401
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Goldman-Wohl D, Cesla T, Smith Y, Greenfield C, Dechend R, Staff A, Sugulle M, Weedon-Fekjær M, Johnsen G, Yagel S, Haimov-Kochman R. Expression profiling of autophagy associated genes in placentas of preeclampsia. Placenta 2013; 34:959-62. [DOI: 10.1016/j.placenta.2013.07.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/24/2013] [Accepted: 07/29/2013] [Indexed: 10/26/2022]
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402
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McElrath TF, Allred EN, Van Marter L, Fichorova RN, Leviton A. Perinatal systemic inflammatory responses of growth-restricted preterm newborns. Acta Paediatr 2013; 102:e439-42. [PMID: 23819682 DOI: 10.1111/apa.12339] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 04/11/2013] [Accepted: 06/28/2013] [Indexed: 12/24/2022]
Abstract
AIM To compare the early post-natal pattern of systemic inflammation in growth-restricted infants born before the 28th week of gestation to that of appropriately grown peers. METHODS We measured the concentrations of 25 inflammation-related proteins in blood spots collected from 939 newborns during the first 2 post-natal weeks. We calculated the odds ratios (99% confidence intervals) that concentrations would be in the highest quartile. RESULTS Severely growth-restricted infants (birth weight Z-score <-2) were not at increased risk of systemic inflammation shortly after birth. On post-natal day 14, however, they were significantly more likely than their peers to have a CRP, IL-1β, IL-6, TNF-α, IL-8, MCP-4, ICAM-1, ICAM-3, E-SEL, MMP-9, VEGF-R2 and/or IGFBP-1 concentration in the highest quartile. These increased risks could not be attributed to delivery indication, bacteremia or duration of ventilation. CONCLUSION Growth-restricted preterm newborns appear to be at increased risk of elevated concentrations of inflammation-associated proteins by post-natal day 14.
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Affiliation(s)
- TF McElrath
- Department of Obstetrics and Gynecology; Brigham & Women's Hospital; Harvard Medical School; Boston; MA; USA
| | - EN Allred
- Neuroepidemiology Unit; Department of Neurology; Boston Children's Hospital; Harvard Medical School; Boston; MA; USA
| | - L Van Marter
- Division of Newborn Medicine; Brigham & Women's Hospital; Harvard Medical School; Boston; MA; USA
| | - RN Fichorova
- Department of Obstetrics and Gynecology; Brigham & Women's Hospital; Harvard Medical School; Boston; MA; USA
| | - A Leviton
- Neuroepidemiology Unit; Department of Neurology; Boston Children's Hospital; Harvard Medical School; Boston; MA; USA
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403
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Knöfler M, Pollheimer J. Human placental trophoblast invasion and differentiation: a particular focus on Wnt signaling. Front Genet 2013; 4:190. [PMID: 24133501 PMCID: PMC3783976 DOI: 10.3389/fgene.2013.00190] [Citation(s) in RCA: 200] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 09/06/2013] [Indexed: 12/12/2022] Open
Abstract
Wingless ligands, a family of secreted proteins, are critically involved in organ development and tissue homeostasis by ensuring balanced rates of stem cell proliferation, cell death and differentiation. Wnt signaling components also play crucial roles in murine placental development controlling trophoblast lineage determination, chorioallantoic fusion and placental branching morphogenesis. However, the role of the pathway in human placentation, trophoblast development and differentiation is only partly understood. Here, we summarize our present knowledge about Wnt signaling in the human placenta and discuss its potential role in physiological and aberrant trophoblast invasion, gestational diseases and choriocarcinoma formation. Differentiation of proliferative first trimester cytotrophoblasts into invasive extravillous trophoblasts is associated with nuclear recruitment of β -catenin and induction of Wnt-dependent T-cell factor 4 suggesting that canonical Wnt signaling could be important for the formation and function of extravillous trophoblasts. Indeed, activation of the pathway was shown to promote trophoblast invasion in different in vitro trophoblast model systems as well as trophoblast cell fusion. Methylation-mediated silencing of inhibitors of Wnt signaling provided evidence for epigenetic activation of the pathway in placental tissues and choriocarcinoma cells. Similarly, abundant nuclear expression of β -catenin in invasive trophoblasts of complete hydatidiform moles suggested a role for hyper-activated Wnt signaling. In contrast, upregulation of Wnt inhibitors was noticed in placentae of women with preeclampsia, a disease characterized by shallow trophoblast invasion and incomplete spiral artery remodeling. Moreover, changes in Wnt signaling have been observed upon cytomegalovirus infection and in recurrent abortions. In summary, the current literature suggests a critical role of Wnt signaling in physiological and abnormal trophoblast function.
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Affiliation(s)
- Martin Knöfler
- Department of Obstetrics and Fetal-Maternal Medicine, Reproductive Biology Unit, Medical University of Vienna Austria
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404
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The expression of B7-H1 and B7-H4 co-stimulatory molecules on myeloid and plasmacytoid dendritic cells in pre-eclampsia and normal pregnancy. J Reprod Immunol 2013; 99:33-8. [DOI: 10.1016/j.jri.2013.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 04/01/2013] [Accepted: 04/15/2013] [Indexed: 12/11/2022]
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405
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Alpoim PN, Godoi LC, Freitas LG, Gomes KB, Dusse LM. Assessment of l-arginine asymmetric 1 dimethyl (ADMA) in early-onset and late-onset (severe) preeclampsia. Nitric Oxide 2013; 33:81-2. [DOI: 10.1016/j.niox.2013.07.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 07/11/2013] [Accepted: 07/15/2013] [Indexed: 11/24/2022]
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406
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van der Hoorn MLP, van Egmond A, Swings GMJS, van Beelen E, van der Keur C, Tirado-González I, Blois SM, Karumanchi SA, Bianchi DW, Claas FHJ, Scherjon SA. Differential immunoregulation in successful oocyte donation pregnancies compared with naturally conceived pregnancies. J Reprod Immunol 2013; 101-102:96-103. [PMID: 24029471 DOI: 10.1016/j.jri.2013.08.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 07/29/2013] [Accepted: 08/01/2013] [Indexed: 12/29/2022]
Abstract
In oocyte donation (OD) pregnancies, there is a higher level of antigenic dissimilarity between mother and fetus compared with naturally conceived (NC) pregnancies. We hypothesize that a higher degree and/or a different type of immunoregulation is necessary to maintain an uncomplicated OD pregnancy. Different immunological aspects of successful OD pregnancies (n=28) were compared with those of NC pregnancies (n=51), and non-donor IVF (n=20) pregnancies. Maternal peripheral blood mononuclear cells (mPBMCs) were characterized by flow cytometry; the outcome correlated with the number of mother-child HLA mismatches. The fetus-specific alloreactivity of mPBMCs was measured in a mixed lymphocyte reaction. The percentages of CD4(+)CD25(bright) and CD4(+)CD25(dim) cells were higher in mPBMCs of OD and IVF pregnancies compared with NC pregnancies. The percentage of CD4(+)CD25(dim) cells in mPBMCs of OD pregnancies correlated positively with the number of HLA mismatches. Functional studies showed a lower proliferative response to umbilical cord blood by mPBMCs in OD pregnancies. In conclusion, we found a higher degree of peripheral immunoregulation in OD and IVF pregnancies compared with NC pregnancies. A higher number of HLA mismatches in successful OD pregnancies leads to increased percentages of activated T cells in peripheral blood, but not to a higher alloreactivity to the fetus. These studies show that immunoregulation in OD pregnancy is different from that in NC pregnancies. The antigenic dissimilarity in OD pregnancies may play a role in the pathophysiology of preeclampsia.
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Affiliation(s)
- Marie-Louise P van der Hoorn
- Department of Obstetrics, Leiden University Medical Center, P.O. Box 9600 (location code: K6-26), 2300 RC Leiden, The Netherlands.
| | - Angela van Egmond
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Godelieve M J S Swings
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Els van Beelen
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Carin van der Keur
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Irene Tirado-González
- Charité Centrum 12 for Internal Medicine and Dermatology, Laboratory of Reproductive Medicine, University Medicine of Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Sandra M Blois
- Charité Centrum 12 for Internal Medicine and Dermatology, Laboratory of Reproductive Medicine, University Medicine of Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - S Ananth Karumanchi
- Center for Vascular Biology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Diana W Bianchi
- Mother Infant Research Institute at Tufts Medical Center, Boston, MA, USA
| | - Frans H J Claas
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Sicco A Scherjon
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands; Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands
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407
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Hirashima C, Ohkuchi A, Takahashi K, Suzuki H, Matsuda Y, Matsubara S, Suzuki M. Additive effects of mean blood pressure and bilateral notching in the second trimester on subsequent angiogenesis-related factors. Hypertens Res 2013; 37:76-81. [DOI: 10.1038/hr.2013.88] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 05/29/2013] [Accepted: 06/21/2013] [Indexed: 11/09/2022]
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408
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Blois SM, Barrientos G. Galectin signature in normal pregnancy and preeclampsia. J Reprod Immunol 2013; 101-102:127-134. [PMID: 23953090 DOI: 10.1016/j.jri.2013.05.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 05/03/2013] [Accepted: 05/15/2013] [Indexed: 01/09/2023]
Abstract
Members of the galectin family are expressed within the female reproductive tract and have been shown to be involved in multiple biological functions that support the progression of pregnancy. Specific expression patterns of different members of this family have been identified at the maternal decidua and on the placental side. In some cases, mechanisms by which galectins exert their functions have been delineated in adverse pregnancy outcomes. This review summarizes studies on galectins that have been documented to be important for pregnancy maintenance, either supporting the maternal adaptation to pregnancy or the placentation process. In addition, we focus our discussion on the role of galectins in preeclampsia, a specific life-threatening pregnancy disorder.
