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Hu M, Li J, Baker PN, Tong C. Revisiting preeclampsia: a metabolic disorder of the placenta. FEBS J 2021; 289:336-354. [PMID: 33529475 DOI: 10.1111/febs.15745] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/13/2021] [Accepted: 01/29/2021] [Indexed: 12/31/2022]
Abstract
Preeclampsia (PE) is a leading cause of maternal and neonatal mortality and morbidity worldwide, impacting the long-term health of both mother and offspring. PE has long been characterized by deficient trophoblast invasion into the uterus and consequent placental hypoperfusion, yet the upstream causative factors and effective interventional targets for PE remain unknown. Alterations in the metabolism of preeclamptic placentas are thought to result from placental ischemia, while disturbances of the metabolism and of metabolites in PE pathogenesis are largely ignored. In fact, as one of the largest fetal organs at birth, the placenta consumes a considerable amount of glucose and fatty acid. Increasing evidence suggests glucose and fatty acid exist as energy substrates and regulate placental development through bioactive derivates. Moreover, recent findings have revealed that the placental metabolism adapts readily to environmental changes, altering its response to nutrients and endocrine signals; this adaptability optimizes pregnancy outcomes by diversifying available carbon sources for energy production, hormone synthesis, angiogenesis, immune activation, and tolerance, and fetoplacental growth. These observations raise the possibility that carbohydrate and lipid metabolism abnormalities play a role in both the etiology and clinical progression of PE, sparking a renewed interest in the interrelationship between PE and metabolic dysregulation. This review will focus on key metabolic substrates and regulatory molecules in the placenta and aim to provide novel insights with respect to the metabolism's role in modulating placental development and functions. Further investigations from this perspective are poised to decipher the etiology of PE and suggest potential therapies.
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Affiliation(s)
- Mingyu Hu
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, China
| | - Ji Li
- Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | | | - Chao Tong
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, China
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Godhamgaonkar AA, Wadhwani NS, Joshi SR. Exploring the role of LC-PUFA metabolism in pregnancy complications. Prostaglandins Leukot Essent Fatty Acids 2020; 163:102203. [PMID: 33227645 DOI: 10.1016/j.plefa.2020.102203] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/09/2020] [Accepted: 11/07/2020] [Indexed: 12/14/2022]
Abstract
Maternal nutrition during pregnancy plays a significant role in growth and development of the placenta and influencing pregnancy outcome. Suboptimal nutritional status during early gestational period compromises the normal course of pregnancy leading to adverse maternal and fetal outcomes. Omega-3 and omega-6 long chain polyunsaturated fatty acids (LC-PUFA) are important for the growth and development of the placenta. Maternal fatty acids and their metabolites influence the normal course of pregnancy by regulating cell growth and development, cell signaling, regulate angiogenesis, modulate inflammatory responses and influence various structural and functional processes. Alterations in LC-PUFA and their metabolites may result in inadequate spiral artery remodeling or placental angiogenesis leading to structural and functional deficiency of the placenta which contributes to several pregnancy complications like preeclampsia, gestational diabetes mellitus, intrauterine growth restriction, and results in adverse birth outcomes. In this review, we summarize studies examining the role of fatty acids and their metabolites in pregnancy. We also discuss the possible molecular mechanisms through which LC-PUFA influences placental growth and development. Studies have demonstrated that omega-3 fatty acid supplementation lowers the incidence of preterm births, but its effect on reducing pregnancy complications are inconclusive.
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Affiliation(s)
- Aditi A Godhamgaonkar
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune-Satara Road, Pune 411043, India
| | - Nisha S Wadhwani
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune-Satara Road, Pune 411043, India
| | - Sadhana R Joshi
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune-Satara Road, Pune 411043, India.
