysfunction, as part of an exaggerated systemic inflammatory response, might dominate in the origins of late onset pre-eclampsia. Because the multifactorial pathogenesis of different pre-eclampsia phenotypes has not been fully elucidated, prevention and prediction are still not possible, and symptomatic clinical management should be mainly directed to prevent maternal morbidity (eg, eclampsia) and mortality. Expectant management of women with early onset disease to improve perinatal outcome should not preclude timely delivery-the only definitive cure. Pre-eclampsia foretells raised rates of cardiovascular and metabolic disease in later life, which could be reason for subsequent lifestyle education and intervention.
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Affiliation(s)
- Eric A P Steegers
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands.
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369
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Soto E, Romero R, Richani K, Espinoza J, Chaiworapongsa T, Nien JK, Edwin SS, Kim YM, Hong JS, Goncalves LF, Yeo L, Mazor M, Hassan SS, Kusanovic JP. Preeclampsia and pregnancies with small-for-gestational age neonates have different profiles of complement split products. J Matern Fetal Neonatal Med 2010; 23:646-57. [PMID: 19900030 PMCID: PMC3482544 DOI: 10.3109/14767050903301009] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The activation of the complement system results in the generation of split products with pro-inflammatory properties. The objective of this study was to determine whether preeclampsia and small-for-gestational age (SGA) are associated with changes in the maternal plasma concentrations of anaphylatoxins C3a, C4a and C5a. METHODS A cross-sectional study was conducted in the following groups: (a) normal pregnant women (n = 134); (b) women who delivered an SGA neonate (n = 53); (c) preeclampsia with (n = 52) and without SGA (n = 54). Maternal plasma anaphylatoxin concentrations were determined by enzyme-linked immunoassay. RESULTS (1) Women with preeclampsia with or without SGA had a significantly higher median plasma C5a concentration than that of normal pregnant women and those with SGA alone (all P < 0.01); (2) women with SGA alone did not have an increase in plasma C5a concentration; (3) in contrast, the median maternal plasma concentration of C4a was lower in women with preeclampsia and SGA than that of those with a normal pregnancy (P = 0.001); (4) no changes in C3a were observed among the study groups. CONCLUSION Preeclampsia is associated with increased plasma concentration of C5a, regardless of the presence or absence of an SGA fetus. In contrast, there was no difference in the plasma C3a, C4a and C5a concentration in patients with SGA.
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Affiliation(s)
- Eleazar Soto
- Perinatology Research Branch, NICHD/NIF/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIF/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
| | - Karina Richani
- Perinatology Research Branch, NICHD/NIF/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
| | - Jimmy Espinoza
- Perinatology Research Branch, NICHD/NIF/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, NICHD/NIF/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Jyh Kae Nien
- Perinatology Research Branch, NICHD/NIF/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Sam S. Edwin
- Perinatology Research Branch, NICHD/NIF/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
| | - Yeon Mee Kim
- Perinatology Research Branch, NICHD/NIF/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
| | - Joon Seok Hong
- Department of Obstetrics and Gynecology, Seoul National University, Seoul, Korea
| | - Luis F. Goncalves
- Perinatology Research Branch, NICHD/NIF/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Lami Yeo
- Perinatology Research Branch, NICHD/NIF/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Moshe Mazor
- Department of Obstetrics and Gynecology, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Sonia S. Hassan
- Perinatology Research Branch, NICHD/NIF/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, NICHD/NIF/DHHS, Bethesda, Maryland and Detroit, Michigan, USA
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, Detroit, Michigan, USA
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370
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Lorquet S, Pequeux C, Munaut C, Foidart JM. Aetiology and physiopathology of preeclampsia and related forms. Acta Clin Belg 2010; 65:237-41. [PMID: 20954461 DOI: 10.1179/acb.2010.051] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Preeclampsia, a pregnancy-specific syndrome characterized by hypertension, proteinuria and oedema, resolves on placental delivery. Its pathogenesis is thought to be associated to a hypoxic placenta. Placental hypoxia is responsible for the maternal vascular dysfunction via the increased placental release of anti-angiogenic factors such as soluble flt1 and endoglin. These soluble receptors bind VEGF, PLGF and TGFbeta1 and 3 in the maternal circulation, causing endothelial dysfunction in many maternal tissues. Despite these recent and important new molecular findings, it is important to consider that normal pregnancy is also characterized by systemic inflammation, oxidative stress and alterations in levels of angiogenic factors and vascular reactivity. Both the placenta and maternal vasculatures are major sources of reactive oxygen and nitrogen species which can produce powerful pro-oxidants that covalently modify proteins and alter vascular function in preeclampsia. Finally, the recent demonstration of activating auto-antibodies to the Angiotensin 1 receptor that experimentally play a major pathogenic role in preeclampsia further indicates the pleiotropism of aetiologies of this condition.