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Affiliation(s)
- Sandra M Blois
- Universitätsmedizin Berlin, Charité-Center 12 Internal Medicine and Dermatology, Reproductive Medicine Research Group, Berlin, Germany.
| | - Gabriela Barrientos
- Laboratorio de Fisiología Molecular Placentaria, Instituto de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, CONICET, Buenos Aires, Argentina
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409
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Saito S, Nakashima A. A review of the mechanism for poor placentation in early-onset preeclampsia: the role of autophagy in trophoblast invasion and vascular remodeling. J Reprod Immunol 2013; 101-102:80-88. [PMID: 23969229 DOI: 10.1016/j.jri.2013.06.002] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 06/07/2013] [Accepted: 06/08/2013] [Indexed: 01/12/2023]
Abstract
Shallow trophoblast invasion and impaired vascular remodeling of spiral arteries have been recognized in early-onset preeclampsia. Placentation and vascular remodeling are multistep processes, and hypoxia, placental oxidative stress, excessive or atypical maternal immune response to trophoblasts, exaggerated inflammation, and increased production of anti-angiogenic factors such as the soluble form of the vascular endothelial growth factor (VEGF) receptor (sFlt-1) and soluble endoglin (sENG) may play a role in poor placentation in preeclampsia. Recent findings suggest that autophagy plays an important role in extravillous trophoblast (EVT) invasion and vascular remodeling under hypoxia, and sENG inhibits EVT invasion and vascular remodeling by the inhibition of autophagy under hypoxic conditions. In this review, we discuss the relationship between inadequate autophagy and poor placentation in preeclampsia.
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Affiliation(s)
- Shigeru Saito
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan.
| | - Akitoshi Nakashima
- Department of Obstetrics and Gynecology, University of Toyama, Toyama, Japan
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410
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Romero R, Whitten A, Korzeniewski SJ, Than NG, Chaemsaithong P, Miranda J, Dong Z, Hassan SS, Chaiworapongsa T. Maternal floor infarction/massive perivillous fibrin deposition: a manifestation of maternal antifetal rejection? Am J Reprod Immunol 2013; 70:285-98. [PMID: 23905710 DOI: 10.1111/aji.12143] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 05/07/2013] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Massive perivillous fibrin deposition (MPFD) and maternal floor infarction (MFI) are related placental lesions often associated with fetal death and fetal growth restriction. A tendency to recur in subsequent pregnancies has been reported. This study was conducted to determine whether this complication of pregnancy could reflect maternal antifetal rejection. METHODS Pregnancies with MPFD were identified (n = 10). Controls consisted of women with uncomplicated pregnancies who delivered at term without MPFD (n = 175). Second-trimester maternal plasma was analyzed for panel-reactive anti-HLA class I and class II antibodies. The prevalence of chronic chorioamnionitis, villitis of unknown etiology, and plasma cell deciduitis was compared between cases and controls. Immunohistochemistry was performed on available umbilical vein segments from cases with MPFD (n = 4) to determine whether there was evidence of complement activation (C4d deposition). Specific maternal HLA-antibody and fetal HLA-antigen status were also determined in paired specimens (n = 6). Plasma CXCL-10 concentrations were measured in longitudinal samples of cases (n = 28 specimens) and controls (n = 749 specimens) by ELISA. Linear mixed-effects models were used to test for differences in plasma CXCL-10 concentration. RESULTS (i) The prevalence of plasma cell deciduitis in the placenta was significantly higher in cases with MPFD than in those with uncomplicated term deliveries (40% versus 8.6%, P = 0.01), (ii) patients with MPFD had a significantly higher frequency of maternal anti-HLA class I positivity during the second trimester than those with uncomplicated term deliveries (80% versus 36%, P = 0.01); (iii) strongly positive C4d deposition was observed on umbilical vein endothelium in cases of MPFD, (iv) a specific maternal antibody against fetal HLA antigen class I or II was identified in all cases of MPFD; and 5) the mean maternal plasma concentration of CXCL-10 was higher in patients with evidence of MPFD than in those without evidence of MFPD (P < 0.001). CONCLUSION A subset of patients with MPFD has evidence of maternal antifetal rejection.
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Affiliation(s)
- Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, Bethesda, MD, USA
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411
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Lian IA, Langaas M, Moses E, Johansson Å. Differential gene expression at the maternal-fetal interface in preeclampsia is influenced by gestational age. PLoS One 2013; 8:e69848. [PMID: 23936112 PMCID: PMC3729459 DOI: 10.1371/journal.pone.0069848] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 06/12/2013] [Indexed: 01/20/2023] Open
Abstract
Genome-wide transcription data of utero-placental tissue has been used to identify altered gene expression associated with preeclampsia (PE). As many women with PE deliver preterm, there is often a difference in gestational age between PE women and healthy pregnant controls. This may pose a potential bias since gestational age has been shown to dramatically influence gene expression in utero-placental tissue. By pooling data from three genome-wide transcription studies of the maternal-fetal interface, we have evaluated the relative effect of gestational age and PE on gene expression. A total of 18,180 transcripts were evaluated in 49 PE cases and 105 controls, with gestational age ranging from week 14 to 42. A total of 22 transcripts were associated with PE, whereas 92 transcripts with gestational age (nominal P value <1.51*10−6, Bonferroni adjusted P value <0.05). Our results indicate that gestational age has a great influence on gene expression both in normal and PE-complicated pregnancies. This effect might introduce serious bias in data analyses and needs to be carefully assessed in future genome-wide transcription studies.
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Affiliation(s)
- Ingrid A. Lian
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Mette Langaas
- Department of Mathematical Sciences, NTNU, Trondheim, Norway
| | - Eric Moses
- Centre for Genetic Epidemiology and Biostatistics, University of Western Australia, Perth, Australia
| | - Åsa Johansson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- * E-mail:
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412
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Barakonyi A, Miko E, Szereday L, Polgar PD, Nemeth T, Szekeres-Bartho J, Engels GL. Cell Death Mechanisms and Potentially Cytotoxic Natural Immune Cells in Human Pregnancies Complicated by Preeclampsia. Reprod Sci 2013; 21:155-66. [DOI: 10.1177/1933719113497288] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Aliz Barakonyi
- Department of Medical Microbiology and Immunology, Clinical Centre, University of Pecs, Pecs, Hungary
- Janos Szentagothai Research Centre, Pecs, Hungary
| | - Eva Miko
- Department of Medical Microbiology and Immunology, Clinical Centre, University of Pecs, Pecs, Hungary
- Janos Szentagothai Research Centre, Pecs, Hungary
| | - Laszlo Szereday
- Department of Medical Microbiology and Immunology, Clinical Centre, University of Pecs, Pecs, Hungary
- Janos Szentagothai Research Centre, Pecs, Hungary
| | - Petra Dora Polgar
- Department of Medical Microbiology and Immunology, Clinical Centre, University of Pecs, Pecs, Hungary
| | - Timea Nemeth
- Department of Languages for Specific Purposes, Medical School, University of Pecs, Pecs, Hungary
| | - Julia Szekeres-Bartho
- Department of Medical Microbiology and Immunology, Clinical Centre, University of Pecs, Pecs, Hungary
- Janos Szentagothai Research Centre, Pecs, Hungary
| | - Geraldine Laura Engels
- Department of Medical Microbiology and Immunology, Clinical Centre, University of Pecs, Pecs, Hungary
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413
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Betoni JS, Derr K, Pahl MC, Rogers L, Muller CL, Packard RE, Carey DJ, Kuivaniemi H, Tromp G. MicroRNA analysis in placentas from patients with preeclampsia: comparison of new and published results. Hypertens Pregnancy 2013; 32:321-39. [PMID: 23844600 DOI: 10.3109/10641955.2013.807819] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim was to identify differences in microRNA expression between patients with and without preeclampsia. METHODS Microarray-based study was carried out with placental samples. RESULTS Comparison of eight previous studies with the current study revealed a total of 138 microRNAs; only 20/138 (14%), however, were seen in more than one study and the results agreed in the direction of change. Bioinformatic analysis of these 20 microRNAs identified a wide range of biological functions including apoptosis and cell movement for their mRNA targets. CONCLUSION The associations between miRNA expression and preeclampsia suggest a potential role for microRNAs in preeclampsia pathobiology.
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Affiliation(s)
- James S Betoni
- Department of Maternal Fetal Medicine, Geisinger Clinic , Danville, PA , USA
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414
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Behrouz GF, Farzaneh GS, Leila J, Jaleh Z, Eskandar KS. Presence of auto-antibody against two placental proteins, annexin A1 and vitamin D binding protein, in sera of women with pre-eclampsia. J Reprod Immunol 2013; 99:10-6. [PMID: 23830177 DOI: 10.1016/j.jri.2013.04.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/20/2013] [Accepted: 04/30/2013] [Indexed: 10/26/2022]
Abstract
Pre-eclampsia (PE) is one of the most complex and life-threatening pregnancy disorders. PE is characterized by maternal hypertension and proteinuria. There is much evidence to support an immunological etiology for PE and auto-immunity is considered a predisposing factor for PE. The aim of the present study was the investigation of placental proteins as targets for auto-antibodies in PE patients. 2D-PAGE technique was used for separation of the total human placental proteins. After separation, protein spots were transferred to the PVDF membranes and blotted with sera from 20 PE patients and compared with membranes blotted with 20 sera from normal women. MALDI TOF/TOF mass spectrometry technique was used for identification of differentially blotted spots. Moreover, the results of mass analysis were confirmed using western blot with commercial mAbs and RT-PCR technique. The results indicated that two placental proteins, annexin A1 and vitamin D binding protein (DBP), might be targeted by PE sera. The expression of annexin A1 and DBP was also confirmed at RNA level using the RT-PCR technique. Furthermore, the mass results were confirmed by western blotting with commercial mAbs against two targeted proteins. The data of the present study suggest two new placental proteins, annexin A1 and DBP, as placental immune targets. Considering the relation among vitamin D deficiency, increased risk of PE, and the role of annexin A1 in the resolution of inflammation, production of antibody against annexin A1 and DBP may be considered a new auto-immune hypothesis in pre-eclampsia that calls for further investigation in future work.
