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Zhang L, Lv Y. microRNA-203 Targets Insulin-Like Growth Factor Receptor 1 to Inhibit Trophoblast Vascular Remodeling to Augment Preeclampsia. Am J Perinatol 2024; 41:355-364. [PMID: 34891198 DOI: 10.1055/s-0041-1740300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Preeclampsia (PE) is a pregnancy-specific condition featured by high blood pressure, edema, and proteinuria. Research about the role of microRNA (miR)-203 in PE remains insufficient. This experiment is designed to investigate the specific role of miR-203 in trophoblasts in PE. STUDY DESIGN miR-203 expression in placenta tissues of normal pregnant women and PE patients was examined to analyze the relevance between miR-203 and PE diagnostic efficiency and between miR-203 and blood pressure (systolic pressure and diastolic pressure) and proteinuria of PE patients. miR-203 expression was downregulated in hypoxia-cultured trophoblasts using miR-203 inhibitor to assess matrix metalloproteinase-9 (MMP-9) level. Then, the angiogenesis of trophoblasts with different treatments was determined. Subsequently, the target relation between miR-203 and insulin-like growth factor receptor 1 (IGF-1R) was predicted and verified. Additionally, the effect of IGF-1R in the mechanism of miR-203 modulating trophoblast vascular remodeling was detected. RESULTS miR-203 was overexpressed in the placenta of PE patients and it acted as a promising diagnostic indicator for PE. Moreover, miR-203 was positively associated with blood pressure (systolic pressure and diastolic pressure) and proteinuria of PE patients. miR-203 silencing in hypoxia-cultured trophoblasts enhanced trophoblast vascular remodeling. Mechanically, miR-203 bound to IGF-1R to suppress its transcription. IGF-1R downregulation counteracted the promotive effect of miR-203 silencing on trophoblast vascular remodeling. CONCLUSION miR-203 was overexpressed in PE, and it targeted IGF-1R to limit trophoblast vascular remodeling. KEY POINTS · miR-203 is overexpressed in the placenta of PE patients.. · miR-203 acts as a potential diagnostic marker for PE.. · miR-203 targets IGF-1R to reduce trophoblast vascular remodeling in PE..
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Affiliation(s)
- Li Zhang
- Department of Obstetrics, Maternal and Child health Hospital of Hubei Province, Wuhan City, Hubei Province, People's Republic of China
| | - Yuxia Lv
- Department of Obstetrics, Maternal and Child health Hospital of Hubei Province, Wuhan City, Hubei Province, People's Republic of China
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Bretón I, Ballesteros-Pomar MD, Calle-Pascual A, Alvarez-Sala LA, Rubio-Herrera MA. Micronutrients in Pregnancy after Bariatric Surgery: A Narrative Review. J Clin Med 2023; 12:5429. [PMID: 37629473 PMCID: PMC10455502 DOI: 10.3390/jcm12165429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Bariatric surgery is increasingly used in women of childbearing age due to the rising prevalence of obesity and the effectiveness and availability of this treatment. Pregnancy in women with previous bariatric surgery deserves special attention. Weight loss induced by surgery reduces the risks that obesity poses to pregnancy. But on the other hand, decreased intake and malabsorption may increase the risk of malnutrition and micronutrient deficiency and negatively affect maternal and foetal health. The aim of this narrative review is to provide an updated analysis of the impact of different bariatric surgery techniques on mineral and micronutrient nutritional status during pregnancy and the possible effect on maternal-foetal health.
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Affiliation(s)
- Irene Bretón
- Department of Endocrinology and Nutrition, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Department of Medicine, Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
| | - María D. Ballesteros-Pomar
- Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, 24008 León, Spain
| | - Alfonso Calle-Pascual
- Department of Medicine, Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
| | - Luis Antonio Alvarez-Sala
- Department of Medicine, Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Miguel Angel Rubio-Herrera
- Department of Medicine, Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, 28040 Madrid, Spain
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Chen Y, Zhou C, Zhao X, Che R, Wu Y, Wan S, Pei J, Yao L, Hua X. Extracellular Vesicles Derived from Human Umbilical Cord Mesenchymal Stem Cells Promote Trophoblast Cell Proliferation and Migration by Targeting TFPI2 in Preeclampsia. Stem Cells Int 2023; 2023:7927747. [PMID: 37559681 PMCID: PMC10409582 DOI: 10.1155/2023/7927747] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/28/2023] [Accepted: 05/30/2023] [Indexed: 08/11/2023] Open
Abstract
Preeclampsia is a pregnancy disorder characterized by systemic organ damage and high blood pressure. It has been reported that microRNA-195 (miR-195) is associated with preeclampsia. In this study, we discovered the target of miR-195 in regulating human extravillous cytotrophoblast-derived transformed cell proliferation and migration. We analyzed the clinicopathological factors of preeclampsia and normal pregnancies. The messenger ribonucleic acid (mRNA) levels of miR-195 and tissue factor pathway inhibitor 2 (TFPI2) were measured in placental tissues derived from normal and preeclampsia patients by real-time polymerase chain reaction (PCR). Human umbilical cord mesenchymal stem cell (hUC-MSC)-derived extracellular vesicles were verified by western blot. HTR8-S/Vneo cell proliferation was evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide, and cell migration rate was assessed by the transwell assay. Relative luciferase activities were measured in TFPI2 wild-type (WT) and mutant cells. miR-195 expression was negatively correlated with TFPI2 mRNA levels in preeclampsia patients. Extracellular vesicles derived from hUC-MSCs enhanced HTR8-S/Vneo cell proliferation and migration. In addition, miR-195 isolated from hUC-MSCs enhanced HTR8-S/Vneo cell proliferation and migration by targeting TFPI2. Our findings demonstrate that the upregulation of miR-195 in extracellular vesicles derived from hUC-MSCs promotes HTR8-S/Vneo cell proliferation and migration by targeting TFPI2.
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Affiliation(s)
- Ying Chen
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China
| | - Chenchen Zhou
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China
| | - Xiaobo Zhao
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China
| | - Ronghua Che
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China
| | - Yuelin Wu
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China
- Shanghai Key Laboratory of Maternal Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China
| | - Sheng Wan
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China
- Shanghai Key Laboratory of Maternal Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China
| | - Jinda Pei
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China
| | - Liping Yao
- Department of Ultrasound, Shanghai First Maternity and Infant Hospital, Tongji University school of Medicine, Shanghai 201204, China
| | - Xiaolin Hua
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China
- Shanghai Key Laboratory of Maternal Medicine, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China
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Chen Y, Liu K, Song K, Fang C, Zhu L, Wu G, Zha J, Zha J. Spontaneous hepatic haemorrhage after caesarean section in a patient with uraemia and superimposed preeclampsia: a case report. J Int Med Res 2023; 51:3000605231166510. [PMID: 37032603 PMCID: PMC10107969 DOI: 10.1177/03000605231166510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023] Open
Abstract
Perinatal spontaneous hepatic haemorrhage is a very rare disease affecting pregnant women, particularly those on long-term dialysis, that has a high maternal and infant mortality rate. Most patients experience preeclampsia with haemolysis, elevated liver enzymes and low platelets syndrome. Here, the case of a 35-year-old multigravida patient with known chronic kidney disease and chronic hypertension with uraemia, who developed spontaneous hepatic haemorrhage after caesarean section, is described. The patient experienced sudden massive circulatory failure, but hemodynamics were temporarily stabilized after emergency surgery. Following transfer to the intensive care unit for continued treatment, her blood pressure and haemoglobin level continued to drop. Selective hepatic artery embolization was performed on day 2 after delivery, and her vital signs gradually stabilized. On day 30 after delivery, the patient was discharged in a stable condition. The newborn recovered after therapy in neonatal intensive care for 2 months. The present case suggests that, for perinatal spontaneous hepatic haemorrhage, timely and accurate diagnosis, multidisciplinary management and determining the therapeutic approach according to clinical symptoms are essential.