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Affiliation(s)
- S Lorquet
- Department Universitaire de Gynécologie Obstétrique, Hôpital de La Citadelle, Liège, Belgique
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371
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372
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Gould PS, Gu M, Liao J, Ahmad S, Cudmore MJ, Ahmed A, Vatish M. Upregulation of Urotensin II Receptor in Preeclampsia Causes In Vitro Placental Release of Soluble Vascular Endothelial Growth Factor Receptor 1 in Hypoxia. Hypertension 2010; 56:172-8. [PMID: 20479331 DOI: 10.1161/hypertensionaha.110.152074] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Phillip S. Gould
- From the Clinical Sciences Research Institute (P.S.G., M.G., J.L., M.V.), Warwick Medical School, University of Warwick, Coventry, United Kingdom; Albert Einstein College of Medicine (M.V.), Bronx, NY; Department of Reproductive and Vascular Biology (S.A., M.J.C., A.A.), Institute of Biomedical Research, Medical School, University of Birmingham, Edgbaston, Birmingham, West Midlands, United Kingdom; Birmingham Women’s Hospital (S.A., M.J.C., A.A.), Edgbaston, Birmingham, West Midlands, United
| | - Mei Gu
- From the Clinical Sciences Research Institute (P.S.G., M.G., J.L., M.V.), Warwick Medical School, University of Warwick, Coventry, United Kingdom; Albert Einstein College of Medicine (M.V.), Bronx, NY; Department of Reproductive and Vascular Biology (S.A., M.J.C., A.A.), Institute of Biomedical Research, Medical School, University of Birmingham, Edgbaston, Birmingham, West Midlands, United Kingdom; Birmingham Women’s Hospital (S.A., M.J.C., A.A.), Edgbaston, Birmingham, West Midlands, United
| | - Jianqin Liao
- From the Clinical Sciences Research Institute (P.S.G., M.G., J.L., M.V.), Warwick Medical School, University of Warwick, Coventry, United Kingdom; Albert Einstein College of Medicine (M.V.), Bronx, NY; Department of Reproductive and Vascular Biology (S.A., M.J.C., A.A.), Institute of Biomedical Research, Medical School, University of Birmingham, Edgbaston, Birmingham, West Midlands, United Kingdom; Birmingham Women’s Hospital (S.A., M.J.C., A.A.), Edgbaston, Birmingham, West Midlands, United
| | - Shakil Ahmad
- From the Clinical Sciences Research Institute (P.S.G., M.G., J.L., M.V.), Warwick Medical School, University of Warwick, Coventry, United Kingdom; Albert Einstein College of Medicine (M.V.), Bronx, NY; Department of Reproductive and Vascular Biology (S.A., M.J.C., A.A.), Institute of Biomedical Research, Medical School, University of Birmingham, Edgbaston, Birmingham, West Midlands, United Kingdom; Birmingham Women’s Hospital (S.A., M.J.C., A.A.), Edgbaston, Birmingham, West Midlands, United
| | - Melissa J. Cudmore
- From the Clinical Sciences Research Institute (P.S.G., M.G., J.L., M.V.), Warwick Medical School, University of Warwick, Coventry, United Kingdom; Albert Einstein College of Medicine (M.V.), Bronx, NY; Department of Reproductive and Vascular Biology (S.A., M.J.C., A.A.), Institute of Biomedical Research, Medical School, University of Birmingham, Edgbaston, Birmingham, West Midlands, United Kingdom; Birmingham Women’s Hospital (S.A., M.J.C., A.A.), Edgbaston, Birmingham, West Midlands, United
| | - Asif Ahmed
- From the Clinical Sciences Research Institute (P.S.G., M.G., J.L., M.V.), Warwick Medical School, University of Warwick, Coventry, United Kingdom; Albert Einstein College of Medicine (M.V.), Bronx, NY; Department of Reproductive and Vascular Biology (S.A., M.J.C., A.A.), Institute of Biomedical Research, Medical School, University of Birmingham, Edgbaston, Birmingham, West Midlands, United Kingdom; Birmingham Women’s Hospital (S.A., M.J.C., A.A.), Edgbaston, Birmingham, West Midlands, United
| | - Manu Vatish
- From the Clinical Sciences Research Institute (P.S.G., M.G., J.L., M.V.), Warwick Medical School, University of Warwick, Coventry, United Kingdom; Albert Einstein College of Medicine (M.V.), Bronx, NY; Department of Reproductive and Vascular Biology (S.A., M.J.C., A.A.), Institute of Biomedical Research, Medical School, University of Birmingham, Edgbaston, Birmingham, West Midlands, United Kingdom; Birmingham Women’s Hospital (S.A., M.J.C., A.A.), Edgbaston, Birmingham, West Midlands, United
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373