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Affiliation(s)
- Gharesi-Fard Behrouz
- Department of Immunology, Shiraz University of Medical Sciences, Shiraz, Iran; Infertility Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran.
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415
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Palei AC, Spradley FT, Warrington JP, George EM, Granger JP. Pathophysiology of hypertension in pre-eclampsia: a lesson in integrative physiology. Acta Physiol (Oxf) 2013; 208:224-33. [PMID: 23590594 PMCID: PMC3687012 DOI: 10.1111/apha.12106] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 03/26/2013] [Accepted: 04/11/2013] [Indexed: 12/16/2022]
Abstract
Despite being one of the leading causes of maternal death and a major contributor of maternal and perinatal morbidity, the mechanisms responsible for the pathogenesis of pre-eclampsia have yet to be fully elucidated. However, it is evident that this is a complex disorder involving multiple organ systems, and by using integrative approaches, enormous progress has been made towards understanding the pathophysiology of pre-eclampsia. Growing evidence supports the concept that the placenta plays a central role in the pathogenesis of pre-eclampsia and that reduced uteroplacental perfusion, which develops as a result of abnormal cytotrophoblast invasion of spiral arterioles, triggers the cascade of events leading to the maternal disorder. Placental ischaemia leads to release of soluble placental factors, many of which are classified as anti-angiogenic or pro-inflammatory. Once these ischaemic placental factors reach the maternal circulation, they cause widespread activation and dysfunction of the maternal vascular endothelium that results in enhanced formation of endothelin-1 and superoxide, increased vascular sensitivity to angiotensin II and decreased formation of vasodilators such as nitric oxide. This review highlights these links between placental ischaemia, maternal endothelial activation and renal dysfunction in the pathogenesis of hypertension in pre-eclampsia.
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Affiliation(s)
- Ana C. Palei
- Department of Physiology and Biophysics, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216
- Cardiovascular-Renal Research Center, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216
| | - Frank T. Spradley
- Department of Physiology and Biophysics, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216
- Cardiovascular-Renal Research Center, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216
| | - Junie P. Warrington
- Department of Physiology and Biophysics, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216
- Cardiovascular-Renal Research Center, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216
| | - Eric M. George
- Department of Physiology and Biophysics, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216
- Cardiovascular-Renal Research Center, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216
| | - Joey P. Granger
- Department of Physiology and Biophysics, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216
- Cardiovascular-Renal Research Center, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216
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416
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LaMarca B, Cornelius D, Wallace K. Elucidating immune mechanisms causing hypertension during pregnancy. Physiology (Bethesda) 2013; 28:225-33. [PMID: 23817797 PMCID: PMC3742131 DOI: 10.1152/physiol.00006.2013] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Preeclampsia is associated with hypertension and increased infant and maternal morbidity and mortality. The underlying cause of preeclampsia is largely unknown, but it is clear that an immunological component plays a key pathophysiological role. This review will highlight immunological key players in the pathology of preeclampsia and discuss their role in the pathophysiology observed in the reduced placental perfusion (RUPP) rat model of preeclampsia.
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Affiliation(s)
- Babbette LaMarca
- Department of Pharmacology and Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi, USA.
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417
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Novotny S, Wallace K, Herse F, Moseley J, Darby M, Heath J, Gill J, Wallukat G, Martin JN, Dechend R, LaMarca B. CD4 + T Cells Play a Critical Role in Mediating Hypertension in Response to Placental Ischemia. JOURNAL OF HYPERTENSION : OPEN ACCESS 2013; 2:14873. [PMID: 25401050 PMCID: PMC4231445 DOI: 10.4172/2167-1095.1000116] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Similar to preeclamptic women, hypertension in the chronic Reduced Uterine Perfusion Pressure Rat Model Of Preeclampsia (RUPP) is associated with increased CD4+ T cells, cytokines, sFlt-1 and agonistic autoantibodies to the AngII receptor (AT1-AA). We examined the effect inhibition of T cell co-stimulation in RUPP rats treated with (A) (abatacept, 250 mg/kg, infused i.v. at gestation day 13), on hypertension and sFlt-1, TNF-α and AT1-AA. RUPP surgical procedure was performed on day 14. On day 19 MAP increased from 94+2 mmHg in Normal Pregnant (NP) to 123 ± 3 mmHg in RUPP control rats. This response was attenuated by Abatacept, MAP was 104 ± 2 mmHg in RUPP ± A, and 96 ± 2 mmHg NP ± A. Percent circulating CD4+ T cells were 66 ± 3% in RUPPs compared to 55 ± 3% NP rats (p<0.04) but were normalized in RUPP ± A rats (54 ± 3%). The twofold increase in TNF alpha seen in RUPPs (277 ± 47 pg/ml) was decreased to 80 ± 18 pg/ml in RUPP+A. Placental sFlt-1 was reduced 70 % to 151 ± 28 in RUPP ± A compared 488 ± 61 pg/ml in RUPP (p<0.001). AT1-AA decreased from 20 ± 0.8 bpm in control RUPP to 6 ± 0.7 bpm in RUPP ± A. We next determined the effect of RUPP in causing hypertension in pregnant T cell deficient rats by examining MAP in NP (123 ± 5 mmHg) and RUPP athymic nude rats (123 ± 7 mmHg). In the absence of T cells, hypertension in response to placental ischemia was completely abolished. Collectively these data indicate that CD4+ Tcells in response to placental ischemia play an important role in the pathophysiology of hypertension associated with preeclampsia.
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Affiliation(s)
- Sarah Novotny
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, USA
| | - Kedra Wallace
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, USA
| | - Florian Herse
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, USA
| | - Janae Moseley
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, USA
| | - Marie Darby
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, USA
| | - Judith Heath
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, USA
| | - James Gill
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, USA
| | - Gerd Wallukat
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, USA
| | - James N Martin
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, USA
| | - Ralf Dechend
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, USA
| | - Babbette LaMarca
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, USA
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418
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Rakova N, Muller DN, Staff AC, Luft FC, Dechend R. Novel ideas about salt, blood pressure, and pregnancy. J Reprod Immunol 2013; 101-102:135-139. [PMID: 23726817 DOI: 10.1016/j.jri.2013.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 04/02/2013] [Indexed: 10/26/2022]
Abstract
The molecular mechanisms leading to preeclampsia are poorly understood. It has been related to certain immune mechanisms, as well as the pathological regulation of the renin-angiotensin system together with perturbed salt and plasma volume regulation. Finally, a non-specific, vascular, inflammatory response is generated, which leads to the clinical syndrome. Here, we present novel findings in salt (NaCl) metabolism implying that salt is not only important in blood pressure control and volume homeostasis, but also in immune regulation. Sodium and chloride can be stored without accumulation of water in the interstitium at hypertonic concentrations through interactions with proteoglycans. Macrophages in the interstitium act as osmosensors for salt, producing increased amounts of vascular endothelial factor C, which increases the density of the lymph-capillary network and the production of nitric oxide in vessels. An increased interstitial salt concentration activates the innate immune system, especially Th17 cells, and may be an important trigger for autoimmune diseases. The novel findings with the idea of sodium storage and local mechanisms of volume and immune regulation are appealing for preeclampsia and may unify the "immune" and "vascular" hypotheses of preeclampsia.
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Affiliation(s)
- Natalia Rakova
- Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Dominik N Muller
- Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Anne Cathrine Staff
- Department of Obstetrics and Gynaecology, Oslo University Hospital, Ulleval, Norway; Faculty of Medicine, University of Oslo, Norway
| | - Friedrich C Luft
- Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Ralf Dechend
- Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Berlin, Germany; HELIOS-Klinik, Berlin-Buch, Germany.