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Affiliation(s)
- Yuanyuan Chen
- Department of Critical Care Medicine, Anqing Municipal Hospital, Anqing City, Anhui Province, China
| | - Kai Liu
- Cardiovascular Department, Anqing Municipal Hospital, Anqing City, Anhui Province, China
| | - Kangjie Song
- Department of Hepatobiliary Surgery, Anqing Municipal Hospital, Anqing City, Anhui Province, China
| | - Changtai Fang
- Department of Critical Care Medicine, Anqing Municipal Hospital, Anqing City, Anhui Province, China
| | - Lianghua Zhu
- Department of Critical Care Medicine, Anqing Municipal Hospital, Anqing City, Anhui Province, China
| | - Gaofei Wu
- Department of Critical Care Medicine, Anqing Municipal Hospital, Anqing City, Anhui Province, China
| | - Junjing Zha
- Department of Critical Care Medicine, Anqing Municipal Hospital, Anqing City, Anhui Province, China
| | - Jiaan Zha
- Department of Critical Care Medicine, Anqing Municipal Hospital, Anqing City, Anhui Province, China
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Silva Filho SE, Dainez S, Gonzalez MAMC, Angelis F, Vieira JE, Sandes CS. Intraoperative Analgesia with Magnesium Sulfate versus Remifentanil Guided by Plethysmographic Stress Index in Post-Bariatric Dermolipectomy: A Randomized Study. Anesthesiol Res Pract 2022; 2022:2642488. [PMID: 36339775 PMCID: PMC9629917 DOI: 10.1155/2022/2642488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/25/2022] [Accepted: 10/11/2022] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Magnesium sulfate reduces pain scores and analgesic consumption. Its use as an analgesic resource in opioid-free or opioid-sparing techniques have also been tested. The evaluation of the antinociceptive potency of drugs and doses indirectly, through hemodynamic oscillations has been questioned. A relatively new algorithm called the plethysmographic stress index has been considered sensitive and relatively specific as a parameter for assessing the need for intraoperative analgesia. OBJECTIVES The aim of this trial was to assess the intraoperative analgesic capacity of magnesium sulfate compared to remifentanil. The secondary objectives were propofol consumption and its latency, the consumption of opioids, ephedrine, and cisatracurium. Patients and Methods. Forty patients scheduled for post-bariatric dermolipectomy were randomly assigned to two groups to receive total intravenous anesthesia with target-controlled hypnosis induced with propofol. Analgesia was obtained in the remifentanil group with remifentanil at an initial dose of 0.2 μg·kg-1·min-1 and in the magnesium sulfate group with magnesium sulfate 40 mg·kg-1 + 10 mg·kg-1·h-1. RESULTS There was no statistical hemodynamic difference between the groups before and after orotracheal intubation (p = 0.062) and before and after the surgical incision (p = 0.656). There was also no statistical difference in the variation of mean arterial pressure before and after intubation (p = 0.656) and before and after the surgical incision (p = 0.911). There was similar consumption of cisatracurium, ephedrine, and postoperative opioids between the groups. Some patients in the magnesium sulfate group needed more intraoperative fentanyl and propofol, although the latency of propofol was similar in both the groups. CONCLUSION We conclude that using magnesium sulfate in intravenous general anesthesia for post-bariatric dermolipectomy is related to a significant reduction in opioid consumption without compromising hemodynamic stability. Overall, PSI monitoring was helpful in driving the analgesic strategy. The use of magnesium sulfate proved to be an important adjunct in the scenario presented, allowing the use of opioids to be avoided in certain cases. We found no statistical differences in the consumption of neuromuscular blocker and vasoconstrictor. Substituting opioids for magnesium sulfate leads to an increase in propofol consumption in the scenario presented. Studies with a larger sample are needed to corroborate the results presented and evaluate other potential advantages in reducing opioid consumption.
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Affiliation(s)
- S. E. Silva Filho
- Department of Anesthesiology, Hospital da Sociedade Portuguesa de Beneficência de Santos, Santos, SP, Brazil
| | - S. Dainez
- Department of Anesthesiology, Hospital da Sociedade Portuguesa de Beneficência de Santos, Santos, SP, Brazil
| | - M. A. M. C. Gonzalez
- Department of Anesthesiology, Hospital da Sociedade Portuguesa de Beneficência de Santos, Santos, SP, Brazil
| | - F. Angelis
- Department of Anesthesiology, Hospital da Sociedade Portuguesa de Beneficência de Santos, Santos, SP, Brazil
| | - J. E. Vieira
- Department of Anesthesiology, Universidade de Sao Paulo, Santos, SP, Brazil
| | - C. S. Sandes
- Hospital Santos Dumont, Sao Jose Dos Campos, SP, Brazil
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Zhang C, Hu J, Wang X, Gu H. High level of homocysteine is associated with pre-eclampsia risk in pregnant woman: a meta-analysis. Gynecol Endocrinol 2022; 38:705-712. [PMID: 35970196 DOI: 10.1080/09513590.2022.2110233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
OBJECTIVE We aimed to investigate the correlation between blood homocysteine (Hcy) levels and pre-eclampsia (PE) risk in pregnant women. METHODS Related articles were searched using PubMed, Embase, and Web of Science databases. Methodological quality of included studies was evaluated using the Newcastle-Ottawa Quality Assessment Scale (NOS). Cochran's Q and I2 tests were used to evaluate heterogeneity. Egger's test was used to evaluate publication bias. A sensitivity analysis was performed to test stability of the results using a one-by-one elimination method. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess certainty of evidence. RESULTS Nine studies (4384 PE and 26021 non-PE patients) were included in the meta-analysis. The methodology of them was of good quality, with NOS scores of 5-8. However, there was a significant heterogeneity among included studies. Therefore, the random effect model was generated and combined results suggested a significant association between increased level of Hcy in pregnant women and PE risk. Although a significant publication bias was found in the current study with a P value of 0.006 in the Egger test, sensitivity analysis showed that the combined results were stable and did not vary significantly from any single study. However, the GRADE evidence quality was very low, which may lower the recommendation of pooled results. CONCLUSIONS Increased levels of Hcy in maternal blood were significantly associated with the risk of PE, but low certainty of evidence need to be improved by more high-quality studies.
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Affiliation(s)
- Caihong Zhang
- Department of Obstetrics and Gynaecology, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Jingjing Hu
- Department of Laboratory Diagnostics, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Xia Wang
- Department of Medical Information, Naval Military Medical University, Shanghai, China
| | - Hang Gu
- Department of Obstetrics and Gynaecology, Changhai Hospital, Naval Military Medical University, Shanghai, China
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Ferroptosis and Its Emerging Role in Pre-Eclampsia. Antioxidants (Basel) 2022; 11:antiox11071282. [PMID: 35883776 PMCID: PMC9312356 DOI: 10.3390/antiox11071282] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/25/2022] [Accepted: 06/25/2022] [Indexed: 11/27/2022] Open
Abstract
Iron is essential for cell survival, and iron deficiency is a known risk factor for many reproductive diseases. Paradoxically, such disorders are also more common in cases of iron overload. Here, we evaluated the role of ferroptosis in women’s health, particularly focusing on pre-eclampsia (PE). PE is a multisystem disorder and is one of the leading causes of maternal and perinatal morbidity and mortality, especially when the condition is of early onset. Nevertheless, the exact etiological mechanism of PE remains unclear. Interestingly, ferroptosis, as a regulated iron-dependent cell death pathway, involves a lethal accumulation of lipid peroxides and shares some characteristics with PE pathophysiology. In this review, we comprehensively reviewed and summarized recent studies investigating the molecular mechanisms involved in the regulation and execution of ferroptosis, as well as ferroptosis mechanisms in the pathology of PE. We propose that ferroptosis not only plays an important role in PE, but may also become a novel therapeutic target for PE.
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Jin M, Cao B, Lin C, Li J, Xu Q, Ren Q, Xu S, Tang C. Tianma Gouteng Decoction Exerts Pregnancy-Protective Effects Against Preeclampsia via Regulation of Oxidative Stress and NO Signaling. Front Pharmacol 2022; 13:849074. [PMID: 35401241 PMCID: PMC8985411 DOI: 10.3389/fphar.2022.849074] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/04/2022] [Indexed: 11/30/2022] Open
Abstract
Preeclampsia (PE), a pregnancy-specific syndrome with the major molecular determinants of placenta-borne oxidative stress and consequently impaired nitric oxide (NO) generation, has been considered to be one of the leading causes of maternal morbidity as well as mortality and preterm delivery worldwide. Several medical conditions have been found to be associated with increased PE risk, however, the treatment of PE remains unclear. Here, we report that Tianma Gouteng Decoction (TGD), which is used clinically for hypertension treatment, regulates oxidative stress and NO production in human extravillous trophoblast-derived TEV-1 cells. In human preeclamptic placental explants, reactive oxygen species (ROS) levels were elevated and NO production was inhibited, while TGD treatment at different periods effectively down-regulated the H2O2-induced ROS levels and significantly up-regulated the H2O2-suppressed NO production in human TEV-1 cells. Mechanistically, TGD enhanced the activity of total nitric oxide synthase (TNOS), which catalyze L-arginine oxidation into NO, and simultaneously, TGD promoted the expression of neuronal nitric oxide synthase (nNOS) and endothelial nitric oxide synthase (eNOS), two isoforms of nitric oxide synthetases (NOS) in human placenta, resulting in the increased NO generation. More importantly, TGD administration not only increased the weight gain during pregnancy and revealed a hypotensive effect, but also improved the placental weight gain and attenuated fetal growth restriction in an NG-nitro-L-arginine methyl ester (L-NAME)-induced mouse PE-like model. Our results thereby provide new insights into the role of TGD as a potentially novel treatment for PE.