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Siddiqui IA, Jaleel A, Tamimi W, Al Kadri HMF. Role of oxidative stress in the pathogenesis of preeclampsia. Arch Gynecol Obstet 2010; 282:469-74. [DOI: 10.1007/s00404-010-1538-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 05/31/2010] [Indexed: 10/19/2022]
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374
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Foidart JM, Munaut C, Chantraine F, Akolekar R, Nicolaides KH. Maternal plasma soluble endoglin at 11-13 weeks' gestation in pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:680-687. [PMID: 20205159 DOI: 10.1002/uog.7621] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To examine the performance of screening for pre-eclampsia (PE) by a combination of maternal factors, soluble endoglin (sEng), pregnancy associated plasma protein-A (PAPP-A), placental growth factor (PlGF) and uterine artery lowest pulsatility index (L-PI) at 11-13 weeks' gestation. METHODS Uterine artery L-PI, sEng, PAPP-A and PlGF were measured at 11-13 weeks in 90 singleton pregnancies that subsequently developed PE, including 30 that required delivery before 34 weeks (early PE) and 60 with late PE, and 180 unaffected controls. Screening performance for PE by maternal factors, sEng, PAPP-A, PlGF and uterine artery L-PI and their combinations was determined. RESULTS In early PE, compared to controls, plasma sEng and uterine L-PI were significantly increased and serum PAPP-A and PlGF were decreased. In late PE, compared to controls, serum PlGF was decreased and uterine L-PI was increased but plasma sEng and serum PAPP-A were not significantly different. In screening for early PE, the detection rate for a 10% false-positive rate was 46.7% for sEng alone and 96.3% for a combination of maternal factors, sEng, PlGF and uterine artery L-PI. CONCLUSIONS Effective screening for early PE can be provided by a combination of maternal factors, sEng, PlGF and uterine artery L-PI at 11-13 weeks' gestation.
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Affiliation(s)
- J-M Foidart
- Department of Obstetrics and Gynecology, University of Liège, Liège, Belgium
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375
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Park JK, Jeong JW, Kang MY, Baek JC, Shin JK, Lee SA, Choi WS, Lee JH, Paik WY. Inhibition of the PI3K-Akt pathway suppresses sFlt1 expression in human placental hypoxia models in vitro. Placenta 2010; 31:621-9. [PMID: 20488538 DOI: 10.1016/j.placenta.2010.04.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 04/12/2010] [Accepted: 04/14/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Although elevated expression of soluble fms-like tyrosine kinase 1 (sFlt1) plays a major role in the pathogenesis of pre-eclampsia, it is unclear how hypoxia regulates placental sFlt1 expression. Thus, we investigated sFlt1 expression in placentas from normal and preeclamptic pregnancies and in human placental hypoxia models in vitro to examine the role of the PI3K-Akt pathway in regulating the expression of this molecule. METHODS We examined the expression of VEGF, PlGF, sFlt1, PI3K, Akt, and HIF-1 in placental samples from ten women with pre-eclampsia and ten normotensive control patients and in human choriocarcinoma trophoblast cells treated with 600muM CoCl(2) by Western blotting. Using models of placental hypoxia, we also determined whether inhibition of the PI3K-Akt pathway plays a direct role in regulating the expression of sFlt1. RESULTS The VEGF, PlGF, sFlt1, PI3K, Akt, and HIF-1 levels were significantly higher in the preeclamptic placentas than the normal placentas. In the placental hypoxia models, the expression of VEGF and PlGF increased in a time-dependent manner, whereas the expression of sFlt1 plateaued after 3h of CoCl(2) treatment. The expression levels of p-Akt and PI3K were maximal after 6 and 12h of CoCl(2) treatment, respectively. The expression of HIF-1alpha increased in a time-dependent manner with CoCl(2) treatment. Inhibition of the PI3K-Akt pathway with the PI3K-specific inhibitor LY294002 leads to decreased sFlt1 levels and unchanged or increased VEGF and PlGF levels. CONCLUSION Inhibition of the PI3K-Akt pathway may be a useful therapeutic approach, if it were to decrease sFlt1 secretion without inhibiting VEGF or PlGF secretion. This pathway provides a potential target for a new treatment strategy in patients with pre-eclampsia.
