Thrombophilic mutations and susceptibility to preeclapmsia in Western Iran

The association of the prothrombin G20210A single-nucleotide polymorphism and the risk of preeclampsia: Systematic review and meta-analysis

OBJECTIVE

We conducted this systematic review and meta-analysis to assess the association between the risk of preeclampsia and the prothrombin G20210A single-nucleotide polymorphism.

STUDY DESIGN

We followed the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines. Relevant published studies were searched in the data base. The retrieved studies were assessed for quality by using the Modified Newcastle-Ottawa Scale for quality assessment. OpenMeta Analyst software was used for the statistics.

RESULTS

Twenty-eight case-control studies enrolling 3821 cases and 4808 controls were included in this systematic review and meta-analysis. We found a significantly increased preeclampsia risk associated with the G20210A polymorphism in three models: allele contrast (A vs. G), OR 2.183, 95 % CI 1.665-2.862; heterozygote (AG vs. GG), OR 2.233, 95 % CI 1.690-2.95; and the dominant model (AA + AG vs. GG) OR 2.240, 95 % CI 1.700-2.950. However, the association was not observed in the homozygote (AA vs. GG) OR 1.310, 95 % CI = 0.632-2.713 r recessive model (AA vs. AG + GG), OR 1.315, 95 % CI = 0.642-2.695.

CONCLUSIONS

In this meta-analysis, the prothrombin G20210A single-nucleotide polymorphism was associated with an increased risk of preeclampsia.

MTHFR and F5 genetic variations have association with preeclampsia in Pakistani patients: a case control study

BACKGROUND

To study the role of single nucleotide variants (SNVs) of genes related to preeclampsia in Pakistani pregnant women.

METHODS

After ethical approval and getting informed consent; 250 pregnant women were enrolled and equally divided into two groups (125 preeclamptic cases and 125 normotensive pregnant women). Demographic details and medical history were recorded, and 10 ml blood sample was obtained for DNA extraction. The tetra-primer amplification refractory mutation system (ARMS) assays were developed for assessing the variants of three preeclampsia related genes; F5, MTHFR and VEGFA. An association of six SNVs; F5:c.1601G > A (rs6025), F5:c.6665A > G (rs6027), MTHFR: c.665C > T (rs1801133), MTHFR: c.1286A > C (rs1801131), VEGFA: c.-2055A > C (rs699947) and VEGFA: c.*237C > T (rs3025039) with preeclampsia was determined by using different genetic models.

RESULTS

Genotyping of the SNVs revealed that patients with MTHFR:c.665C > T, have increased susceptibility to preeclampsia (CT versus CC/TT: OR = 2.79, 95% CI = 1.18-6.59; P* = 0.046 and CT/TT vs CC: OR = 2.91, 95% CI = 1.29-6.57; P* = 0.0497, in overdominant and dominant models, respectively), whereas F5:c.6665A > G, (A/G vs AA/GG: OR = 0.42, 95% CI = 0.21-0.84; P* = 0.038 in overdominant model) and MTHFR:c.1286A > C, (CC versus AA: OR = 0.36, 95% CI = 0.18-0.72; P* = 0.0392 in codominant model) have significantly decreased risk for preeclampsia. F5:c.1601G > A, VEGFA: c.-2055A > C and VEGFA: c.*237C > T variants revealed no relationship with the disease.

CONCLUSION

This is the first case control study describing the protective role of F5:c.6665A > G against preeclampsia in any world population. In addition, the present study confirmed the association and role of MTHFR gene variations in the development of preeclampsia in Pakistani patients. Further genetic studies may be required to better understand the complex genetic mechanism of SNVs in preeclampsia related genes in pregnant women.

Association of hypertensive disorders of pregnancy risk and factor V Leiden mutation: A meta-analysis

AIM

To date, the conclusions of studies on a possible association between factor V Leiden (FVL, FV G1691A, rs6025) and hypertensive disorders of pregnancy (HDP) are conflicting. Here, we aimed to estimate the relationship between the risk of HDP and FVL.

METHODS

Eligible studies focused on FVL and HDP were searched from the PubMed and the Web of Science databases up to March 31, 2018. We used random effects model for the meta-analysis, and I² statistic to assess the degree of heterogeneity between all included studies. To evaluate the association between FVL and the risk of HDP, we calculated the odds ratio (OR) and 95% confidence intervals (CI) comparing cases and controls of all samples and each subgroup based on different regions.