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Affiliation(s)
- Meiyuan Jin
- National Clinical Research Center for Child Health of the Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Obstetrics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Bin Cao
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Chao Lin
- Department of Neurosurgery, The Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiayong Li
- Department of Ophthalmology, Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
| | - Qiang Xu
- National Clinical Research Center for Child Health of the Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qianlei Ren
- National Clinical Research Center for Child Health of the Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shouying Xu
- National Clinical Research Center for Child Health of the Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Chao Tang, Shouying Xu,
| | - Chao Tang
- National Clinical Research Center for Child Health of the Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Chao Tang, Shouying Xu,
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DJ-1 upregulates the Nrf2/GPX4 signal pathway to inhibit trophoblast ferroptosis in the pathogenesis of preeclampsia. Sci Rep 2022; 12:2934. [PMID: 35190654 PMCID: PMC8861185 DOI: 10.1038/s41598-022-07065-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/01/2022] [Indexed: 01/01/2023] Open
Abstract
Ferroptosis is a newly discovered mode of cell death that involves disorders in iron metabolism and the accumulation of reactive oxygen species (ROS) in the plasma membrane. Preeclampsia (PE) is a gestational idiopathic disease that is characterized by hypertension and albuminuria, begins after 20 weeks of pregnancy. DJ-1 is a prerequisite for activating and stabilizing Nrf2 to allow translocation to the nucleus to carry out further functions. Detecting the expression levels of DJ-1, the Nrf2/GPX4 signaling pathway and ferroptosis markers in placental tissues of pregnant women with and without PE. Analyzing the effects of the ferroptosis inducer (RSL3) and the inhibitor (Fer-1) on the mortality rate of BeWo cells and DJ-1+/+, DJ-1-/- BeWo cells. Ferroptosis markers (MDA concentration and morphology of trophoblast cells) and DJ-1 and its downstream the Nrf2/GPX4 signaling pathway increased significantly in PE pathological state. The expression levels of DJ-1 protein in the control group and the PE group were positively correlated with the expression levels of Nrf2/GPX4 signaling pathway protein, and negatively correlated with the MDA concentration. BeWo cells were sensitive to the ferroptosis inducer (RSL3) and the inhibitor (Fer-1). The high expression levels of DJ-1 in BeWo cells can resist ferroptosis by regulating the Nrf2/GPX4 signaling pathway. Ferroptosis is involved in the pathogenesis of PE. DJ-1 can mediate the trophoblast cells ferroptosis and play a protective role in the pathogenesis of preeclampsia by regulating the Nrf2/GPX4 signaling pathway.
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Gao C, Yang H, Xia F. Increased LINC00922 in preeclampsia regulates the proliferation, invasion, and migration of placental trophoblast cells. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1553. [PMID: 34790759 PMCID: PMC8576713 DOI: 10.21037/atm-21-4923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/21/2021] [Indexed: 12/24/2022]
Abstract
Background Recent studies have shown that the abnormal expression of long-chain non-coding RNAs (lncRNAs) can significantly affect the biological function of trophoblast cells and lead to the occurrence of preeclampsia (PE). This study explores the expression of lncRNA LINC00922 in PE and its effect on the function of placental trophoblast cells, along with the corresponding molecular mechanism, providing a theoretical basis and molecular target for understanding the occurrence, early diagnosis, and targeted therapy of PE. Methods Fluorescence quantitative PCR was used to detect the expression of LINC00922 in 30 cases of PE tissues and normal tissues. The CCK-8 assay, clone formation experiment, and flow cytometry were used to detect the effects of LINC00922 knockdown or overexpression on the proliferation, colony formation, and cell cycle of HTR-8/SVneo placental trophoblast cells. The Transwell assay was used to detect the effects of LINC00922 knockdown or overexpression on the invasion and migration of HTR 8/SVneo cells, and western blot was used to detect the expression of cell cycle-related proteins and invasion and migration-related proteins. Results LINC00922 was highly expressed in PE tissues. Knockdown of LINC00922 significantly inhibited the proliferation, invasion, and migration of HTR-8/SVneo cells, along with colony formation and the ability to induce cell cycle arrest in the G0/G1 phase. However, overexpression of LINC00922 had the opposite effect. Knockdown or overexpression of LINC00922 significantly affected the expression of cell cycle-related proteins cyclin-dependent kinase 2 (CDK2), G1/S-specific cyclin-D1 (Cyclin D1), p21, proliferating cell nuclear antigen (PCNA), matrix metallopeptidase 9 (MMP-9), vimentin, and E-cadherin, but had no significant effect on the expression of matrix metallopeptidase 2 (MMP-2). Conclusions LINC00922 was highly expressed in PE, and functional experiments showed that LINC00922 could significantly affect the proliferation and invasion abilities of placental trophoblast cells, suggesting that LINC00922 may play an important role in the occurrence, early diagnosis, and treatment of PE.
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Affiliation(s)
- Chengzhen Gao
- Department of gynaecology and obstetrics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hui Yang
- Department of gynaecology and obstetrics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Fei Xia
- Department of gynaecology and obstetrics, The First Affiliated Hospital of Soochow University, Suzhou, China
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Tabet M, Banna S, Luong L, Kirby R, Chang JJ. Pregnancy Outcomes after Preeclampsia: The Effects of Interpregnancy Weight Change. Am J Perinatol 2021; 38:1393-1402. [PMID: 32521560 DOI: 10.1055/s-0040-1713000] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aimed to examine the effects of interpregnancy weight change on pregnancy outcomes, including recurrent preeclampsia, preterm birth, small-for-gestational age (SGA), large-for-gestational age (LGA), and cesarean delivery, among women with a history of preeclampsia. We also evaluated whether these associations were modified by prepregnancy body mass index (BMI) category in the first pregnancy (BMI < 25 vs. ≥25 kg/m2) and if associations were present among women who maintained a healthy BMI category in both pregnancies. STUDY DESIGN We conducted a population-based retrospective cohort study including 15,108 women who delivered their first two nonanomalous singleton live births in Missouri (1989-2005) and experienced preeclampsia in the first pregnancy. We performed Poisson regression with robust error variance to estimate relative risks and 95% confidence intervals for outcomes of interest after controlling for potential confounders. RESULTS Interpregnancy weight gain was associated with increased risk of recurrent preeclampsia, LGA, and cesarean delivery. These risks increased in a "dose-response" manner with increasing magnitude of interpregnancy weight gain and were generally more pronounced among women who were underweight or normal weight in the first pregnancy. Interpregnancy weight loss exceeding 1 BMI unit was associated with increased risk of SGA among underweight and normal weight women, while interpregnancy weight loss exceeding 2 BMI units was associated with reduced risk of recurrent preeclampsia among overweight and obese women. CONCLUSION Even small changes in interpregnancy weight may significantly affect pregnancy outcomes among formerly preeclamptic women. Appropriate weight management between pregnancies has the potential to attenuate such risks. KEY POINTS · Interpregnancy weight change among formerly preeclamptic women significantly affects pregnancy outcomes.. · Interpregnancy weight gain is associated with increased risk of recurrent preeclampsia, large-for-gestational-age and cesarean delivery.. · Interpregnancy weight loss is associated with increased risk of small-for-gestational age and recurrent preeclampsia..