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Affiliation(s)
- J K Park
- Department of Obstetrics and Gynecology, School of Medicine, Gyeongsang National University, JinJu, Republic of Korea
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376
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Chaiworapongsa T, Romero R, Gotsch F, Kusanovic JP, Mittal P, Kim SK, Erez O, Vaisbuch E, Mazaki-Tovi S, Kim CJ, Dong Z, Yeo L, Hassan SS. Acute pyelonephritis during pregnancy changes the balance of angiogenic and anti-angiogenic factors in maternal plasma. J Matern Fetal Neonatal Med 2010; 23:167-78. [PMID: 20213923 DOI: 10.3109/14767050903067378] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Angiogenic factors have been implicated in the pathophysiology of sepsis. In experimental models of sepsis (endotoxemia and/or cecal ligation puncture), there is increased expression of vascular endothelial growth factors (VEGF) and the administration of exogenous soluble VEGF receptor (sVEGFR)-1, an antagonist to VEGF, reduces morbidity and mortality. Moreover, a dramatic elevation in sVEGFR-1 has been demonstrated in human sepsis. Although a balance between angiogenic and anti-angiogenic factors is essential for feto-placental development, the changes of angiogenic factors during pregnancy in the context of infection have never been explored. Angiogenic factors also play crucial roles in the pathophysiology of preeclampsia (PE). This study was conducted to determine if maternal plasma concentrations of placental growth factor (PlGF), sVEGFR-2, and soluble endoglin (sEng) change in pregnancies complicated by acute pyelonephritis (AP) compared with normal pregnancy and PE. STUDY DESIGN A case-control study was conducted in patients with AP, normal pregnant (NP) women, and patients with PE (n=36 for each group) matched for gestational age. AP was diagnosed in the presence of fever (temperature >or=38 degrees C), clinical signs of infection, and a positive urine culture for microorganisms. Plasma concentrations of PlGF, sVEGFR-2, and sEng were determined by ELISA. The results of plasma sVEGFR-1 concentrations have previously been reported, but were included in this study to provide a complete picture of the angiogenic/anti-angiogenic profiles. Serum concentrations of interleukin (IL)-1beta, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12p70, IL-13, interferon (IFN)-gamma, granulocyte macrophage colony stimulating factor, and tumor necrosis factor (TNF) were also determined using high sensitivity multiplexed immunoassays in patients with AP and NP. RESULTS AP was associated with a lower median plasma concentration of PlGF and sVEGFR-2 than NP (both p<0.001). There were no significant differences in the median plasma concentrations of sEng and sVEGFR-1 between AP and NP (p=0.7 and 0.5, respectively). In contrast, there was a 5-fold decrease of the median plasma concentration of PlGF, and an 8-10-fold increase of the median plasma concentrations of sVEGFR-1 and sEng in PE compared with those in AP (all p<0.001). No significant difference in the median plasma concentration of sVEGFR-2 was observed between patients with PE and AP (p=0.5). Pregnant women with AP had median plasma concentrations of IL-6, IL-7, IL-8, IL-10, IFN-gamma, and TNF-alpha significantly higher than those in NP women (all p<0.001, except IL-7 p=0.004). CONCLUSION AP is associated with changes in the profile of angiogenic and anti-angiogenic factors. Although some of these changes resemble those in PE (decreased PlGF and sVEGFR-2), the magnitude of the changes of PlGF is much higher in PE. We conclude that despite high plasma inflammatory cytokine concentrations, acute systemic inflammation in pregnancy has a different angiogenic/anti-angiogenic profile than that of PE.
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377
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Zhang Y, Diao Z, Su L, Sun H, Li R, Cui H, Hu Y. MicroRNA-155 contributes to preeclampsia by down-regulating CYR61. Am J Obstet Gynecol 2010; 202:466.e1-7. [PMID: 20452491 DOI: 10.1016/j.ajog.2010.01.057] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2009] [Revised: 12/28/2009] [Accepted: 01/20/2010] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of this study was to characterize the molecular mechanism of preeclampsia (PE) development through miR-155. STUDY DESIGN PE and normal placentas were used to measure miR-155 and cysteine-rich protein 61 (CYR61) expression. CYR61 3' untranslated region was validated as the target of miR-155 using in vitro transfections. miR-155 and CYR61 expression levels were assessed by real-time reverse transcription polymerase chain reaction or Western blot. RESULTS An inverse correlation was found between miR-155 and CYR61 expression levels, with miR-155 up-regulated and CYR61 down-regulated in PE tissues. Luciferase assays and CYR61 transfection assays experimentally validated that miR-155 efficiently targets the 3' untranslated region of CYR61. CONCLUSION This study reported for the first time that overexpression of miR-155 contributes to PE development by targeting and down-regulating angiogenic regulating factor CYR61, leading to pathological alterations. This finding not only characterizes a new mechanism for the disease but also provides a potential therapeutic target.