RESULTS

Fifty citations on FVL and HDP were identified through the literature search, and a meta-analysis on the GA + AA genotype between 6041 cases and 8364 controls was conducted. The holistic analysis found that pregnant women with GA or AA genotype of FVL have a 1.97-fold (95% CI: 1.64-2.35, P < 0.00001) increased risk of HDP compared with GG carriers. While the OR are 2.23 (95% CI: 1.76-2.84, P < 0.00001) and 1.90 (95% CI: 1.12-3.23, P = 0.02) in Europe and the Middle East subgroups, respectively.

CONCLUSION

Factor V Leiden mutation is associated with an increased risk of HDP, and is particularly associated with preeclampsia and eclampsia in European women. However, further high-quality studies are warranted to confirm the possible effectiveness of FVL in HDP patients.

New insight into the role of long non-coding RNAs in the pathogenesis of preeclampsia

OBJECTIVE

Dysregulation of lncRNAs and the absence of coordination between them could affect the normal placentation, uteroplacental circulation, and endothelial cell function. All these misfunctions can finally lead to preeclampsia.

METHODS

 In the present review, we discuss current literature (till May 2018) about lncRNAs expression and function in the placenta, trophoblast cells, and decidua.

RESULTS AND CONCLUSION

It is explained how altered expression of the lncRNAs and abnormal regulation of them affect the risk of preeclampsia. However, the interaction between various lncRNAs and coordinate regulation of them in health and failure of such coordinative mechanisms in diseases such as preeclampsia need to be elucidated.

Factor-V Leiden G1691A and prothrombin G20210A polymorphisms in Sudanese women with preeclampsia, a case -control study

Background

Preeclampsia can lead to adverse maternal and perinatal outcomes. There are few studies on the association of preeclampsia with thrombophilia in Africa including Sudan.

Methods

A case –controls study was conducted at Saad Abualila Hospital in Khartoum, Sudan during the period of February through November 2017. The cases were women with preeclampsia and healthy pregnant women were the controls (180 women in each arm of the study). Genotyping for Factor-V Leiden 1691G/A and Prothrombin gene variation 20210G/A was done by polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP).

Results

There was no significant difference in the age, parity, body mass index (BMI) and the other characteristics between the cases and the controls. Genotypes distribution of Factor V Leiden 1691G/A and prothrombin gene 20210G/A in controls was in accordance with the Hardy–Weinberg equilibrium (P > 0.05). The factor V Leiden-variation was present in 9.6% of the cases compared with 0.6% of the controls, P < 0.001 (OR = 18.60, 95% CI = 2.38–136.1). Only 4 patients with severe preeclampsia had homozygous variation A/A and it was not detected in the controls. Prothrombin G20210A variations not detected neither in the cases nor in the controls group.

Conclusions

High prevalence of Factor V Leiden 1691G/A variation in preeclamptic patients compared to controls suggest an involvement of this variation in predisposing to preeclampsia in this setting.

The effect of VDR gene polymorphisms and vitamin D level on blood pressure, risk of preeclampsia, gestational age, and body mass index

We investigated the influence of vitamin D receptor (VDR) polymorphisms and vitamin D level on the blood pressure and the risk of preeclampsia. In a case-control study, 200 pregnant women, including 100 individuals with preeclampsia along with 100 healthy pregnant women, were studied for VDR FokI, TaqI, and BmsI polymorphisms and serum 25 (OH)-D level using polymerase chain reaction-restriction fragment length polymorphism method and commercial kit, respectively. The mean level of 25 (OH)-D in preeclamptic patients was significantly lower (16.6 ± 4.2 ng/mL, P < 0.001) compared with controls (19.6 ± 3.8 ng/mL). Among all women, a significantly higher systolic blood pressure and before-pregnancy body mass index and also lower gestational age were observed in the presence of 25 (OH)-D level < 20 ng/mL compared with the 20 to 30 ng/mL. A significantly higher frequency of VDR FokI C allele in preeclamptic patients (83%) than controls (74%) was associated with a 1.72-fold increased risk of preeclampsia. In all the studied individuals, the systolic and diastolic blood pressures were significantly higher in the presence of the FokI CC genotype compared with the TC and TT+TC genotypes. Neither VDR Taq1 nor VDR BmsI was associated with the risk of preeclampsia. The haplotype FokI C, TaqI C and BmsI A (CCA) compared with haplotype CTG increased the risk of preeclampsia by 1.4-fold (P = 0.33). Our study suggests an association between VDR FokI polymorphism and an insufficient serum level of 25 (OH)-D with the risk of preeclampsia and also the influence of insufficient 25 (OH)-D level and VDR FokI polymorphism on maternal factors, including blood pressure.