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Affiliation(s)
- Maya Tabet
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri
| | - Soumya Banna
- School of Medicine, Saint Louis University, Saint Louis, Missouri
| | - Lan Luong
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri
| | - Russell Kirby
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida
| | - Jen Jen Chang
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri
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Ma Y, Wu H, Liang X, Zhang C, Ma Y, Wei Y, Li J, Chen H. Identification of downstream targets and signaling pathways of long non-coding RNA NR_002794 in human trophoblast cells. Bioengineered 2021; 12:6617-6628. [PMID: 34516352 PMCID: PMC8806843 DOI: 10.1080/21655979.2021.1974808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Preeclampsia (PE) is a huge threat to pregnant women. Our previous study demonstrated that long non-coding RNA (lncRNA) NR_002794 was highly expressed in placentas of PE patients and could regulate the phenotypes of trophoblast cells. However, the downstream regulatory mechanisms of NR_002794 remain unknown. In this text, some potential downstream targets or signaling pathways of NR_002794 were identified through RNA sequencing (RNA-seq) and bioinformatics analysis in SWAN71 trophoblast cells. Western blot assay demonstrated that NR_002794 inactivated protein kinase B (AKT) and extracellular signal-regulated kinase 1/2 (ERK1/2) pathways and activated cell apoptotic signaling in SWAN71 cells. Both RNA-seq and reverse transcription-quantitative PCR (RT-qPCR) outcomes showed that NR_002794 up-regulation could notably inhibit the expression of C-C motif chemokine ligand 4 like 2 (CCL4L2), interleukin 15 receptor subunit alpha (IL15RA), interleukin 32 (IL32), and tyrosine kinase with immunoglobulin-like and EGF-like domains 1 (TIE1), while NR_002794 knockdown induced these gene expressions in SWAN71 cells. CCK-8, BrdU, Transwell, wound healing, and flow cytometry analyses showed that NR_002794 inhibited cell proliferation and migration and induced cell apoptosis through down-regulating TIE1 in SWAN71 cells. In conclusion, lncRNA NR_002794 could exert its functions by regulating AKT and ERK1/2 pathways and TIE1 expression in human trophoblast cells.
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Affiliation(s)
- Yinyao Ma
- Department of Obstetrics, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, P.R. China
| | - Hua Wu
- Department of Obstetrics, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, P.R. China
| | - Xuxia Liang
- Department of Obstetrics, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, P.R. China
| | - Chun Zhang
- Department of Obstetrics, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, P.R. China
| | - Yanhua Ma
- Department of Obstetrics, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, P.R. China
| | - Yanfen Wei
- Department of Obstetrics, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, P.R. China
| | - Jing Li
- Department of Obstetrics, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, P.R. China
| | - Hui Chen
- Department of Obstetrics, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, P.R. China
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Ugochinyere IF, Chiamaka NS, Obinna AE, Chukwunyelu AAM, Amechi AJ. Sonographic Assessment of Renal Volume in Normotensive Pregnant Women and Women With Pregnancy-Induced Hypertension in Enugu Metropolis. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021. [DOI: 10.1177/87564793211021094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Renal volume (RV) assessment during obstetric sonography is rarely considered in our locality. Understanding the changes in RV in both normotensive pregnant (NP) and pregnancy-induced hypertensive (PIH) women is important in making correct diagnosis regarding pregnancy outcome. This study is aimed at determining the RV in NP and PIH women and correlating RV with fetal gestational age (FGA), body mass index (BMI), and parity in NP women. Materials and Methods: This cross-sectional study involved 450 patients recruited at a Tertiary Hospital. A pilot study was done to determine the interobserver variability in RV measurement. RV was calculated using the following formula: L × W × AP × 0.523. Parity, BMI, and blood pressure were documented, while FGA was calculated as an average of FGAs obtained from the measurements of fetal biometric parameters. Results: Mean RV of PIH women was significantly higher than that of NP women ( P < .05). RV shows a positive significant relationship with BMI and FGA, while it shows a negative relationship with parity in NP ( P < .05). Conclusion: Reference range values of RV were generated for clinical use in our locality, while there is statistically significant difference between RV in NP and PIH women.
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Affiliation(s)
- Idigo Felicitas Ugochinyere
- Department of Medical Radiography and Radiological Sciences, Faculty of Health Sciences & Technology, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
| | | | - Abonyi Everistus Obinna
- Department of Medical Radiography and Radiological Sciences, Faculty of Health Sciences & Technology, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
| | - Anakwue Angel-Mary Chukwunyelu
- Department of Medical Radiography and Radiological Sciences, Faculty of Health Sciences & Technology, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
| | - Agbo Julius Amechi
- Department of Medical Radiography and Radiological Sciences, Faculty of Health Sciences & Technology, College of Medicine, University of Nigeria, Enugu Campus, Nigeria
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Vitamin D stimulates miR-26b-5p to inhibit placental COX-2 expression in preeclampsia. Sci Rep 2021; 11:11168. [PMID: 34045549 PMCID: PMC8160000 DOI: 10.1038/s41598-021-90605-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 05/13/2021] [Indexed: 11/15/2022] Open
Abstract
Vitamin D insufficiency or deficiency during pregnancy has been associated with an increased risk of preeclampsia. Increased placental cyclooxygenase-2 (COX-2) activity was proposed to contribute to the inflammatory response in preeclampsia. This study was to investigate if vitamin D can benefit preeclampsia by inhibiting placental COX-2 expression. Placenta tissues were obtained from 40 pregnant women (23 normotensive and 17 preeclampsia). miR-26b-5p expression was assessed by quantitative PCR. Vitamin D receptor (VDR) expression and COX-2 expression were determined by immunostaining and Western blot. HTR-8/SVneo trophoblastic cells were cultured in vitro to test anti-inflammatory effects of vitamin D in placental trophoblasts treated with oxidative stress inducer CoCl2. 1,25(OH)2D3 was used as bioactive vitamin D. Our results showed that reduced VDR and miR-26b-5p expression, but increased COX-2 expression, was observed in the placentas from women with preeclampsia compared to those from normotensive pregnant women. Transient overexpression of miR-26b-5p attenuated the upregulation of COX-2 expression and prostaglandin E2 (PGE2) production induced by CoCl2 in placental trophoblasts. 1,25(OH)2D3 treatment inhibited CoCl2-induced upregulation of COX-2 in placental trophoblasts. Moreover, miR-26b-5p expression were significantly upregulated in cells treated with 1,25(OH)2D3, but not in cells transfected with VDR siRNA. Conclusively, downregulation of VDR and miR-26b-5p expression was associated with upregulation of COX-2 expression in the placentas from women with preeclampsia. 1,25(OH)2D3 could promote miR-26b-5p expression which in turn inhibited COX-2 expression and PGE2 formation in placental trophoblasts. The finding of anti-inflammatory property by vitamin D through promotion of VDR/miR-26b-5p expression provides significant evidence that downregulation of vitamin D/VDR signaling could contribute to increased inflammatory response in preeclampsia.
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Li Y, Xing BX, Wang YH, Yu S, Zhao H, Lv QQ, Lu CX. CTHRC1 promotes growth, migration and invasion of trophoblasts via reciprocal Wnt/β-catenin regulation. J Cell Commun Signal 2021; 16:63-74. [PMID: 34043142 DOI: 10.1007/s12079-021-00625-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 05/17/2021] [Indexed: 01/03/2023] Open
Abstract
Preeclampsia (PE) is a pregnancy complication that is characterized by high blood pressure and is associated with high maternal and fetal morbidities. At a mechanistic level, PE is characterized by reduced invasion ability of trophoblasts. Collagen triple helix repeat containing-1 (CTHRC1) is a well-known tumor-promoting factor in several malignant tumors, but its role in trophoblasts remains unknown. In this study, we characterized the expression of CTHRC1 in placenta tissue samples from PE pregnancies and from normal pregnancies. We used the trophoblasts cell lines HTR-8/SVneo and JEG-3 to investigate the role of CTHRC1 in cell migration, invasion and proliferation. Western blot, PCR and TOP/FOP luciferase activity assays were used to investigate the molecular mechanisms underlying these cell behaviors. Placenta tissue samples obtained from pregnant women with PE expressed lower levels of CTHRC1 than those of placenta tissues from women with normal pregnancies. Down-regulation of CTHRC1 impaired cell proliferation, migration and invasion of trophoblasts, while CTHRC1 overexpression promoted nuclear translocation of β-catenin, a result that was further confirmed by TOP/FOP luciferase activity assay. Our findings suggest that CTHRC1 promotes migration and invasion of trophoblasts via reciprocal Wnt/β-catenin signaling pathway. Down-regulation of CTHRC1 may be a potential mechanism underpinning the development of preeclampsia.