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Affiliation(s)
- Yanqing Zhang
- Drum Tower Clinical Medical College, Nanjing Medical University, and the Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing, China
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378
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Lynch AM, Salmon JE. Dysregulated complement activation as a common pathway of injury in preeclampsia and other pregnancy complications. Placenta 2010; 31:561-7. [PMID: 20427084 DOI: 10.1016/j.placenta.2010.03.010] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2009] [Revised: 03/21/2010] [Accepted: 03/25/2010] [Indexed: 11/17/2022]
Abstract
The complement system protects the host against invading organisms, initiates inflammation and dispose of immune complexes and the products of inflammatory injury. The complement system provides an important link between the innate and adaptive immune systems. Experimental observations suggest that increased complement activation causes and/or perpetuates inflammation during pregnancy. Recent studies suggest a link between complement activation and preeclampsia. Excessive activation or insufficient regulation of complement recruits leukocytes and unleashes potent inflammatory and anti-angiogenic mediators associated with placental insufficiency and maternal endothelial dysfunction characteristic of preeclampsia. We review the animal and human studies that link complement activation and pathogenic events in preeclampsia, present evidence that activation of the complement system is associated with the development of preeclampsia and provides new targets to prevent its complications.
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Affiliation(s)
- A M Lynch
- Department of Obstetrics and Gynecology, University of Colorado Denver School of Medicine, Aurora, CO 80045, USA
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379
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Huda SS, Brodie LE, Sattar N. Obesity in pregnancy: prevalence and metabolic consequences. Semin Fetal Neonatal Med 2010; 15:70-6. [PMID: 19896913 DOI: 10.1016/j.siny.2009.09.006] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Rates of obesity have increased exponentially worldwide to almost epidemic proportions. This is associated with a marked increase in adverse maternal and perinatal outcomes and subsequent burden on health care resources. In particular, maternal obesity is linked to numerous metabolic complications including subfertility, gestational diabetes, hypertensive disorders of pregnancy and thromboembolism with potential long-term health consequences for both mother and child. The underlying pathophysiology linking maternal obesity and adverse outcomes is complex but is likely to involve alterations in glucose and lipid metabolism, inflammation, perturbances in adipokines and vascular dysfunction all seen in obese women. Intervention studies are underway to determine whether alteration of maternal lifestyle can improve maternal and fetal outcomes.
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Affiliation(s)
- Shahzya S Huda
- Reproductive and Maternal Medicine, University of Glasgow, Queen Elizabeth Building, 10 Alexander Parade, Glasgow G31 2ER, UK.
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380
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Abstract
Pre-eclampsia develops in stages, only the last being the clinical illness. This is generated by a non-specific, systemic (vascular), inflammatory response, secondary to placental oxidative stress and not by reactivity to fetal alloantigens. However, maternal adaptation to fetal (paternal alloantigens) is crucial in the earlier stages. A pre-conceptual phase involves maternal tolerization to paternal antigens by seminal plasma. After conception, regulatory T cells, interacting with indoleamine 2,3-dioxygenase, together with decidual NK cell recognition of fetal HLA-C on extravillous trophoblast may facilitate placental growth by immunoregulation. Complete failure of this mechanism would cause miscarriage, while partial failure would cause poor placentation and dysfunctional uteroplacental perfusion. The first pregnancy preponderance and partner specificity of pre-eclampsia can be explained by this model. For the first time, the pathogenesis of pre-eclampsia can be related to defined immune mechanisms that are appropriate to the fetomaternal frontier. Now, the challenge is to prove the detail.
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Affiliation(s)
- Christopher W G Redman
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, John Radcliffe Hospital, Oxford, UK.
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381
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Young BC, Levine RJ, Karumanchi SA. Pathogenesis of preeclampsia. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2010; 5:173-92. [PMID: 20078220 DOI: 10.1146/annurev-pathol-121808-102149] [Citation(s) in RCA: 470] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Preeclampsia is a systemic syndrome that occurs in 3 to 5% of pregnant women and classically manifests as new-onset hypertension and proteinuria after 20 weeks of gestation. Preeclampsia is a leading cause of maternal and neonatal morbidity and mortality. The only known cure is delivery of the placenta. Recent discoveries, however, have led to important advances in understanding the pathogenesis of the condition. Placental antiangiogenic factors are upregulated and disrupt the maternal endothelium. This change in the normal angiogenic balance toward an antiangiogenic state can result in hypertension, proteinuria, glomerular endotheliosis, HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome, and cerebral edema-the clinical signs of preeclampsia and eclampsia. The regulation of these antiangiogenic factors in the placenta is unknown. The recent discoveries of upregulated antiangiogenic factors provide promise for future testing to predict and diagnose preeclampsia as well as therapeutic targets for amelioration of the clinical disease.