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419
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Mobasher Z, Salam MT, Goodwin TM, Lurmann F, Ingles SA, Wilson ML. Associations between ambient air pollution and Hypertensive Disorders of Pregnancy. ENVIRONMENTAL RESEARCH 2013; 123:9-16. [PMID: 23522615 PMCID: PMC4539955 DOI: 10.1016/j.envres.2013.01.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 01/21/2013] [Accepted: 01/28/2013] [Indexed: 05/18/2023]
Abstract
BACKGROUND Exposure to ambient air pollution is linked to adverse pregnancy outcomes. Previous reports examining the relationship between ambient air pollution and Hypertensive Disorders of Pregnancy have been inconsistent. OBJECTIVES We evaluated the effects of ambient air pollution on the odds of Hypertensive Disorder of Pregnancy and whether these associations varied by body mass index (BMI). METHODS We conducted a retrospective, case-control study among 298 predominantly Hispanic women (136 clinically confirmed cases) who attended the Los Angeles County+University of Southern California Women's and Children's Hospital during 1996-2008. Trimester-specific carbon monoxide (CO), nitrogen dioxide (NO2), ozone (O3), and particulate matter with aerodynamic diameter <10 μm and <2.5 μm (PM10, PM2.5) exposure were estimated based on 24-hour exposure level at residential address. Logistic regression models were fitted to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for two standard deviation increase in exposure levels. RESULTS Exposures to CO and PM2.5 in the 1st trimester were significantly associated with Hypertensive Disorders of Pregnancy, and these associations were modified by BMI. In non-obese women (BMI <30), 1st trimester exposures to PM2.5 and CO were significantly associated with increased odds of Hypertensive Disorder of Pregnancy (ORs per 2-standard deviation increase in PM2.5 (7 μg/m(3)) and CO (1 ppm) exposures were 9.10 [95% CI: 3.33-24.6] and 4.96 [95% CI: 1.85-13.31], respectively). Additionally, there was a significantly positive association between exposure to O3 in the 2nd trimester and Hypertensive Disorder of Pregnancy (OR per 15 ppb=2.05; 95% CI: 1.22-3.46). CONCLUSION Among non-obese women, 1st trimester exposure to PM2.5 and carbon monoxide are associated with increased odds of Hypertensive Disorder of Pregnancy.
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Affiliation(s)
- Zahra Mobasher
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
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420
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Rosser ML, Katz NT. Preeclampsia: an obstetrician's perspective. Adv Chronic Kidney Dis 2013; 20:287-96. [PMID: 23928395 DOI: 10.1053/j.ackd.2013.02.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 02/15/2013] [Indexed: 01/23/2023]
Abstract
Preeclampsia is a pregnancy-specific syndrome that usually develops after 20 weeks gestation. The exact pathogenic mechanisms remain uncertain and are likely multifactorial. Preeclampsia is a heterogeneous condition with potentially maternal and fetal consequences. As part of the spectrum of hypertensive disorders of pregnancy, preeclampsia may progress rapidly and is a leading cause of maternal and perinatal morbidity and mortality worldwide. In the United States, the incidence of preeclampsia has increased. Clinical manifestations are highly variable and may occur antepartum, intrapartum, or postpartum. Hypertension and proteinuria are the traditional hallmarks for the diagnosis of preeclampsia. These signs may occur with or without multisystem dysfunction and fetal involvement. Risk factors have been identified for the development of preeclampsia; however, ideal methods for prevention, screening, and treatment remain elusive. Preeclampsia resolves after delivery of the fetus, but patients may still have hypertension postpartum. Women and fetuses affected by preeclampsia are at higher risk of developing long-term health issues. There appear to be risk factors common to hypertensive disorders of pregnancy and cardiovascular disease seen later in adulthood. Physicians providing healthcare to women are urged to recognize potential risk factors that arise from patient obstetric histories so that optimal long-term health surveillance is provided.
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421
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Hakim J, Senterman MK, Hakim AM. Preeclampsia is a biomarker for vascular disease in both mother and child: the need for a medical alert system. Int J Pediatr 2013; 2013:953150. [PMID: 23690796 PMCID: PMC3652204 DOI: 10.1155/2013/953150] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 03/28/2013] [Indexed: 11/17/2022] Open
Abstract
This paper reviews the literature pertaining to the impact of preeclampsia not only on the mother but particularly on the children. The review points to the higher blood pressure in children born to preeclamptic mothers compared to controls, their increased tendency to suffer strokes, the reduction in their cognitive ability, and their vulnerability to depression. Mechanisms that may induce these changes are emphasized, particularly the placental vascular insufficiency and the resulting hypoxic and proinflammatory environments in which the fetus develops. The hypothesis proposed is that these changes in the fetal-placental environment result in epigenetic programming of the child towards a higher propensity for vascular disease. The review's main recommendation is that, within ethical boundaries, the medical records of individuals born to preeclamptic mothers should clearly indicate this event and should be made available to the affected individuals so that preventive measures against vascular complications and lifestyle changes that may mitigate the latter can be instituted.
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Affiliation(s)
- Julie Hakim
- Department of Obstetrics and Gynecology, The Ottawa Hospital and the University of Ottawa, General Campus, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6
| | - Mary K. Senterman
- Departments of Pathology & Laboratory Medicine and Obstetrics & Gynecology,
The Ottawa Hospital and the University of Ottawa, General Campus, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6
| | - Antoine M. Hakim
- Division of Neurology, The Ottawa Hospital and the University of Ottawa, Ottawa, ON, Canada K1H 8M5
- Neuroscience Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada K1Y 4E9
- Canadian Stroke Network, Ottawa, ON, Canada K1G 5Z3
- Brain and Mind Research Institute, University of Ottawa, 2413-451 Smyth Road, Ottawa, ON, Canada K1H 8M5
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422
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Tedner SG, Örtqvist AK, Almqvist C. Fetal growth and risk of childhood asthma and allergic disease. Clin Exp Allergy 2013; 42:1430-47. [PMID: 22994341 PMCID: PMC3564398 DOI: 10.1111/j.1365-2222.2012.03997.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction Early genetic and environmental factors have been discussed as potential causes for the high prevalence of asthma and allergic disease in the western world, and knowledge on fetal growth and its consequence on future health and disease development is emerging. Objective This review article is an attempt to summarize research on fetal growth and risk of asthma and allergic disease. Current knowledge and novel findings will be reviewed and open research questions identified, to give basic scientists, immunologists and clinicians an overview of an emerging research field. Methods PubMed-search on pre-defined terms and cross-references. Results Several studies have shown a correlation between low birth weight and/or gestational age and asthma and high birth weight and/or gestational age and atopy. The exact mechanism is not yet clear but both environmental and genetic factors seem to contribute to fetal growth. Some of these factors are confounders that can be adjusted for, and twin studies have been very helpful in this context. Suggested mechanisms behind fetal growth are often linked to the feto-maternal circulation, including the development of placenta and umbilical cord. However, the causal link between fetal growth restriction and subsequent asthma and allergic disease remains unexplained. New research regarding the catch-up growth following growth restriction has posited an alternative theory that diseases later on in life result from rapid catch-up growth rather than intrauterine growth restriction per se. Several studies have found a correlation between a rapid weight gain after birth and development of asthma or wheezing in childhood. Conclusion and clinical relevance Asthma and allergic disease are multifactorial. Several mechanisms seem to influence their development. Additional studies are needed before we fully understand the causal links between fetal growth and development of asthma and allergic diseases.
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Affiliation(s)
- S G Tedner
- Department of Medical Epidemiology and Biostatistics, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
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423
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Staff AC, Benton SJ, von Dadelszen P, Roberts JM, Taylor RN, Powers RW, Charnock-Jones DS, Redman CWG. Redefining preeclampsia using placenta-derived biomarkers. Hypertension 2013; 61:932-42. [PMID: 23460278 DOI: 10.1161/hypertensionaha.111.00250] [Citation(s) in RCA: 259] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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424
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Bonney EA. Demystifying animal models of adverse pregnancy outcomes: touching bench and bedside. Am J Reprod Immunol 2013; 69:567-84. [PMID: 23448345 DOI: 10.1111/aji.12102] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 01/28/2013] [Indexed: 01/21/2023] Open
Abstract
This represents an overview of the use of animal models to study the adverse pregnancy outcomes seen in humans. The purpose is to entice clinicians to utilize some of this information to seek out the literature and have more meaningful and profitable discussions with their academic colleagues and enhance transdisciplinary research in reproductive health.
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Affiliation(s)
- Elizabeth A Bonney
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont College of Medicine, Burlington, VT, USA.
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425
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Pérez Leirós C, Ramhorst R. Tolerance induction at the early maternal-placental interface through selective cell recruitment and targeting by immune polypeptides. Am J Reprod Immunol 2013; 69:359-68. [PMID: 23405982 DOI: 10.1111/aji.12087] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 01/07/2013] [Indexed: 12/12/2022] Open
Abstract
Pregnancy challenges immune cells and immunomodulatory circuits of the mother and the developing fetus to dynamically adapt to each other in an homeostatic and tolerant environment for fetal growth. This entails the coordination of multiple cellular processes all devoted to accommodate and nourish the fetus while protecting the mother from endogenous and exogenous threatens. From the earliest stages of pregnancy, several strategies to efficiently communicate immune and trophoblast cells within the interface or at a distance were identified and chemokines might act at on different targets through direct or indirect mechanisms. Here, we briefly review some mechanisms of T regulatory cell recruitment to the early maternal-placental interfaces to accomplish immunotolerance and homeostatic control and we discuss evidence on two locally released polypeptides, RANTES (regulated on activation, normal, T-cell expressed, and secreted) and vasoactive intestinal peptide (VIP), as novel contributors to the multiplicity of immune tolerant responses and uterine quiescence requirements.
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Affiliation(s)
- Claudia Pérez Leirós
- Immunopharmacology Laboratory, School of Sciences, University of Buenos Aires, IQUIBICEN-CONICET, Buenos Aires, Argentina
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426
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Taglauer ES, Gundogan F, Johnson KL, Scherjon SA, Bianchi DW. Chorionic plate expression patterns of the maspin tumor suppressor protein in preeclamptic and egg donor placentas. Placenta 2013; 34:385-7. [PMID: 23410722 DOI: 10.1016/j.placenta.2013.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Revised: 01/05/2013] [Accepted: 01/23/2013] [Indexed: 12/17/2022]
Abstract
Maspin is a serine protease inhibitor involved in regulating human placental trophoblast cell migration. Maspin has not been studied in preeclampsia (PE) or relative to the maternal-fetal immunological relationship, both of which may involve altered trophoblast migration. We examined maspin expression in placentas from in vitro fertilization (IVF) and egg donor (ED) pregnancies with and without PE. Exclusive to the chorionic plate, the number of maspin-positive extravillous trophoblasts was significantly decreased in IVF-PE vs. IVF (p = 0.005) and ED vs. IVF (p = 0.013). These data suggest maspin expression may be influenced by PE and/or the immunological dynamics of pregnancy.