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Affiliation(s)
- Yan Li
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, 266003, Qingdao, Shandong, China
| | - Bao-Xiang Xing
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, 266003, Qingdao, Shandong, China
| | - Yi-Hao Wang
- Department of Pain Medicine, Qingdao Municipal Hospital, 266011, Qingdao, Shandong, China
| | - Sha Yu
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, 266003, Qingdao, Shandong, China
| | - Han Zhao
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, 266003, Qingdao, Shandong, China
| | - Qing-Qing Lv
- Department of Pathology, The Affiliated Hospital of Qingdao University, 266003, Qingdao, Shandong, China
| | - Cai-Xia Lu
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, 266003, Qingdao, Shandong, China. .,, 16 Jiangsu Road, 266003, Qingdao, China.
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Trends and predictors of eclampsia among singleton and multiple gestations in the United States, 1989-2018. Pregnancy Hypertens 2021; 25:56-61. [PMID: 34058700 DOI: 10.1016/j.preghy.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 05/10/2021] [Accepted: 05/20/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine temporal trends of eclampsia by plurality in the US spanning three decades (1989-2018); and to investigate risk factors for eclampsia among singleton and multiple pregnancies in the US during the study period. STUDY DESIGN We conducted a retrospective cohort study using the Natality data files, including information on all births within the gestational age of 20-42 weeks from 1989 through 2018. We used joinpoint regression analysis to evaluate trends in rates of eclampsia over the study period. We employed logistic regression models to examine the association between plurality and eclampsia after adjusting for socio-demographic and gestational factors. MAIN OUTCOME MEASURES The primary outcome was eclampsia among singleton and multiple pregnancies. FINDINGS There was a 2.8% (95% CI: -5.4, -0.1) average annual reduction in eclampsia rates among singletons, whereas among multiples there was a decline of about 3.7% (95% CI: -6.4, -1.0) annually. Mothers with multiple pregnancies had three-fold increased adjusted odds (OR = 95% CI: 2.95-3.21) of experiencing eclampsia when compared to those with singleton gestations. Non-Hispanic (NH) Black mothers with singletons had 37% greater adjusted odds of developing eclampsia than their NH-White peers (95%CI: 1.33-1.42). CONCLUSION There was an overall decreasing trend in eclampsia incidence in the US from 1989 to 2018, regardless of plurality. The occurrence of eclampsia was associated with plurality, race/ethnicity, maternal age and maternal BMI. Given the heterogeneity in clinical presentations of eclampsia, personalized/standardized risk prediction models are needed to enable consistent diagnosis and timely intervention.
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Pankiewicz K, Fijałkowska A, Issat T, Maciejewski TM. Insight into the Key Points of Preeclampsia Pathophysiology: Uterine Artery Remodeling and the Role of MicroRNAs. Int J Mol Sci 2021; 22:3132. [PMID: 33808559 PMCID: PMC8003365 DOI: 10.3390/ijms22063132] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023] Open
Abstract
Preeclampsia affects about 3-8% of all pregnancies. It represents a complex and multifaceted syndrome with at least several potential pathways leading to the development of disease. The main dogma in preeclampsia is the two-stage model of disease. Stage 1 (placental stage) takes place in early pregnancy and is thought to be impaired placentation due to inadequate trophoblastic invasion of the maternal spiral arteries that leads to reduced placental perfusion and release of numerous biological factors causing endothelial damage and development of acute maternal syndrome with systemic multiorgan failure (stage 2-the onset of maternal clinical symptoms, maternal stage). Recently, in the light of the vast body of evidence, two-stage model of preeclampsia has been updated with a few novel pathways leading to clinical manifestation in the second part of pregnancy. This paper reviews current state of knowledge about pathophysiology of preeclampsia and places particular focus on the recent advances in understanding of uterine artery remodeling alterations, as well as the role of microRNAs in preeclampsia.
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Affiliation(s)
- Katarzyna Pankiewicz
- Department of Obstetrics and Gynecology, Institute of Mother and Child in Warsaw, Kasprzaka 17a, 01-211 Warsaw, Poland; (T.I.); (T.M.M.)
| | - Anna Fijałkowska
- Department of Cardiology, Institute of Mother and Child in Warsaw, Kasprzaka 17a, 01-211 Warsaw, Poland;
| | - Tadeusz Issat
- Department of Obstetrics and Gynecology, Institute of Mother and Child in Warsaw, Kasprzaka 17a, 01-211 Warsaw, Poland; (T.I.); (T.M.M.)
| | - Tomasz M. Maciejewski
- Department of Obstetrics and Gynecology, Institute of Mother and Child in Warsaw, Kasprzaka 17a, 01-211 Warsaw, Poland; (T.I.); (T.M.M.)
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Quiroz Y, Llorens E, Novoa R, Motta G, Llurba E, Porta O, Parra J, Ballarin J, Palou J, Bujons A. Pregnancy in Pateints With Exstrophy-Epispadias Complex: Are Higher Rates of Complications and Spontaneous Abortion Inevitable? Urology 2021; 154:326-332. [PMID: 33662406 DOI: 10.1016/j.urology.2021.01.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report on the characteristics of pregnancy in female patients with EEC (exstrophy-epispadias complex), determining in particular whether they are at higher risk of spontaneous abortion or complications. MATERIALS AND METHOD Fifty patients diagnosed with EEC and treated in a reference center for this pathology were reviewed. Those with an incomplete medical history were excluded, leaving a total of 37 women with a median follow-up of 26 years (1-48 years). The outcome measurements were successful pregnancies, miscarriages, urological, gynecological and obstetric complications, impaired renal function, newborn characteristics, and postpartum urogynecological complications. Descriptive statistics was used. RESULTS Eight patients achieved 17 pregnancies (88.2% spontaneous). Of these pregnancies, 10 (58.8%) were successful, while 7 (41.2%) terminated in miscarriages. Urinary tract infection (UTI) was the most frequent complication (41.6%) and intestinal occlusion was the most severe. A total of 62.5% of the patients presented genital prolapses after pregnancies. A total of 85.7% of patients were dry during the follow-up after their pregnancies. No newborn presented EEC or any other type of malformation. Our study has the limitation of being a retrospective review of a very heterogeneous and small group of patients. CONCLUSION EEC patients can achieve spontaneous pregnancies but have an increased risk of miscarriage. For this reason, monitoring and control by a specialized and integrated multidisciplinary team is required to minimize complications.
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Affiliation(s)
- Yesica Quiroz
- Urology Department, Fundació Puigvert, Barcelona, Spain
| | - Erika Llorens
- Urology Department, Fundació Puigvert, Barcelona, Spain
| | - Rosa Novoa
- Urology Department, Fundació Puigvert, Barcelona, Spain
| | | | - Elisa Llurba
- Gynecology and Obstetrics Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Oriol Porta
- Gynecology and Obstetrics Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Juan Parra
- Gynecology and Obstetrics Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jose Ballarin
- Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | - Joan Palou
- Urology Department, Fundació Puigvert, Barcelona, Spain
| | - Anna Bujons
- Urology Department, Fundació Puigvert, Barcelona, Spain.