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Affiliation(s)
- Brett C Young
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA
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382
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Kulkarni AV, Mehendale SS, Yadav HR, Kilari AS, Taralekar VS, Joshi SR. Circulating angiogenic factors and their association with birth outcomes in preeclampsia. Hypertens Res 2010; 33:561-7. [DOI: 10.1038/hr.2010.31] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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383
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Sharentuya N, Tomimatsu T, Mimura K, Tskitishvili E, Kinugasa-Taniguchi Y, Kanagawa T, Kimura T. Nicotine Suppresses Interleukin-6 Production From Vascular Endothelial Cells: A Possible Therapeutic Role of Nicotine for Preeclampsia. Reprod Sci 2010; 17:556-63. [DOI: 10.1177/1933719110362594] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Namuxila Sharentuya
- Department of Obstetrics & Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takuji Tomimatsu
- Department of Obstetrics & Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan,
| | - Kazuya Mimura
- Department of Obstetrics & Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ekaterine Tskitishvili
- Department of Obstetrics & Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | - Takeshi Kanagawa
- Department of Obstetrics & Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Kimura
- Department of Obstetrics & Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
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384
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Wang CN, Chang SD, Peng HH, Lee YS, Chang YL, Cheng PJ, Chao AS, Wang TH, Wang HS. Change in amniotic fluid levels of multiple anti-angiogenic proteins before development of preeclampsia and intrauterine growth restriction. J Clin Endocrinol Metab 2010; 95:1431-41. [PMID: 20080845 DOI: 10.1210/jc.2009-1954] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT The cause of preeclampsia remains unknown. Excessive antiangiogenic proteins have been proposed to play a pathogenic role in preeclampsia. OBJECTIVE Our objective was to determine the differences in soluble endoglin (sEndoglin), soluble fms-like tyrosine kinase receptor-1 (sFLT1), leptin, adiponectin, and endothelin 1 concentrations between normal and preeclampsia amniotic fluid (AF). Such results may help us understand the pathophysiology of preeclampsia. METHODS We performed a nested case-control study. Seventy-one women with preeclampsia were matched to 71 normotensive controls. The preeclamptic women were broken into two subgroups according to the association with fetal intrauterine growth restriction (IUGR). AF concentrations of sEndoglin, sFLT1, leptin, adiponectin, and endothelin 1 were measured by ELISA. Receiver-operating characteristics curve analysis was used to compare the discriminative values of these potential biomarkers. Functional network analysis was performed using MetaCore to reveal the common functions of the interacting proteins. RESULTS Increased AF concentrations of sFLT1, sEndoglin, endothelin 1, and leptin were found in women who later developed preeclampsia. sFLT1, sEndoglin, leptin, and adiponectin were significantly higher in the preeclampsia with IUGR than those without IUGR. Leptin has the largest area under the curve (0.753). Network analysis revealed that elevated amniotic proteins are involved in the inflammatory process of the human placenta. CONCLUSIONS Significant elevation of leptin can be detected in AF 2 months earlier than the appearance of symptoms; thus, it may be used as a predictive marker for preeclampsia. The increase of these antiangiogenic proteins supports the roles of inflammation and oxidative stress in pathogenesis of preeclampsia.
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385
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Hung TH, Lo LM, Chiu TH, Li MJ, Yeh YL, Chen SF, Hsieh TT. A Longitudinal Study of Oxidative Stress and Antioxidant Status in Women With Uncomplicated Pregnancies Throughout Gestation. Reprod Sci 2010; 17:401-9. [DOI: 10.1177/1933719109359704] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Tai-Ho Hung
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Taipei, Taiwan
| | - Liang-Ming Lo
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Taipei, Taiwan
| | - Tsung-Hong Chiu
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Taipei, Taiwan,
| | - Meng-Jen Li
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Taipei, Taiwan
| | - Yi-Lin Yeh
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Taipei, Taiwan
| | - Szu-Fu Chen
- Department of Physical Medicine and Rehabilitation, Cheng Hsin Rehabilitation Medical Center, Taipei, Taiwan,
| | - T'sang-T'ang Hsieh
- Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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386
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Tranquilli AL, Landi B. The origin of pre-eclampsia: from decidual "hyperoxia" to late hypoxia. Med Hypotheses 2010; 75:38-46. [PMID: 20171021 DOI: 10.1016/j.mehy.2010.01.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 01/20/2010] [Indexed: 11/24/2022]
Abstract
Normal gestation implants on a relatively hypoxic deciduas so that trophoblast deeply invades endometrium and angiogenesis seeks for oxygen supply. If implantation occurs before those hypoxic conditions occur, trophoblast invasion is defective, due to the relatively high oxygen tension in the decidual environment, laying the foundations for subsequent pre-eclampsia.
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Affiliation(s)
- Andrea L Tranquilli
- Department of Clinical Sciences, Section of Women's Health Sciences, Università Politecnica Marche, Ancona, Italy.