Matrix metalloproteinase-2 C-735T and its interaction with matrix metalloproteinase-7 A-181G polymorphism are associated with the risk of preeclampsia: influence on total antioxidant capacity and blood pressure

Matrix metalloproteinase (MMP) -2 C-735 T and MMP-7 A-181 G genotypes were studied in 144 pregnant patients with mild and severe preeclampsia and 103 healthy pregnant women. Significantly higher frequencies of CT and TT genotypes in patients compared to controls increased the risk of preeclampsia by 2.42 and 3.13 times, respectively. In severe preeclamptic women in the presence of MMP-2 CT the level of total antioxidant capacity was significantly lower than MMP-2 CC genotype. Also, in the presence of MMP-2 CT + TT blood pressure was significantly increased compared to CC genotype in all the patients. The combined presence of MMP-2 T and the MMP-7 A alleles compared to MMP-2 C and MMP-7 A alleles significantly increased the risk of preeclampsia by 3.08-fold. Our findings demonstrate an association between the MMP-2 C-735 T polymorphism with blood pressure and the risk of preeclampsia. Also, in the presence of polymorphism total antioxidant capacity level decreased in severe preeclampsia. Impact statement What is already known on this subject: Matrix metalloproteinases (MMPs) including MMP-2 might be involved in the pathogenesis of preeclampsia through alteration of invasive ability of trophoblastic cells and abnormal placentation. In one available study the absence of association between MMP-2 C-735T polymorphism with gestational hypertension or preeclampsia has been reported. What the results of this study add: We found that the presence of MMP-2 C-735T polymorphism increased the risk of preeclampsia and there was a significantly lower level of total antioxidant capacity in the presence of the polymorphism in severe preeclampsia. Also, we found significantly higher systolic and diastolic blood pressures in the presence of MMP-2 C-735T polymorphism. We detected a synergism between the MMP-2 T and the MMP-7 A alleles that increased the risk of preeclampsia. What the implications are of these findings for clinical practice and/or further research: New findings of our study are involvement of lower activity MMP-2 -735 T allele and its synergism with MMP-7 A allele, low promoter activity allele, in the pathogenesis of preeclampsia through possible impairment of placentation and also by decreased total antioxidant capacity and increased blood pressure. Further association studies of the role of MMP-2 polymorphism and MMP-2 activity in relation to oxidative stress parameters and blood pressure could elucidate the role of MMP-2 and MMP-7 in the pathogenesis of preeclampsia.

Maternal genotype and severe preeclampsia: a HuGE review

Severe preeclampsia is a common cause of maternal and perinatal morbidity worldwide. The disease clusters in families; however, individual genetic studies have produced inconsistent results. We conducted a review to examine relationships between maternal genotype and severe preeclampsia. We searched the MEDLINE and Embase databases for prospective and retrospective cohort and case-control studies reporting associations between genes and severe preeclampsia. Four reviewers independently undertook study selection, quality assessment, and data extraction. We performed random-effects meta-analyses by genotype and predefined functional gene group (thrombophilic, vasoactive, metabolic, immune, and cell signalling). Fifty-seven studies evaluated 50 genotypes in 5,049 cases and 16,989 controls. Meta-analysis showed a higher risk of severe preeclampsia with coagulation factor V gene (proaccelerin, labile factor) (F5) polymorphism rs6025 (odds ratio = 1.90, 95% confidence interval: 1.42, 2.54; 23 studies, I(2) = 29%), coagulation factor II (thrombin) gene (F2) mutation G20210A (rs1799963) (odds ratio = 2.01, 95% confidence interval: 1.14, 3.55, 9 studies, I(2) = 0%), leptin receptor gene (LEPR) polymorphism rs1137100 (odds ratio = 1.75, 95% confidence interval: 1.15, 2.65; 2 studies, I(2) = 0%), and the thrombophilic gene group (odds ratio = 1.87, 95% confidence interval: 1.43, 2.45, I(2) = 27%). There were no associations with other gene groups. There was moderate heterogeneity between studies and potential for bias from poor-quality genotyping and inconsistent definition of phenotype. Further studies with robust methods should investigate genetic factors that might potentially be used to stratify pregnancies according to risk of complications.