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Affiliation(s)
- E S Taglauer
- Mother Infant Research Institute at Tufts Medical Center, 800 Washington St. Box 394, Boston, MA 02111, USA.
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427
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Palmsten K, Hernández-Díaz S, Kuriya B, Solomon DH, Setoguchi S. Use of disease-modifying antirheumatic drugs during pregnancy and risk of preeclampsia. Arthritis Care Res (Hoboken) 2013; 64:1730-8. [PMID: 23111855 DOI: 10.1002/acr.21807] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To describe patterns of disease-modifying antirheumatic drug (DMARD) use during pregnancy in a population-based cohort, and to evaluate the association between autoimmune disease, DMARDs, corticosteroids, and nonsteroidal antiinflammatory drugs (NSAIDs) and preeclampsia. METHODS Using health care utilization databases from British Columbia (1997-2006), we compared the risk for preeclampsia among 44,786 women with and without autoimmune disease with study drug dispensings before pregnancy (past users) and before and during the first 20 gestational weeks (continuous users). Relative risks (RRs) and 95% confidence intervals (95% CIs) were estimated. RESULTS Only 414 women (0.1%) had a DMARD dispensing during pregnancy. The incidence of preeclampsia was 2.3% for past DMARD users, 2.7% for past corticosteroid users, and 2.9% for past NSAID users. Compared to past users, the continuous DMARD user RR was 2.29 (95% CI 0.81-6.44), and was 0.89 (95% CI 0.51-1.56) for corticosteroid and 0.84 (95% CI 0.63-1.10) for NSAID users. Compared to women without autoimmune disease, the delivery year-adjusted RR was 2.02 (95% CI 1.11-3.64) for women with systemic lupus erythematosus (SLE). The DMARD results were attenuated when antimalarials were excluded, and the delivery year-adjusted RR was 0.95 (95% CI 0.25-3.55) when the DMARD analysis was restricted to women with autoimmune disease. CONCLUSION Few women were exposed to DMARDs during pregnancy. We observed a 2-fold increased risk of preeclampsia among women with SLE and a nonsignificant increase in risk in DMARD users. The DMARD and preeclampsia association was attenuated when antimalarials were excluded and null when restricted to women with autoimmune disease, which suggests the association is likely due to greater autoimmune disease severity in DMARD users.
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428
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Polavarapu SS, Parton LA, Maramreddy H, Hsu CD. Are placental Fas and Fas ligand gene polymorphisms associated with preeclampsia? Pregnancy Hypertens 2013; 3:34-8. [PMID: 26105738 DOI: 10.1016/j.preghy.2012.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 07/25/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Increased placental trophoblastic apoptosis has been reported in pregnancies complicated by preeclampsia. Fas-Fas ligand is one of the major signal transduction pathways of apoptosis. The objective of this study was to determine if placental Fas and Fas ligand gene polymorphisms differ between patients with and without preeclampsia. STUDY DESIGN Forty-five singleton placentas were studied. Twenty-three placentas were from preeclamptic pregnancies and 22 were from normotensive controls. Genotyping was performed for Fas-1377, Fas-691, Fas-670, Fas ligand-844, Fas ligand-1174, Fas ligand-2777. Chi-square and Fisher's exact tests were used for statistical analysis. RESULTS There were no significant differences in maternal age, parity or race between the two groups. There were no significant differences in genotypes or allele frequencies for the Fas-1377, Fas-691, Fas-670, Fas ligand-844, Fas ligand-1174 and Fas ligand-2777. CONCLUSION Immune intolerance of maternal and placental interaction plays an important role in the pathogenesis of preeclampsia. Our findings do not support the role of placental Fas and Fas ligand gene polymorphisms in the pathogenesis of preeclampsia.
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Affiliation(s)
- Satya S Polavarapu
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Westchester Medical Center, United States.
| | - Lance A Parton
- Division of Newborn Medicine, Department of Pediatrics, New York Medical College, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, United States
| | - Hima Maramreddy
- Division of Newborn Medicine, Department of Pediatrics, New York Medical College, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, United States
| | - Chaur-Dong Hsu
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Westchester Medical Center, United States; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Nassau University Medical Center, United States
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429
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Review: Preeclampsia, acute atherosis of the spiral arteries and future cardiovascular disease: two new hypotheses. Placenta 2012; 34 Suppl:S73-8. [PMID: 23246096 DOI: 10.1016/j.placenta.2012.11.022] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 11/18/2012] [Accepted: 11/21/2012] [Indexed: 11/23/2022]
Abstract
Preeclampsia is a serious complication of pregnancy, potentially lethal for women and offspring. Affected women have an augmented risk of later cardiovascular disease and premature death and may have risk factors in common with older persons developing cardiovascular disease. In some cases of preeclampsia, lipid-filled foam cells accumulate in the walls of the spiral arteries of the uteroplacental circulation (acute atherosis). These lesions resemble the early stages of atherosclerosis and are thought to regress after delivery. The mechanisms that contribute to acute atherosis are largely unknown, but are related to defective vascular remodeling of the spiral arteries in the first half of pregnancy. Spiral artery lipid deposition may also occur in normal pregnancies, which suggests that it may not be confined exclusively to maladapted spiral arteries or caused by hypertension. Our first hypothesis is that there are several pathways to the development of acute atherosis, which converge at the point of excessive decidual inflammation in the final common pathway. Our second hypothesis is that acute atherosis, evolving during the short time of pregnancy, identifies a subset of women at augmented risk for atherosclerosis and later chronic arterial disease better than the diagnosis of preeclampsia itself. If confirmed, this may enable better preventive management for the affected women.
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430
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Hsu P, Santner-Nanan B, Dahlstrom JE, Fadia M, Chandra A, Peek M, Nanan R. Altered Decidual DC-SIGN+ Antigen-Presenting Cells and Impaired Regulatory T-Cell Induction in Preeclampsia. THE AMERICAN JOURNAL OF PATHOLOGY 2012; 181:2149-60. [DOI: 10.1016/j.ajpath.2012.08.032] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 08/02/2012] [Accepted: 08/15/2012] [Indexed: 11/26/2022]
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431
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Devisme L, Merlot B, Ego A, Houfflin-Debarge V, Deruelle P, Subtil D. A case-control study of placental lesions associated with pre-eclampsia. Int J Gynaecol Obstet 2012. [PMID: 23200099 DOI: 10.1016/j.ijgo.2012.08.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate gross and microscopic placental lesions associated with pre-eclampsia and to determine which lesions are most strongly linked to serious pregnancy complications. METHODS A retrospective case-control study of 173 placentas from women with pre-eclampsia and 173 placentas from healthy normotensive women was conducted. RESULTS The mean placental weight in the pre-eclampsia group was lower than that recorded for the control group (280 g vs 360 g; P<0.001). Infarcts (65.9% vs 13.2%; P<0.001) and placental abruption (P<0.001) were most frequent among women with pre-eclampsia. Microscopic findings showed the following lesions to be associated with pre-eclampsia: hypermature villi, defined by absence of intermediate villi (72% vs 16%; P<0.001), excessive syncytial knots (90% vs 9%; P<0.001), decidual vasculopathy (51% vs 8%; P<0.001), villous fibrosis (6% vs 0%; P<0.001), erythroblastosis (11% vs 4%; P<0.01), and avascular terminal villi (9% vs 3%; P<0.05). Increased syncytial knots, infarcts, basal decidual vasculopathy, hypermature villi, and placental erythroblastosis were still associated with pre-eclampsia after logistic regression modeling. CONCLUSION Placental lesions most strongly associated with pre-eclampsia were all causes or expressions of placental hypoxia or ischemia, which appears as the primary mechanism of pre-eclampsia.
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Affiliation(s)
- Louise Devisme
- Department of Pathology, Biology-Pathology Center CHRU de Lille, Lille Cedex, France
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432
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Hahn S, Giaglis S, Hoesli I, Hasler P. Neutrophil NETs in reproduction: from infertility to preeclampsia and the possibility of fetal loss. Front Immunol 2012. [PMID: 23205021 PMCID: PMC3506920 DOI: 10.3389/fimmu.2012.00362] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The intention of this review is to provide an overview of the potential role of neutrophil extracellular traps (NETs) in mammalian reproduction. Neutrophil NETs appear to be involved in various stages of the reproductive cycle, starting with fertility and possibly ending with fetal loss. The first suggestion that NETs may play a role in pregnancy-related disorders was in preeclampsia, where vast numbers were detected in the intervillous space of affected placentae. The induction of NETosis involved an auto-inflammatory component, mediated by the increased release of placental micro-debris in preeclampsia. This report was the first indicating that NETs may be associated with a human pathology not involving infection. Subsequently, NETs have since then been implicated in bovine or equine infertility, in that semen may become entrapped in the female reproductive tract during their passage to the oocyte. In this instance interesting species-specific differences are apparent, in that equine sperm evade entrapment via expression of a DNAse-like molecule, whereas highly motile bovine sperm, once free from seminal plasma (SP) that promotes interaction with neutrophils, appear impervious to NETs entrapment. Although still in the realm of speculation it is plausible that NETs may be involved in recurrent fetal loss mediated by anti-phospholipid antibodies, or perhaps even in fetal abortion triggered by infections with microorganisms such as L. monocytogenes or B. abortus.