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Jiang M, Wang Y, Fu Q, Lin S, Wu J, Di W. Preeclampsia Risk Prediction Model for Chinese Pregnant Patients With Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2020; 72:1602-1610. [PMID: 32433830 DOI: 10.1002/acr.24265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 05/12/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To screen for a high risk of preeclampsia in women with systemic lupus erythematosus (SLE). METHODS A total of 513 antenatal care records of pregnant patients with SLE were obtained, and the data were randomly assigned to either a development set (n = 342) or a validation set (n = 171). Preeclampsia predictors were identified with stepwise regression, and a coefficient B of each variable was used to establish a prediction model and risk scoring system. Goodness-of-fit was assessed by the Hosmer-Lemeshow and Omnibus tests, and the area under the receiver operating characteristic curve (area under the curve) was used to assess discrimination. Validation was performed using the validation set. RESULTS The preeclampsia incidence was 14.4% in the pregnant patients with SLE. A mean arterial pressure (MAP) ≥96.5 mm Hg (odds ratio [OR] 213.15 [95% confidence interval (95% CI) 24.39-999.99]), prepregnancy hypertension (OR 18.19 [95% CI 2.67-125.01]), a hematologic disorder (OR 4.13 [95% CI 1.03-16.67]), positive IgM anticardiolipin antibodies (aCLs) (OR 19.85 [95% CI 1.11-333.33]), serum albumin <31.5 grams/liter (OR 9.88 [95% CI 2.07-47.62]), serum uric acid ≥303 μmoles/liter (OR 5.58 [95% CI 1.40-22.22]), and 24-hour urinary protein ≥0.286 grams (OR 14.39 [95% CI 2.43-83.33]) were selected for the preeclampsia prediction model. The area under the curve was 0.975. Preeclampsia prediction model scores >4 indicated a high risk of preeclampsia. For the validation set, the preeclampsia prediction accuracy was 93.6% (sensitivity 88.5%, specificity 94.5%). CONCLUSION A model for predicting the risk of preeclampsia in pregnant patients with SLE was established on the basis of MAP, prepregnancy hypertension, hematologic disorders, IgM aCLs, albumin, uric acid, and 24-hour urinary protein. The model had good predictive efficiency and can help clinicians improve pregnancy outcomes in high-risk women with early interventions.
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Affiliation(s)
- Meng Jiang
- Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, and Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, China
| | - You Wang
- Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, and Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, China
| | - Qiong Fu
- Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, and Shanghai Institute of Rheumatology, Shanghai, China
| | - Sihan Lin
- Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, and Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, China
| | - Jiayue Wu
- Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, and Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, China
| | - Wen Di
- Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, and Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, China
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Varagic J, Desvigne-Nickens P, Gamble-George J, Hollier L, Maric-Bilkan C, Mitchell M, Pemberton VL, Redmond N. Maternal Morbidity and Mortality: Are We Getting to the "Heart" of the Matter? J Womens Health (Larchmt) 2020; 30:178-186. [PMID: 33259740 PMCID: PMC8020498 DOI: 10.1089/jwh.2020.8852] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Cardiovascular disease (CVD), including hypertensive disorders of pregnancy (HDP) and peripartum cardiomyopathy, is a leading cause of pregnancy-related death in the United States. Women who are African American or American Indian/Alaskan Native, have HDP, are medically underserved, are older, or are obese have a major risk for the onset and/or progression of CVD during and after pregnancy. Paradoxically, women with no preexisting chronic conditions or risk factors also experience significant pregnancy-related cardiovascular (CV) complications. The question remains whether substantial physiologic stress on the CV system during pregnancy reflected in hemodynamic, hematological, and metabolic changes uncovers subclinical prepregnancy CVD in these otherwise healthy women. Equally important and similarly understudied is the concept that women's long-term CV health could be detrimentally affected by adverse pregnancy outcomes, such as preeclampsia, gestational hypertension, and diabetes, and preterm birth. Thus, a critical life span perspective in the assessment of women's CV risk factors is needed to help women and health care providers recognize and appreciate not only optimal CV health but also risk factors present before, during, and after pregnancy. In this review article, we highlight new advancements in understanding adverse, pregnancy-related CV conditions and will discuss promising strategies or interventions for their prevention, diagnosis, and treatment.
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Affiliation(s)
- Jasmina Varagic
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Patrice Desvigne-Nickens
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Joyonna Gamble-George
- Center for Translational Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Lisa Hollier
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Christine Maric-Bilkan
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Megan Mitchell
- Division of Extramural Research Activities, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Victoria L Pemberton
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Nicole Redmond
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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Spiral Arteries in Second Trimester of Pregnancy: When Is It Possible to Define Expected Physiological Remodeling as Abnormal? Reprod Sci 2020; 28:1185-1193. [PMID: 33237514 DOI: 10.1007/s43032-020-00403-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
After undergoing remodeling, uterine spiral arteries turn into wide, flexible tubes, with low resistance. If remodeling does not occur, spontaneous abortions, intrauterine growth restriction, and pregnancy-related hypertensive disorders can ensue. Arterial transformation begins at a very early gestational stage; however, second quarter pregnancy histopathological samples have yet to pinpoint the exact moment when abnormal remodeling transpires. We examined 100 samples, taken from consecutive abortions at 12-23 gestational weeks. Following Pijnenborg and Smith guidelines, blinded pathologists analyzed clinical data on remodeling stages. Lab results showed that arterial remodeling is not synchronic in all vessels; a single sample can include various remodeling stages; neither is remodeling homogenous in a single vessel: change may be occurring in one part of the vessel, but not in another. To our knowledge, no one has published this finding. In the examined age group, Smith stage IV predominates; around week 14, substantial muscle and endothelium loss takes place. After week 17, endovascular or fibrin trophoblast does not usually occur. Although scant consensus exists on what defines preeclampsia etiology, it is clear that it involves abnormal remodeling in decidua vessels. Improved understanding requires further knowledge on both the physiological and pathological aspects of the remodeling process. We observed that muscle and endothelial tissues disappear from weeks 14-17, after which time reendothelization predominates. We list the expected proportion of spiral artery changes for each gestational age which, to date, has not been available.
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Delayed Diagnosis of Colonic Adenocarcinoma in a 30-Year-Old Postpartum Woman Misdiagnosed with HELLP Syndrome. Case Rep Surg 2020; 2020:3085413. [PMID: 32908771 PMCID: PMC7474346 DOI: 10.1155/2020/3085413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/12/2020] [Accepted: 08/07/2020] [Indexed: 11/17/2022] Open
Abstract
Colon cancer is a rare diagnosis in 30-year-old women, which may be further complicated by their concurrent gravid status. Several physiological changes that occur during an intrauterine pregnancy (IUP) can mask symptoms of early colon cancer. Our patient was a 30-year-old, Gravida 2, Para 0 woman with an uncomplicated pregnancy until the 35th week of gestation when she developed preeclampsia and symptoms suggestive of early hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome. Following induction of labor and the subsequent, uncomplicated vaginal delivery, the patient developed symptoms of nausea, vomiting, and constipation with abdominal pain and bloating. Abdominal computed tomography (CT) revealed a large mass in the right colon along with the involvement of periaortic lymph nodes and the presence of liver metastases. Hepatic metastases were possibly responsible for the patient's elevated liver enzyme levels, which were initially considered to have been caused by HELLP syndrome because the patient also had preeclampsia. The rarity of colon cancer in young, pregnant patients with no family history, such as in this case, results in poor prognosis owing to nonspecific symptoms of the developing malignancy being attributed to pregnancy, which further delays diagnosis and subsequent therapy. Of 29 cases of colon cancer in pregnant patients recorded till date, this is the first report of a stage 4 adenocarcinoma of the colon with hepatic metastasis, elevated liver enzyme levels, and increased blood pressure with associated preeclampsia, which was diagnosed in the postpartum period. It may be important to consider broader differential diagnoses in expectant patients presenting with unusual and persistent symptoms.
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Wang D, Na Q, Song GY, Wang L. Human umbilical cord mesenchymal stem cell-derived exosome-mediated transfer of microRNA-133b boosts trophoblast cell proliferation, migration and invasion in preeclampsia by restricting SGK1. Cell Cycle 2020; 19:1869-1883. [PMID: 32597300 DOI: 10.1080/15384101.2020.1769394] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Exosomes have been documented to function in human diseases, yet their transfer of microRNA (miRNA) in preeclampsia (PE) has seldom been reported. This study intends to discuss the role of miR-133b derived from exosomes in human umbilical cord mesenchymal stem cells (hUC-MSCs) in trophoblast cell development in PE. METHODS Placentas from PE patients and normal pregnant women were collected. The hUC-MSCs and their exosomes were obtained and identified. Trophoblast cell HPT-8 and HTR8-S/Vneo were obtained and co-cultured with hUC-MSCs-derived exosomes that had been transfected with different miR-133b plasmids. MiR-133b and glucocorticoid-regulated kinase 1 (SGK1) expression in placental tissues and HPT-8 and HTR8-S/Vneo cells was determined. HTR8-S/Vneo and HPT-8 cell proliferation, cell cycle distribution, apoptosis rate, migration and invasion were detected. RESULTS MiR-133b was down-regulated and SGK1 was up-regulated in placental tissues of PE patients. MiR-133b expression was inversely related to SGK1 expression in HTR8-S/Vneo and HPT-8 cells co-cultured with hUC-MSC-derived exosomes. Exosomes promoted HTR8-S/Vneo and HPT-8 cell proliferation, migration and invasion abilities, cell cycle entry and inhibited apoptosis. Elevated exosome-derived miR-133b from hUC-MSCs boosted HTR8-S/Vneo and HPT-8 cell proliferation, cell cycle progression, migration and invasion and limited cell apoptosis. MiR-133b targeted SGK1. CONCLUSION Collectively, we demonstrate that miR-133b is down-regulated and SGK1 is up-regulated in PE, and miR-133b derived from exosomes in hUM-MSCs facilitates trophoblast cell proliferation, migration and invasion in PE via constraining SGK1.