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387
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Chaiworapongsa T, Romero R, Kusanovic JP, Mittal P, Kim SK, Gotsch F, Than NG, Mazaki-Tovi S, Vaisbuch E, Erez O, Yeo L, Hassan SS, Sorokin Y. Plasma soluble endoglin concentration in pre-eclampsia is associated with an increased impedance to flow in the maternal and fetal circulations. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:155-162. [PMID: 20101637 PMCID: PMC2944768 DOI: 10.1002/uog.7491] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To examine the relationship between abnormalities in uterine (UtA) and/or umbilical artery (UA) Doppler velocimetry and maternal plasma concentrations of soluble endoglin (sEng) in patients with pre-eclampsia (PE). METHODS A cross-sectional study was conducted in 135 normal pregnant women and 69 patients with PE. Patients with PE were subclassified into four groups: those who had Doppler abnormalities in both the UtA and UA, patients who had Doppler abnormalities in the UtA alone, those who had Doppler abnormalities in the UA alone, and patients without Doppler abnormalities in either vessel. Plasma concentrations of sEng were determined by enzyme-linked immunosorbent assay. RESULTS Among patients with PE, those with abnormal UtA and UA Doppler velocimetry had the highest median plasma concentration of sEng compared with any other group (P < 0.001, Kruskal-Wallis test). Women with PE with normal Doppler velocimetry in both vessels had the lowest median plasma concentration of sEng. There was a significant relationship between plasma concentrations of sEng and mean UtA resistance index (Spearman Rho = 0.5, P < 0.001) as well as UA pulsatility index (Spearman Rho = 0.4, P = 0.002). Multiple regression analysis suggested that Doppler abnormalities in the UtA and UA as well as gestational age at blood sampling contributed to plasma sEng concentrations (P < 0.001). CONCLUSIONS Abnormalities of impedance to blood flow in the UtA and UA are associated with an excess of sEng in the circulation of mothers with PE. These findings suggest that the 'antiangiogenic state' in PE is partially reflected in abnormalities of Doppler velocimetry.
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Affiliation(s)
- Tinnakorn Chaiworapongsa
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, MI, United States
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Roberto Romero
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, MI, United States
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, MI, United States
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Pooja Mittal
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, MI, United States
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Sun Kwon Kim
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, MI, United States
| | - Francesca Gotsch
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, MI, United States
| | - Nandor Gabor Than
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, MI, United States
| | - Shali Mazaki-Tovi
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, MI, United States
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Edi Vaisbuch
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, MI, United States
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Offer Erez
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, MI, United States
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Lami Yeo
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, MI, United States
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Sonia S Hassan
- Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, MI, United States
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
| | - Yoram Sorokin
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI
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388
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Rieger L, Segerer S, Bernar T, Kapp M, Majic M, Morr AK, Dietl J, Kämmerer U. Specific subsets of immune cells in human decidua differ between normal pregnancy and preeclampsia--a prospective observational study. Reprod Biol Endocrinol 2009; 7:132. [PMID: 19930648 PMCID: PMC2789084 DOI: 10.1186/1477-7827-7-132] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 11/23/2009] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Changes in the balance of decidual leucocyte populations may lead to an unfavourable uterine microenvironment which may be associated with the development of preeclampsia (PE). In this study, we therefore investigated the leucocyte subpopulations in decidual tissues of 33 women with preeclampsia and 66 control patients. METHODS Decidua was either obtained via curettage during cesarean section or dissected from the surface of the basal plate of the placenta after spontaneous delivery. We used FACS analysis to quantify decidual leukocytes (CD45), NK cells (CD56+/CD16+ and CD56++/CD16-), antigen presenting cells (HLA-DR, DC-Sign, CD14) and T/B cells (CD8, CD4, alpha-beta-T-cell receptor, gamma-delta-T-cell receptor, CD25, CD19). RESULTS The number of decidual cytotoxic CD8+T-lymphocytes (P < 0.02), alpha-beta -T-cell receptor positive T cells (P < 0.03) and of CD56+/CD16+ NK cells (P < 0.03) was lower in decidua from women with PE than in decidua from control patients. CONCLUSION The observed reduction of specific leucocyte subsets could create a microenvironment which is unfavourable for an appropriate placentation and could thereby be involved in the development of preeclamptic symptoms.