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Affiliation(s)
- Sinuhe Hahn
- Department of Biomedicine, University of Basel/Laboratory for Prenatal Medicine, University Clinics, University Women's Hospital Basel, Switzerland
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433
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Kestlerová A, Feyereisl J, Frisová V, Měchurová A, Šůla K, Zima T, Běláček J, Madar J. Immunological and biochemical markers in preeclampsia. J Reprod Immunol 2012; 96:90-4. [PMID: 23131770 DOI: 10.1016/j.jri.2012.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 09/17/2012] [Accepted: 10/03/2012] [Indexed: 01/07/2023]
Abstract
A basic precondition for the development of preeclampsia is the presence of placental trophoblast cells in the maternal blood circulation. On the other hand, while trophoblast cells are present in the blood of all pregnant women, preeclampsia occurs in only 2-5% of them. Evidently, other factors play a crucial role. The aim of this study was to compare a set of selected immunological factors (anti-cardiolipin autoantibodies, trophoblast-induced cell-mediated immunity, C3 and C4 complement components) and biochemical factors (serum immunoglobulins IgA, IgG, IgM) among three groups of women with uncomplicated pregnancy, gestational hypertension, or preeclampsia. Blood samples were taken 2-12h before delivery. In the preeclampsia group, there was a significantly higher number of women positive for anti-cardiolipin autoantibodies, trophoblast-induced cell-mediated immunity was elevated, serum IgG was elevated and C4 complement component was reduced. We conclude that both elevated autoimmune reactivity and the higher immune reactivity to trophoblast may contribute to the onset of preeclampsia.
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Affiliation(s)
- A Kestlerová
- Institute for the Care of Mother and Child, Prague, Czech Republic
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434
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Abildgaard U, Heimdal K. Pathogenesis of the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP): a review. Eur J Obstet Gynecol Reprod Biol 2012; 166:117-23. [PMID: 23107053 DOI: 10.1016/j.ejogrb.2012.09.026] [Citation(s) in RCA: 217] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 08/28/2012] [Accepted: 09/30/2012] [Indexed: 12/31/2022]
Abstract
HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome is serious for the mother and the offspring. HELLP occurs in 0.2-0.8% of pregnancies and in 70-80% of cases it coexists with preeclampsia (PE). This review concerns the pathogenetic mechanisms of HELLP syndrome with an emphasis on differences between HELLP and early onset PE. The syndromes show a familial tendency. A previous HELLP pregnancy is associated with an increased risk of HELLP as well as PE in subsequent pregnancies, indicating related etiologies. No single world-wide genetic cause for excessive risk of HELLP or PE has been identified. Combinations of multiple gene variants, each with a moderate risk, with contributing effects of maternal and environmental factors, are probable etiological mechanisms. Immunological maladaptation is the most probable trigger of the insult to the invading trophoblast. This insult occurs early in the first trimester, as indicated by marker molecules in maternal blood. The levels of fetal messenger RNAs in maternal blood at gestational weeks 15-20 are significantly more abnormal in HELLP than in PE, suggesting that the insult is more extensive in HELLP. High levels of HLA-DR in maternal blood in women with HELLP may suggest a similarity to the rejection reaction. In third trimester placentas, gene derangement is more extensive in HELLP. Anti-angiogenic factors released into maternal blood induce the maternal syndromes. Maternal blood levels of anti-angiogenic sFlt1 are similar, but endoglin and Fas Ligand levels are possibly higher in HELLP than in PE. These factors trigger the vascular endothelium, resulting in an enhanced inflammatory response which is stronger in HELLP. Activated coagulation and complement, with high levels of activated leucocytes, inflammatory cytokines, TNF-α, and active von Willebrand factor, induce thrombotic microangiopathy with platelet-fibrin thrombi in microvessels. The angiopathy results in consumption of circulating platelets, causes hemolysis in affected microvessels and reduces portal blood flow in the liver. Placental Fas Ligand damages hepatocytes, resulting in periportal necrosis. In about one half of women with HELLP, activation of coagulation factors and platelets precipitates disseminated intravascular coagulation, which in a minority becomes uncompensated and contributes to life-threatening multiorgan failure.
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435
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Kilpatrick DC. Birds, babies and blood. Mol Immunol 2012; 55:35-47. [PMID: 22998851 DOI: 10.1016/j.molimm.2012.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 08/20/2012] [Accepted: 08/22/2012] [Indexed: 10/27/2022]
Abstract
This is an autobiographical review describing the author's career in immunology research and summarizing his current understanding of the areas involved. Contributions to autoimmunity, immune deficiency, transfusion immunology, HLA-disease associations, reproductive immunology, cellular therapies, and innate immunity are included; also discussion of medical research ethics and various research-related activities.
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Affiliation(s)
- David C Kilpatrick
- Scottish National Blood Transfusion Service, National Science Laboratory, Edinburgh, United Kingdom.
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436
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Abstract
How difficult is to go from egg to implanted embryo? The evolution of placentation in eutherian mammals created enormous challenges, in particular to the maternal immune system, as the fetus expresses paternal antigens that are capable of triggering immune rejection. Samstein et al. reveal a role for inducible regulatory T cells in the enforcement of maternal-fetal immune tolerance.
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437
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Pregnancy and preeclampsia affect monocyte subsets in humans and rats. PLoS One 2012; 7:e45229. [PMID: 23028864 PMCID: PMC3441708 DOI: 10.1371/journal.pone.0045229] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 08/20/2012] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Both nonclassical and intermediate monocytes have been implicated in different inflammatory conditions. We hypothesized that these monocytes would increase during pregnancy, a condition associated with generalized activation of inflammatory responses and that they would increase even more during preeclampsia, in which inflammatory responses are further stimulated. In the present study we investigated changes in monocyte subsets during healthy pregnancy and preeclampsia in humans and rats. METHODS Blood monocyte subsets of nonpregnant, preeclamptic and healthy pregnant women were identified with CD14 and CD16. In nonpregnant and pregnant rats, blood monocytes were identified with CD172a and CD43, as well as in rats infused with adenosine triphosphate (ATP), a pro-inflammatory stimulus known to induce preeclampsia-like symptoms. Total and CD206-positive macrophages were quantified in placentas of these animals. RESULTS Lower percentages of classical monocytes were found in pregnant women (91%-[83-98%]) compared to nonpregnant women (94%-[90-98%]) and even less in preeclamptic patients (90%-[61-92%]). In contrast, the percentage of combined nonclassical/intermediate monocytes was higher in pregnant women (8.5%-[2.3-16.6%] vs. 5.6%-[1.9-9.5%]) and even higher in preeclamptic patients (9.9%-[7.8-38.7%]), which was caused by a selective increase of intermediate monocytes. In rats, we also found lower percentages of classical monocytes and higher percentages of nonclassical monocytes in pregnant versus nonpregnant rats. ATP infusion increased the percentage of nonclassical monocytes in pregnant rats even further but not in nonpregnant rats. These nonclassical monocytes showed a more activated phenotype in pregnant ATP-infused rats only. Mesometrial triangles of ATP-infused rats had less CD206-positive macrophages as compared to those of saline-infused rats. CONCLUSION The higher percentage of nonclassical/intermediate monocytes found in pregnancy and preeclampsia confirms their association with inflammatory responses. The observation that ATP stimulated numbers/activation of nonclassical monocytes in pregnant rats only, suggests that nonclassical monocytes are specifically altered in pregnancy and may play a role in the pathophysiology of preeclampsia.
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438
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Soeters PB, Grimble RF. The conditional role of inflammation in pregnancy and cancer. Clin Nutr 2012; 32:460-5. [PMID: 22981258 DOI: 10.1016/j.clnu.2012.07.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 07/26/2012] [Accepted: 07/28/2012] [Indexed: 10/28/2022]
Abstract
Cancer growth is characterized by proliferation of tumor cells in conjunction with invasion of all different immune cells that also invade healing wounds. This inflammatory response is necessary for cell proliferation but a second purpose of the inflammatory process is so that a low Th1/Th2 ratio is present with overexpression of IL-10, TGF-β and IFN-γ. Down regulation of NO activity also shifts the balance between M1 and M2 macrophages. Both aspects allow the antigenous nature of the tumor to escape anti-tumor effects of the host. Support for this view comes from observations in pregnancy in which the placenta exhibits identical immune responses and downregulation of NO production to allow trophoblast cells to invade the uterine tissues without being rejected. Cell proliferation requires a metabolic set-up in which the organism produces adequate substrate for growth. This also bears the characteristics of a systemic inflammatory response delivering a similar substrate mix required for cancer and fetal growth. This arrangement is clearly beneficial in pregnancy and therefore supports the view that cancer growth is facilitated by the organism: the cancerous tumor elicits an immunological response opposing anti-tumor effects and induces the host to produce building blocks for growth.
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Affiliation(s)
- Peter B Soeters
- Department of Surgery, Maastricht University Medical Center, The Netherlands.