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Affiliation(s)
- Dan Wang
- Department of Obstetric and Gynecology, Shengjing Hospital of China Medical University , Shengyang, Liaoning, China
| | - Quan Na
- Department of Obstetric and Gynecology, Shengjing Hospital of China Medical University , Shengyang, Liaoning, China
| | - Gui Yu Song
- Department of Obstetric and Gynecology, Shengjing Hospital of China Medical University , Shengyang, Liaoning, China
| | - Leilei Wang
- Department of Obstetric and Gynecology, Shengjing Hospital of China Medical University , Shengyang, Liaoning, China
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Deng Z, Zhang L, Tang Q, Xu Y, Liu S, Li H. Circulating levels of IFN-γ, IL-1, IL-17 and IL-22 in pre-eclampsia: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 248:211-221. [PMID: 32240894 DOI: 10.1016/j.ejogrb.2020.03.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 03/10/2020] [Accepted: 03/16/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Pre-eclampsia (PE) is a common multi-systemic disease, and the effect of cytokines on PE is not clear. The purpose of this meta-analysis was to evaluate the circulating levels of interferon gamma (IFN-γ), interleukin (IL)-1, IL-17 and IL-22 in patients with PE. STUDY DESIGN Relevant studies were identified after a preliminary investigation of studies published up to May 2019 using PubMed and Embase. In this study, all 27 included articles underwent quality rating, with a total of 495 patients with PE and 557 controls. Among them, eight papers and 932 subjects contributed to the meta-analysis of IFN-γ, and six papers and 343 subjects contributed to the meta-analysis of IL-17. Based on the inclusion and exclusion criteria, the retrieved papers were screened and evaluated independently. Relevant data for IFN-γ and IL-17 were extracted for meta-analysis and subgroup analysis, and the stability of the results was evaluated by sensitivity analysis. At the same time, a systematic evaluation was carried out for IL-1 and IL-22 with a small number of included papers. RESULTS Several papers included in the systematic review showed that the circulating levels of IL-22 were higher in patients with severe PE than in controls, while IL-1 levels did not differ significantly between the two groups. The meta-analysis showed that patients with PE had higher circulating levels of IFN-γ than controls [standardized mean difference (SMD) 1.45, 95 % confidence interval (CI) 0.56-2.34]. There was no evidence of a difference in the circulating levels of IL-17 between patients with PE and controls (SMD 0.53, 95 %CI -0.43 to 1.48). CONCLUSION This meta-analysis suggested that changes in circulating levels of IFN-γ might be associated with PE.
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Affiliation(s)
- Ziwen Deng
- Department of Clinical Laboratory, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Lu Zhang
- Medical Genetic Department, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China; Prenatal Diagnosis Centre, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Qian Tang
- Medical Genetic Department, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China; Prenatal Diagnosis Centre, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yinglei Xu
- Medical Genetic Department, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China; Prenatal Diagnosis Centre, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shiguo Liu
- Medical Genetic Department, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China; Prenatal Diagnosis Centre, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
| | - Hui Li
- Department of Clinical Laboratory, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
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Yoon SW, Kang H, Choi GJ. Pharmacologic strategies to prevent hemodynamic changes after intubation in parturient women with hypertensive disorders of pregnancy: A systematic review and network meta-analysis protocol. Medicine (Baltimore) 2019; 98:e18454. [PMID: 31861021 PMCID: PMC6940058 DOI: 10.1097/md.0000000000018454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy are major health issues affecting mothers and infants. General anesthesia is inevitable for certain mothers with these conditions and they may exhibit pronounced hemodynamic instability, especially during induction and airway manipulation. The aims of this study are to combine direct and indirect comparisons of the efficacies of different medications used in attenuating reflex hemodynamic responses and generate intervention ranking by network meta-analysis (NMA). METHODS A systematic and comprehensive search will be performed using MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar databases, beginning from their inceptions to November 2019. Only randomized clinical trials evaluating the efficacy and safety of pharmacologic interventions for preventing hemodynamic changes after intubation in parturient women with hypertensive disorders of pregnancy will be included. The primary endpoints will be maximal mean arterial pressure (MAP) and maximal heart rate after intubation. Maximal systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and maternal/fetal blood gas analysis, as well as safety issues, including Apgar score at 1 minute and 5 minutes after delivery, will be also assessed.We will conduct both pairwise meta-analysis and network meta-analysis. We will use surface under the cumulative ranking curve (SUCRA) values and rankograms to present the hierarchy of pharmacologic interventions. A comparison-adjusted funnel plot will be used to assess the presence of small-study effects. The quality of the studies included will be assessed using the risk of bias tool 2.0. All statistical analyses will be performed using Stata SE, version 15.0 (StataCorp, College Station, TX). RESULTS The results of this systematic review and NMA will be published in a peer-reviewed journal. CONCLUSION This NMA will enable us to determine the order of effectiveness and safety of pharmacological interventions used in attenuating hemodynamic responses for mothers with hypertensive disorders of pregnancy. TRIAL REGISTRATION NUMBER CRD42019136067.
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Das NS, Dheen ST, Ling EA, Bay BH, Srinivasan DK. Therapeutic Prospects in Preeclampsia - A Mini-Review. Curr Med Chem 2019; 26:4786-4798. [PMID: 30836908 DOI: 10.2174/0929867326666190228115423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 02/07/2019] [Accepted: 02/13/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Preeclapmsia (PE) is characterized by early onset symptoms such as elevated blood pressure, proteinuria and edema in the pregnant woman, and may result in seizures in the affected female. Currently, there are no therapeutic drugs available to treat this condition, but there are interventions to regulate the symptoms based on the gestational period of the fetus, although the largely favored option is delivery of the fetus and placenta. OBJECTIVE A search for biomolecules associated with PE was conducted so as to identify diagnostic markers and therapeutic leads. RESULTS The literature search resulted in the identification of biomolecules such as Corin and Placental Protein 13 (PP13), among others that are associated with PE. Thereby, giving an insight into the various mechanistic pathways involved in the causation of PE. However, it is also evident that PE cannot be solely attributed to any single mechanism but is due to an interplay of different factors that have led to the development of this disease condition. CONCLUSION The identified biomarkers would ultimately help in understanding this complex disease and perhaps lead to the discovery of potential effective molecular targets for clinical trials, thereby providing a valuable therapeutic option for affected pregnant women.
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Affiliation(s)
- N S Das
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - S T Dheen
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - E A Ling
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - B H Bay
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - D K Srinivasan
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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27
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Ekawati E, Setyowati S, Budiati T. “Sehati” health education to improve physical and psychological adaptation of the postpartum women having pre-eclampsia. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.04.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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28
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Orosz L, Orosz G, Veress L, Dosa D, Orosz L, Arany I, Fabian A, Medve L, Pap K, Karanyi Z, Toth Z, Poka R, Than NG, Torok O. Screening for preeclampsia in the first trimester of pregnancy in routine clinical practice in Hungary. J Biotechnol 2019; 300:11-19. [PMID: 31055145 DOI: 10.1016/j.jbiotec.2019.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/18/2019] [Accepted: 04/20/2019] [Indexed: 12/01/2022]
Abstract
We aimed to evaluate the contribution of different factors in the Fetal Medicine Foundation algorithms for preeclampsia (PE) risk calculation during first-trimester screening in Hungary. We selected subjects for the nested case-control study from a prospective cohort of 2545 low-risk pregnancies. Eighty-two patients with PE and 82 gestational age-matched controls were included. Individual PE risk was calculated using two risk-assessing softwares. Using Astraia 2.3.1, considering maternal characteristics and biophysical parameters only, detection rates (DR) were 63.6% for early-PE and 67.6% for late-PE. When we added placenta associated plasma protein A (PAPP-A) to the risk calculation, DRs decreased to 54.5% and 64.8% respectively. Using Astraia 2.8.2 with maternal characteristics and biophysical parameters resulted in the DRs of 63.6% (early-PE) and 56.3% (late-PE). If we added PAPP-A to the risk calculation, DRs improved to 72.7% and 54.9%. The addition of placental growth factor (PlGF) did not increase detection rates in either calculation. In conclusion, using maternal characteristics, biophysical parameters, and PAPP-A, an acceptable screening efficacy could be achieved for early-PE during first-trimester screening. Since PlGF did not improve efficacy in our study, we suggest setting new standard curves for PlGF in Eastern European pregnant women, and the evaluation of novel biochemical markers.