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Affiliation(s)
- Lorenz Rieger
- Department of Obstetrics and Gynaecology, University of Würzburg, Josef-Schneider-Str. 4, D-97080 Würzburg, Germany
| | - Sabine Segerer
- Department of Obstetrics and Gynaecology, University of Würzburg, Josef-Schneider-Str. 4, D-97080 Würzburg, Germany
| | - Thomas Bernar
- Department of Obstetrics and Gynaecology, University of Würzburg, Josef-Schneider-Str. 4, D-97080 Würzburg, Germany
| | - Michaela Kapp
- Department of Obstetrics and Gynaecology, University of Würzburg, Josef-Schneider-Str. 4, D-97080 Würzburg, Germany
| | - Monika Majic
- Department of Obstetrics and Gynaecology, University of Würzburg, Josef-Schneider-Str. 4, D-97080 Würzburg, Germany
| | - Ann-Katrin Morr
- Department of Obstetrics and Gynaecology, University of Würzburg, Josef-Schneider-Str. 4, D-97080 Würzburg, Germany
| | - Johannes Dietl
- Department of Obstetrics and Gynaecology, University of Würzburg, Josef-Schneider-Str. 4, D-97080 Würzburg, Germany
| | - Ulrike Kämmerer
- Department of Obstetrics and Gynaecology, University of Würzburg, Josef-Schneider-Str. 4, D-97080 Würzburg, Germany
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389
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Pringle KG, Kind KL, Sferruzzi-Perri AN, Thompson JG, Roberts CT. Beyond oxygen: complex regulation and activity of hypoxia inducible factors in pregnancy. Hum Reprod Update 2009; 16:415-31. [PMID: 19926662 PMCID: PMC2880912 DOI: 10.1093/humupd/dmp046] [Citation(s) in RCA: 168] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
In the first trimester the extravillous cytotrophoblast cells occlude the uterine spiral arterioles creating a low oxygen environment early in pregnancy, which is essential for pregnancy success. Paradoxically, shallow trophoblast invasion and defective vascular remodelling of the uterine spiral arteries in the first trimester may result in impaired placental perfusion and chronic placental ischemia and hypoxia later in gestation leading to adverse pregnancy outcomes. The hypoxia inducible factors (HIFs) are key mediators of the response to low oxygen. We aimed to elucidate mechanisms of regulation of HIFs and the role these may play in the control of placental differentiation, growth and function in both normal and pathological pregnancies. The Pubmed database was consulted for identification of the most relevant published articles. Search terms used were oxygen, placenta, trophoblast, pregnancy, HIF and hypoxia. The HIFs are able to function throughout all aspects of normal and abnormal placental differentiation, growth and function; during the first trimester (physiologically low oxygen), during mid-late gestation (where there is adequate supply of blood and oxygen to the placenta) and in pathological pregnancies complicated by placental hypoxia/ischemia. During normal pregnancy HIFs may respond to complex alterations in oxygen, hormones, cytokines and growth factors to regulate placental invasion, differentiation, transport and vascularization. In the ever-changing environment created during pregnancy, the HIFs appear to act as key mediators of placental development and function and thereby are likely to be important contributors to both normal and adverse pregnancy outcomes.
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Affiliation(s)
- K G Pringle
- Research Centre for Reproductive Health, Discipline of Obstetrics and Gynaecology, University of Adelaide, Adelaide, SA 5005, Australia
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390
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Is there a link between insulin resistance and inflammatory activation in preeclampsia? Med Hypotheses 2009; 73:813-7. [DOI: 10.1016/j.mehy.2009.01.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 01/27/2009] [Accepted: 01/28/2009] [Indexed: 12/24/2022]
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391
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Wikström AK, Larsson A, Åkerud H, Olovsson M. Increased Circulating Levels of the Antiangiogenic Factor Endostatin in Early-Onset But Not Late-Onset Preeclampsia. Reprod Sci 2009; 16:995-1000. [DOI: 10.1177/1933719109339348] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden,
| | - Anders Larsson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Helena Åkerud
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Matts Olovsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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392
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Xia Y, Kellems RE. Is preeclampsia an autoimmune disease? Clin Immunol 2009; 133:1-12. [PMID: 19501024 DOI: 10.1016/j.clim.2009.05.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Accepted: 05/06/2009] [Indexed: 01/27/2023]
Abstract
Preeclampsia is a life-threatening hypertensive disease of pregnancy. The condition is characterized by the presence of autoantibodies that activate the major angiotensin receptor, AT(1). Research conducted during the past decade has shown that these autoantibodies activate AT(1) receptors on a variety of cell types and provoke biological responses that are relevant to the pathophysiology of preeclampsia. The introduction of these autoantibodies into pregnant mice results in hypertension, proteinuria and a variety of other features of preeclampsia including small fetuses and placentas. These findings demonstrate the pathophysiological role of these autoantibodies in preeclampsia. The biological properties of these autoantibodies can be blocked by a 7-amino acid peptide that corresponds to a specific sequence associated with the second extracellular loop of the AT(1) receptor. The fact that autoantibodies from different individuals are directed to a common epitope provides obvious diagnostic and therapeutic opportunities. Research reviewed here raises the intriguing possibility that preeclampsia may be a pregnancy-induced autoimmune condition characterized by the presence of disease-causing angiotensin receptor activating autoantibodies.
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Affiliation(s)
- Yang Xia
- Department of Biochemistry and Molecular Biology, The University of Texas -- Houston, Medical School, Houston, TX 77030, USA.
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