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439
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Molecular genetics of preeclampsia and HELLP syndrome - a review. Biochim Biophys Acta Mol Basis Dis 2012; 1822:1960-9. [PMID: 22917566 DOI: 10.1016/j.bbadis.2012.08.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 08/06/2012] [Accepted: 08/07/2012] [Indexed: 11/24/2022]
Abstract
Preeclampsia is characterised by new onset hypertension and proteinuria and is a major obstetrical problem for both mother and foetus. Haemolysis elevated liver enzymes and low platelets (HELLP) syndrome is an obstetrical emergency and most cases occur in the presence of preeclampsia. Preeclampsia and HELLP are complicated syndromes with a wide variety in severity of clinical symptoms and gestational age at onset. The pathophysiology depends not only on periconceptional conditions and the foetal and placental genotype, but also on the capability of the maternal system to deal with pregnancy. Genetically, preeclampsia is a complex disorder and despite numerous efforts no clear mode of inheritance has been established. A minor fraction of HELLP cases is caused by foetal homozygous LCHAD deficiency, but for most cases the genetic background has not been elucidated yet. At least 178 genes have been described in relation to preeclampsia or HELLP syndrome. Confined placental mosaicism (CPM) is documented to cause early onset preeclampsia in some cases; the overall contribution of CPM to the occurrence of preeclampsia has not been adequately investigated yet. This article is part of a Special Issue entitled: Molecular Genetics of Human Reproductive Failure.
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440
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Placental expression of D-chiro-inositol phosphoglycans in preeclampsia. Placenta 2012; 33:882-4. [PMID: 22835680 DOI: 10.1016/j.placenta.2012.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 07/10/2012] [Accepted: 07/11/2012] [Indexed: 01/08/2023]
Abstract
Abnormalities in glucose metabolism linked to D-chiro-inostol phosphoglycans (IPGs) have been described in human placentas of preeclamptic women. In this study, a semi-quantitative approach to assess the histological assessment of IPGs revealed no significant differences between early and late onset preeclampsia and gestational age matched controls. However, there was a tendency towards higher values in early onset preeclampsia for villous stroma and placental vessels. Moreover, in control cases staining of plasma in placental vessels was present only in one part of vessels of mature intermediate villi while in preeclamptic specimens all placental vessels showed a similar staining. The tendencies of more staining in villous stroma associated with a differential staining of placental vessels only in preeclamptic specimens support a vectoral movement of D-chiro-inositol phosphoglycans from the fetus to the placenta.
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441
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Kucukgoz Gulec U, Tuncay Ozgunen F, Baris Guzel A, Buyukkurt S, Seydaoglu G, Ferhat Urunsak I, Cuneyt Evruke I. An Analysis of C-Reactive Protein, Procalcitonin, and D-Dimer in Pre-Eclamptic Patients. Am J Reprod Immunol 2012; 68:331-7. [DOI: 10.1111/j.1600-0897.2012.01171.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 06/06/2012] [Indexed: 01/30/2023] Open
Affiliation(s)
- Umran Kucukgoz Gulec
- Department of Obstetrics and Gynecology; Faculty of Medicine; Cukurova University; Adana; Turkey
| | - Fatma Tuncay Ozgunen
- Department of Obstetrics and Gynecology; Faculty of Medicine; Cukurova University; Adana; Turkey
| | - Ahmet Baris Guzel
- Department of Obstetrics and Gynecology; Faculty of Medicine; Cukurova University; Adana; Turkey
| | - Selim Buyukkurt
- Department of Obstetrics and Gynecology; Faculty of Medicine; Cukurova University; Adana; Turkey
| | - Gulsah Seydaoglu
- Department of Biostatistics; Faculty of Medicine; Cukurova University; Adana; Turkey
| | - Ibrahim Ferhat Urunsak
- Department of Obstetrics and Gynecology; Faculty of Medicine; Cukurova University; Adana; Turkey
| | - Ismail Cuneyt Evruke
- Department of Obstetrics and Gynecology; Faculty of Medicine; Cukurova University; Adana; Turkey
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442
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Soluble fms-like tyrosine kinase 1 and soluble endoglin are elevated circulating anti-angiogenic factors in pre-eclampsia. Pregnancy Hypertens 2012; 2:358-67. [PMID: 26105603 DOI: 10.1016/j.preghy.2012.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 06/24/2012] [Indexed: 01/05/2023]
Abstract
Pre-eclampsia, characterized by hypertension and proteinuria, affects approximately 3-5% of all pregnancies worldwide and is a major cause of maternal and fetal morbidity and mortality. Maternal endothelial dysfunction is associated with disease pathogenesis. Recently, reports have shown that elevated levels of circulating soluble fms-like tyrosine kinase 1 [sFlt1] and soluble endoglin [sEng] are associated with pre-eclampsia. Flt1 is a receptor for vascular endothelial growth factor receptor [VEGF], whereas endoglin [Eng] is an auxiliary receptor for transforming growth factor-β [TGF-β] super-family members. Both signaling pathways modulate angiogenesis and are involved in vascular homeostasis. Increased levels of sFlt1 and sEng dysregulate VEGF and TGF-β signaling respectively, resulting in endothelial dysfunction of maternal blood vessels. This review summarizes our current knowledge of Flt1 and endoglin and soluble forms in pre-eclampsia. Furthermore, it highlights the predictive and early-screening value of circulating levels of sFlt1 and sEng for the risk of developing pre-eclampsia.
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443
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Maternal sugar consumption and risk of preeclampsia in nulliparous Norwegian women. Eur J Clin Nutr 2012; 66:920-5. [DOI: 10.1038/ejcn.2012.61] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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444
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Boij R, Svensson J, Nilsson-Ekdahl K, Sandholm K, Lindahl TL, Palonek E, Garle M, Berg G, Ernerudh J, Jenmalm M, Matthiesen L. Biomarkers of coagulation, inflammation, and angiogenesis are independently associated with preeclampsia. Am J Reprod Immunol 2012; 68:258-70. [PMID: 22626009 DOI: 10.1111/j.1600-0897.2012.01158.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 04/17/2012] [Indexed: 02/06/2023] Open
Abstract
PROBLEM Although preeclampsia has been associated with inflammation, coagulation, and angiogenesis, their correlation and relative contribution are unknown. METHOD OF STUDY About 114 women with preeclampsia, 31 with early onset (EOP) and 83 with late onset preeclampsia (LOP), and 100 normal pregnant controls were included. A broad panel of 32 biomarkers reflecting coagulation, inflammation, and angiogenesis was analyzed. RESULTS Preeclampsia was associated with decreased antithrombin, IL-4 and placental growth factor levels and with increased C3a, pentraxin-3, and sFlt-1 levels, with more marked differences in the EOP group. The Th1-associated chemokines CXCL10 and CXCL11 were significantly higher in the preeclampsia and EOP group than in controls, respectively. No correlations between the biomarkers were found in preeclampsia. Multivariate logistic regression tests confirmed the results. CONCLUSIONS Cytokines, chemokines and complement activation seem to be part of a Th1-like inflammatory reaction in preeclampsia, most pronounced in EOP, where chemokines may be more useful than cytokines as biomarkers. Biomarkers were not correlated suggesting partly independent or in time separated mechanisms.
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Affiliation(s)
- Roland Boij
- Department of Obstetrics and Gynecology, County Hospital Ryhov, Jönköping, Sweden.
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445
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Männik J, Vaas P, Rull K, Teesalu P, Laan M. Differential placental expression profile of human Growth Hormone/Chorionic Somatomammotropin genes in pregnancies with pre-eclampsia and gestational diabetes mellitus. Mol Cell Endocrinol 2012; 355:180-7. [PMID: 22387044 PMCID: PMC3325480 DOI: 10.1016/j.mce.2012.02.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 02/09/2012] [Accepted: 02/09/2012] [Indexed: 12/23/2022]
Abstract
The human GH/CSH cluster consisting of one pituitary-expressed (GH1) and four placenta-expressed loci has been implicated in maternal metabolic adaptation to pregnancy, regulation of intrauterine and postnatal growth. We investigated how the mRNA expression profile of placental GH2, CSH1 and CSH2 genes and their alternative transcripts correlates with maternal pre-eclampsia (PE) and/or gestational diabetes mellitus (GD). The expression of studied genes in PE placentas (n=17) compared to controls (n=17) exhibited a trend for reduced transcript levels. The alternative transcripts retaining intron 4, GH2-2 and CSH1-2 showed significantly reduced expression in PE cases without growth restriction (P=0.007, P=0.008, respectively). In maternal GD (n=23), a tendency of differential expression was detected only for the GH2 gene and in pregnancies with large-for-gestational-age newborns. Our results, together with those reported by others, are consistent with a pleiotropic effect of placental hGH/CSH genes at the maternal-fetal interface relating to the regulation of fetal growth and the risk of affected maternal metabolism.