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Affiliation(s)
- Laszlo Orosz
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Debrecen Medical and Health Science Centre, Nagyerdei korut 98, 4032, Debrecen, Hungary
| | - Gergo Orosz
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Debrecen Medical and Health Science Centre, Nagyerdei korut 98, 4032, Debrecen, Hungary
| | - Lajos Veress
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen Medical and Health Science Centre, Nagyerdei korut 98, 4032, Debrecen, Hungary
| | - Diana Dosa
- Department of Family and Occupational Medicine, Faculty of Public Health and Faculty of Medicine, University of Debrecen Medical and Health Science Centre, Moricz Zsigmond krt. 22, 4032, Debrecen, Hungary
| | - Laszlo Orosz
- Departement of Obststrics and Gynaecology, Andras Josa County and Teaching Hospital, Szent Istvan ut. 68, 4400, Nyiregyhaza, Hungary.
| | - Ibolya Arany
- Departement of Neonatology, Andras Josa County and Teaching Hospital, Szent Istvan ut. 68, 4400, Nyiregyhaza, Hungary
| | - Antal Fabian
- Departement of Obststrics and Gynaecology, Andras Josa County and Teaching Hospital, Szent Istvan ut. 68, 4400, Nyiregyhaza, Hungary
| | - Laszlo Medve
- Departement of Obststrics and Gynaecology, Andras Josa County and Teaching Hospital, Szent Istvan ut. 68, 4400, Nyiregyhaza, Hungary
| | - Karoly Pap
- Departement of Obststrics and Gynaecology, Andras Josa County and Teaching Hospital, Szent Istvan ut. 68, 4400, Nyiregyhaza, Hungary
| | - Zsolt Karanyi
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen Medical and Health Science Centre, Nagyerdei korut 98, 4032, Debrecen, Hungary
| | - Zoltan Toth
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Debrecen Medical and Health Science Centre, Nagyerdei korut 98, 4032, Debrecen, Hungary
| | - Robert Poka
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Debrecen Medical and Health Science Centre, Nagyerdei korut 98, 4032, Debrecen, Hungary
| | - Nandor Gabor Than
- Systems Biology of Reproduction Lendulet Research Group, Institute of Enzymology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Magyar Tudosok krt. 2, 1117, Budapest, Hungary; Maternity Private Clinic of Obstetrics and Gynecology, Kiralyhago ter 8, 1126, Budapest, Hungary; First Department of Pathology and Experimental Cancer Research, Semmelweis University, Ulloi ut 26, 1085, Budapest, Hungary.
| | - Olga Torok
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Debrecen Medical and Health Science Centre, Nagyerdei korut 98, 4032, Debrecen, Hungary.
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Extra-adrenal paraganglioma masquerading as severe preeclampsia. Obstet Gynecol Sci 2018; 61:520-523. [PMID: 30018907 PMCID: PMC6046359 DOI: 10.5468/ogs.2018.61.4.520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/15/2017] [Accepted: 08/16/2017] [Indexed: 12/29/2022] Open
Abstract
Paraganglioma in pregnancy is an extremely rare condition and its diagnosis is often delayed because the clinical symptoms can mimic those of preeclampsia or gestational hypertension. Here, we report the case of a 32-year-old, gravida 2, para 1 woman who presented with severe headache, palpitation, and sweating at 37 weeks' gestation. Although emergent cesarean section was performed on the assumption of severe preeclampsia, blood pressure fluctuated and heart rate remained tachycardiac. We suspected that she might have thromboembolic lesion in the chest or pheochromocytoma. Chest and abdominal computed tomography revealed a 4 cm mass in the left para-aortic space. Serum and urinary catecholamine levels were found to be significantly increased. She underwent laparoscopic mass removal and the pathology confirmed paraganglioma. When typical paroxysmal hypertension is accompanied by headache, palpitation, and sweating during pregnancy, adrenal tumors should be considered.
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Abstract
In pregnancy, there are numerous changes which occur to accommodate the needs of both the fetus and placenta. These changes present us with a unique set of clinical challenges particularly in the setting of any disease processes occurring during pregnancy. It is essential to understand that the systems profoundly affected are the cardiovascular and renal systems. The most predominant disease process occurring in pregnancy affecting both the cardiovascular and renal system is the spectrum of hypertensive disorders specifically pre-eclampsia. Due to its high incidence worldwide, it is considered as the most common cause of infant and maternal morbidity and mortality. While the international definition, classification scheme and diagnostic criteria for Hypertensive Disorders of Pregnancy still must be agreed upon, hypertension has been the mandatory feature for all established guidelines. Pre-eclampsia particularly the severe form which is recognized as HELLP (Hemolysis, Elevated Liver enzymes and Low Platelet count) syndrome is the primary cause of acute kidney injury in pregnancy. In this review, we would primarily discuss the hemodynamic and vascular changes, anatomical and physiologic renal adaptations occurring during normal pregnancy and the complications which arise in the setting of hypertensive diseases. Mainly focusing on the pre-eclampsia spectrum, since knowledge of these is of clinical importance not only in understanding its role in the disease process but more so its implications for prevention, screening, diagnosis, and management.
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Pre-Eclampsia and Eclampsia: An Update on the Pharmacological Treatment Applied in Portugal. J Cardiovasc Dev Dis 2018; 5:jcdd5010003. [PMID: 29367581 PMCID: PMC5872351 DOI: 10.3390/jcdd5010003] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/09/2018] [Accepted: 01/14/2018] [Indexed: 12/13/2022] Open
Abstract
Pre-eclampsia and eclampsia are two hypertensive disorders of pregnancy, considered major causes of maternal and perinatal death worldwide. Pre-eclampsia is a multisystemic disease characterized by the development of hypertension after 20 weeks of gestation, with the presence of proteinuria or, in its absence, of signs or symptoms indicative of target organ injury. Eclampsia represents the consequence of brain injuries caused by pre-eclampsia. The correct diagnosis and classification of the disease are essential, since the therapies for the mild and severe forms of pre-eclampsia are different. Thus, this review aims to describe the most advisable antepartum pharmacotherapy for pre-eclampsia and eclampsia applied in Portugal and based on several national and international available guidelines. Slow-release nifedipine is the most recommended drug for mild pre-eclampsia, and labetalol is the drug of choice for the severe form of the disease. Magnesium sulfate is used to prevent seizures caused by eclampsia. Corticosteroids are used for fetal lung maturation. Overall, the pharmacological prevention of these diseases is limited to low-dose aspirin, so it is important to establish the safest and most effective available treatment.
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Polymorphism of ERCC1 rs3212986 in Chinese Han women with preeclampsia. Pregnancy Hypertens 2017; 10:192-195. [PMID: 29153678 DOI: 10.1016/j.preghy.2017.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 08/13/2017] [Accepted: 08/26/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the association between polymorphism of rs3212986 in ERCC1 and susceptibility to preeclampsia in the Chinese Han population. STUDY DESIGN Samples of 642 preeclampsia patients and 877 controls were genotyped for rs3212986 using TaqMan allele discrimination assays. The genetic and allelic distributions between the groups were compared by Pearson's χ2 test. RESULT There was no difference in the genotypic and allelic distributions between cases and controls (P>0.05). Statistical difference in genotypic frequencies of rs3212986 was observed between early-onset and late-onset preeclampsia (χ2=6.985, P=0.030). When subdivided into TT/GG+GT groups, a significant difference was found between early-onset and late-onset preeclampsia (χ2=6.528, P=0.011, OR=2.011, 95%CI 1.167-3.465). CONCLUSION The polymorphisms of rs3212986 showed no association with the risk of preeclampsia in the Chinese Han population. However, the difference in the genotypic distribution between early-onset and late-onset preeclampsia suggest the need for future studies.
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