Association between thrombophilia gene polymorphisms and preeclampsia: a meta-analysis

OBJECTIVE

To estimate the relationship between the risk of preeclampsia and two thrombophilia gene single-nucleotide polymorphisms (SNPs), the factor V G1691A SNP and the prothrombin G20210A SNP.

DATE SOURCES

A systematic search of the English-language literature up to November 2012 was performed using Medline and EMBASE. Search terms included "preeclampsia," "thrombophilia," "factor V Leiden," "prothrombin gene 20210," and their combinations.

RESULT(S)

Thirty-seven studies with 5048 preeclampsia patients and 6796 controls were included in the meta-analysis. We found that the prothrombin G20210A polymorphism was associated with an increased risk of all preeclampsia (pooled odds ratio (OR) = 1.81, 95% confidence interval (CI) 1.25-2.63) and severe preeclampsia (pooled OR = 3.02, 95%CI 2.06-4.45). Meanwhile, the pooled OR for the association between factor V Leiden and all preeclampsia was 1.60 (95%CI 1.28-2.00) and 2.45 (95%CI 1.63-3.69) for the cases of severe preeclampsia.

CONCLUSION(S)

This meta-analysis supports that the factor V G1691A SNP and the prothrombin G20210A SNP are associated with an increased risk for both preeclampsia overall and severe preeclampsia.

MMP-9 (-1562 C:T) polymorphism as a biomarker of susceptibility to severe pre-eclampsia

AIM

To investigate the role of MMP-9 (-1562 C:T) polymorphism as a biomarker for susceptibility to pre-eclampsia.

PATIENTS & METHODS

MMP-9 variants were detected in 160 women with mild and severe pre-eclampsia and 112 healthy pregnant women.

RESULTS

A significantly higher frequency of MMP-9 CT genotype was observed in both mild and severe pre-eclamptic women compared with controls. In the presence of CT + TT genotype the risk of severe pre-eclampsia increased 2.37-fold (p = 0.02). In women with early-onset pre-eclampsia the frequency of MMP-9 CT + TT genotype was significantly higher (p = 0.045) compared with those with late-onset pre-eclampsia.

CONCLUSION

The MMP-9 variant could be a useful biomarker of susceptibility to severe pre-eclampsia and early-onset severe pre-eclampsia.

Preeclampsia and angiotensin converting enzyme (ACE) I/D and angiotensin II type-1 receptor (AT1R) A1166C polymorphisms: association with ACE I/D polymorphism

BACKGROUND

The aim of the present study was to investigate the association between angiotensin converting enzyme (ACE) insertion/deletion (I/D) and angiotensin II type-1 receptor (AT1R) A1166C polymorphisms with the risk of preeclampsia and lipid peroxidation in preeclamptic women from Western Iran.

METHODS

One hundred and ninety-eight preeclamptic women (128 women with mild and 70 with severe forms) and 100 age- and parity-matched controls were enrolled in this case-control study.

RESULTS

The presence of D allele of ACE was associated with a 1.8-fold increased risk of preeclampsia (p=0.002) in total preeclamptic patients. The frequency of AT1R AC+CC genotypes was higher in mild preeclamptic women (32%) compared to controls (27.2%) (p>0.05). In mild preeclamptic women with ID genotype, the level of total antioxidant capacity (TAC) was significantly decreased compared to those with II genotype. Also, there was a trend toward increasing malondialdehyde (MDA) and decreasing TAC levels in mild and severe preeclamptic women with AT1R AA through CC genotypes.

CONCLUSIONS

Our study indicates that lipid peroxidation and oxidative stress are involved in the development of preeclampsia that might be influenced by polymorphism in the renin-angiotensin-aldosterone system genes.