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Affiliation(s)
- Jaana Männik
- Human Molecular Genetics Group, Institute of Molecular and Cell Biology, University of Tartu, Riia 23, 51010 Tartu, Estonia
| | - Pille Vaas
- Human Molecular Genetics Group, Institute of Molecular and Cell Biology, University of Tartu, Riia 23, 51010 Tartu, Estonia
- Women’s Clinic of Tartu University Hospital, L. Puusepa 8, 51014 Tartu, Estonia
| | - Kristiina Rull
- Human Molecular Genetics Group, Institute of Molecular and Cell Biology, University of Tartu, Riia 23, 51010 Tartu, Estonia
- Women’s Clinic of Tartu University Hospital, L. Puusepa 8, 51014 Tartu, Estonia
| | - Pille Teesalu
- Women’s Clinic of Tartu University Hospital, L. Puusepa 8, 51014 Tartu, Estonia
| | - Maris Laan
- Human Molecular Genetics Group, Institute of Molecular and Cell Biology, University of Tartu, Riia 23, 51010 Tartu, Estonia
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446
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Pre-eclampsia and offspring cardiovascular health: mechanistic insights from experimental studies. Clin Sci (Lond) 2012; 123:53-72. [PMID: 22455350 PMCID: PMC3315178 DOI: 10.1042/cs20110627] [Citation(s) in RCA: 138] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Pre-eclampsia is increasingly recognized as more than an isolated disease of pregnancy. Women who have had a pregnancy complicated by pre-eclampsia have a 4-fold increased risk of later cardiovascular disease. Intriguingly, the offspring of affected pregnancies also have an increased risk of higher blood pressure and almost double the risk of stroke in later life. Experimental approaches to identify the key features of pre-eclampsia responsible for this programming of offspring cardiovascular health, or the key biological pathways modified in the offspring, have the potential to highlight novel targets for early primary prevention strategies. As pre-eclampsia occurs in 2–5% of all pregnancies, the findings are relevant to the current healthcare of up to 3 million people in the U.K. and 15 million people in the U.S.A. In the present paper, we review the current literature that concerns potential mechanisms for adverse cardiovascular programming in offspring exposed to pre-eclampsia, considering two major areas of investigation: first, experimental models that mimic features of the in utero environment characteristic of pre-eclampsia, and secondly, how, in humans, offspring cardiovascular phenotype is altered after exposure to pre-eclampsia. We compare and contrast the findings from these two bodies of work to develop insights into the likely key pathways of relevance. The present review and analysis highlights the pivotal role of long-term changes in vascular function and identifies areas of growing interest, specifically, response to hypoxia, immune modification, epigenetics and the anti-angiogenic in utero milieu.
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447
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Soto E, Romero R, Kusanovic JP, Ogge G, Hussein Y, Yeo L, Hassan SS, Kim CJ, Chaiworapongsa T. Late-onset preeclampsia is associated with an imbalance of angiogenic and anti-angiogenic factors in patients with and without placental lesions consistent with maternal underperfusion. J Matern Fetal Neonatal Med 2012; 25:498-507. [PMID: 21867402 PMCID: PMC3401571 DOI: 10.3109/14767058.2011.591461] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE An imbalance between maternal angiogenic/anti-angiogenic factors concentrations has been observed in preeclampsia (PE) and other obstetrical syndromes. However, the frequency of pathologic findings in the placenta and the changes in maternal plasma angiogenic/anti-angiogenic factor concentrations differ between late- and early-onset PE. The aim of this study was to determine if the maternal plasma concentrations of placental growth factor (PlGF), soluble endoglin (sEng), and soluble vascular endothelial growth factor receptor-1 and 2 (sVEGFR-1 and sVEGFR-2) are different in late-onset PE with and without placental pathologic findings consistent with maternal underperfusion. STUDY DESIGN A cross-sectional study was conducted including 64 uncomplicated women and 66 women with late-onset PE (>34 weeks) who had blood samples and placenta available for pathologic examination. Patients with late-onset PE were divided into those with and without placental histologic findings consistent with maternal underperfusion as proposed by the Society for Pediatric Pathology. Maternal plasma concentrations of PlGF, sEng, sVEGFR-1 and sVEGRF-2 were determined by ELISA. Non-parametric statistics were used for analysis. RESULTS 1) the prevalence of placental histological findings consistent with maternal underperfusion among women with late-onset PE was higher than that of those with an uncomplicated pregnancy (47% (31/66) vs. 7.8% (5/64), respectively; p < 0.01); 2) patients with late-onset PE and histological findings consistent with maternal underperfusion had a significantly lower median plasma concentration of PlGF, plasma PlGF/sVEGFR-1 ratio and plasma PlGF/sEng ratio than those with late-onset PE without placental underperfusion lesions (each p < 0.05); 3) the most common pathological findings in the placenta of patient with PE were lesions consistent with villous changes (77%, 24/31); and 4) isolated vascular lesions in the placenta were found only in 2 cases (6.5%), and the rest had a combination of villous and vascular lesions. CONCLUSIONS Nearly half of the patients with late-onset PE have placental lesions consistent with maternal underperfusion. These lesions are associated with an imbalance in the maternal concentration of angiogenic/anti-angiogenic factors. We propose that there is a link between maternal underperfusion and an anti-angiogenic state characterized by the changes in the concentrations of angiogenic and anti-angiogenic factors in women with late onset PE.
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Affiliation(s)
- Eleazar Soto
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, United States
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, United States
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, United States
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, United States
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, United States
| | - Giovanna Ogge
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, United States
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, United States
| | - Youssef Hussein
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, United States
| | - Lami Yeo
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, United States
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, United States
| | - Sonia S Hassan
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, United States
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, United States
| | - Chong Jai Kim
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, United States
- Department of Pathology, Wayne State University, Detroit, MI, United States
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, United States
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, United States
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448
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Pennington KA, Schlitt JM, Jackson DL, Schulz LC, Schust DJ. Preeclampsia: multiple approaches for a multifactorial disease. Dis Model Mech 2012; 5:9-18. [PMID: 22228789 PMCID: PMC3255538 DOI: 10.1242/dmm.008516] [Citation(s) in RCA: 205] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Preeclampsia is a pregnancy-specific disorder characterized by hypertension and excess protein excretion in the urine. It is an important cause of maternal and fetal morbidity and mortality worldwide. The disease is almost exclusive to humans and delivery of the pregnancy continues to be the only effective treatment. The disorder is probably multifactorial, although most cases of preeclampsia are characterized by abnormal maternal uterine vascular remodeling by fetally derived placental trophoblast cells. Numerous in vitro and animal models have been used to study aspects of preeclampsia, the most common being models of placental oxygen dysregulation, abnormal trophoblast invasion, inappropriate maternal vascular damage and anomalous maternal-fetal immune interactions. Investigations into the pathophysiology and treatment of preeclampsia continue to move the field forward, albeit at a frustratingly slow pace. There remains a pressing need for novel approaches, new disease models and innovative investigators to effectively tackle this complex and devastating disorder.
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Affiliation(s)
- Kathleen A Pennington
- Department of Obstetrics, Gynecology and Women's Health, University of Missouri School of Medicine, 500 North Keene Street, Columbia, MO 65201, USA
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449
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Li J, LaMarca B, Reckelhoff JF. A model of preeclampsia in rats: the reduced uterine perfusion pressure (RUPP) model. Am J Physiol Heart Circ Physiol 2012; 303:H1-8. [PMID: 22523250 DOI: 10.1152/ajpheart.00117.2012] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Preeclampsia is defined as new-onset hypertension with proteinuria after 20 wk gestation and is hypothesized to be due to shallow trophoblast invasion in the spiral arteries thus resulting in progressive placental ischemia as the fetus grows. Many animal models have been developed that mimic changes in maternal circulation or immune function associated with preeclampsia. The model of reduced uterine perfusion pressure in pregnant rats closely mimics the hypertension, immune system abnormalities, systemic and renal vasoconstriction, and oxidative stress in the mother, and intrauterine growth restriction found in the offspring. The model has been successfully used in many species; however, rat and primate are the most consistent in comparison of characteristics with human preeclampsia. The model suffers, however, from lack of the ability to study the mechanisms responsible for abnormal placentation that ultimately leads to placental ischemia. Despite this limitation, the model is excellent for studying the consequences of reduced uterine blood flow as it mimics many of the salient features of preeclampsia during the last weeks of gestation in humans. This review discusses these features.
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Affiliation(s)
- Jing Li
- Women's Health Research Center, Jackson, Mississippi, USA
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Thomopoulos C, Tsioufis C, Michalopoulou H, Makris T, Papademetriou V, Stefanadis C. Assisted reproductive technology and pregnancy-related hypertensive complications: a systematic review. J Hum Hypertens 2012; 27:148-57. [PMID: 22495105 DOI: 10.1038/jhh.2012.13] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Hypertensive complications in pregnancy are the leading cause of maternal morbidity, at least in the developed countries. In recent years, infertility issues are managed with ever growing therapeutic options namely assisted reproductive technologies (ART), which improve the ratio of successful induction of pregnancy. It is still debated whether various ART modalities are associated with adverse pregnancy outcomes, including hypertensive complications, particularly with higher incidence of preeclampsia. The main source of controversy stems from the diversity of effect modifiers modulating the association between ART-oriented pregnancy and hypertensive disorders. Indeed, women undergoing an ART procedure are affected by diverse causes of infertility, are frequently characterized by different genetic patterns with respect to their artificially conceived embryo and experienced multiple gestations. In order to investigate whether ART modalities are associated with increased incidence of hypertensive complications in pregnancy, we reviewed all published studies carried out before the end of 2010 and identified in the PubMed database. Among the 47 studies finally selected and by acknowledging the potential of shortcomings related to the different study design and populations, the overall evidence suggests that ART-oriented pregnancies-especially the in-vitro fertilization techniques-are accompanied by increased risk for gestational hypertension and preeclampsia as compared with non-ART pregnancies, even after adjustment for confounders. Multiple gestations, advanced age and underlying polycystic ovary syndrome resulted in constant confounders of the questioned association. Reducing multiple gestations by implementing single embryo techniques might be the therapeutic limiting step to lower the rate of hypertensive complications in assisted pregnancies.
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Affiliation(s)
- C Thomopoulos
- Department of Cardiology, Helena Venizelou General and Maternity Hospital, Athens, Greece.
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