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Basak S, Vilasagaram S, Duttaroy AK. Maternal dietary deficiency of n-3 fatty acids affects metabolic and epigenetic phenotypes of the developing fetus. Prostaglandins Leukot Essent Fatty Acids 2020; 158:102109. [PMID: 32474355 DOI: 10.1016/j.plefa.2020.102109] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/13/2020] [Indexed: 02/07/2023]
Abstract
Polyunsaturated fatty acids (PUFAs) play multiple physiological roles. They regulate the structure and function of cell membranes and cell growth and proliferation, and apoptosis. In addition, PUFAs are involved in cellular signaling, gene expression and serve as precursors to second messengers such as eicosanoids, docosanoids etc. and regulate several physiological processes including placentation, inflammation, immunity, angiogenesis, platelet function, synaptic plasticity, neurogenesis, bone formation, energy homeostasis, pain sensitivity, stress, and cognitive functions. Linoleic acid, 18:2n-6 (LA) and alpha-linolenic acid, 18:3n-3 (ALA) are the two essential fatty acids obtained from the diets and subsequently their long-chain polyunsaturated fatty acids (LCPUFAs) are accumulated in the body. The maternal plasma LCPUFAs especially accumulated in larger amounts in the brain during the third trimester of pregnancy via the placenta and postnatally from mother's breast milk. Various studies, including ours, suggest PUFA's important role in placentation, as well as in growth and development of the offspring. However, intakes of maternal n-3 PUFAs during pregnancy and lactation are much lower in India compared with the Western population. In India, n-3 fatty acid status is further reduced by higher intake of n-6 PUFA rich oils and trans fats. More data on the impacts of long term maternal n-3 PUFA deficiency on placental structure and function, gene expression, epigenetic changes and resultant cognitive function of fetus & infants are emerging. This review summarizes the impacts of n-3 PUFA deficiency in utero on fetal growth and development, adiposity, energy metabolism, musculoskeletal development, and epigenetic changes in feto-placental axis from the recently available pre-clinical and clinical data.
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Affiliation(s)
- Sanjay Basak
- Molecular Biology Division, National Institute of Nutrition, Indian Council of Medical Research, Hyderabad 500007, India.
| | - Srinivas Vilasagaram
- Molecular Biology Division, National Institute of Nutrition, Indian Council of Medical Research, Hyderabad 500007, India
| | - Asim K Duttaroy
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
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Rani A, Chavan-Gautam P, Mehendale S, Wagh G, Mani NS, Joshi S. Region-specific changes in the mRNA and protein expression of LCPUFA biosynthesis enzymes and transporters in the placentae of women with preeclampsia. Placenta 2020; 95:33-43. [PMID: 32452400 DOI: 10.1016/j.placenta.2020.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/14/2020] [Accepted: 04/20/2020] [Indexed: 12/15/2022]
Abstract
The biosynthesis and transport of long chain polyunsaturated fatty acids (LCPUFA) require the activity of fatty acid desaturase (FADS) enzymes, fatty acid transport proteins (FATP) and fatty acid binding proteins (FABP). In a previous study we have demonstrated region-specific changes in the LCPUFA levels in preeclampsia (PE) as compared to the normotensive control (NC) placentae. AIM To understand the region-specific changes in the mRNA levels and protein expression of biosynthesis enzymes and transporters of LCPUFA in PE and NC placentae. METHODS In this cross-sectional study, 20 NC women and 44 women with PE (23 term (TPE) and 21 preterm PE (PTPE)) were recruited. The samples were collected from four regions of the placentae considering cord insertion as the center (CM, central maternal/basal; CF, central fetal/chorionic; PM, peripheral maternal/basal and PF, peripheral fetal/chorionic). The mRNA levels were estimated using qRT-PCR. Statistical analysis was done using both post hoc least significant difference (LSD) test and Benjamini Hochberg correction in the analysis of covariance. Preliminarily, localization and expression of proteins were studied by immunohistochemistry (n = 3/group). RESULTS The mRNA levels of FADS1, FADS2 and FATP1 were lower in the central regions (CM and CF) of the PE placentae (both TPE and PTPE) as compared to NC. These differences in the mRNA levels were observed by the LSD test and were not significant after the Benjamini Hochberg correction. Preliminary findings of IHC indicate that the protein expression of FADS1 and FATP4 was higher in the basal regions (CM and PM) of the PE placentae as compared to NC. FADS1, FADS2 and FATP4 proteins were localized in the syncytiotrophoblasts, cytotrophoblasts, mesenchymal cells, endothelial cells of the fetal capillaries and extravillous trophoblasts of the placenta. CONCLUSION FADS enzymes are detected in the placentae of Indian women. In PE placentae, there are region-specific alterations in the mRNA and protein levels of LCPUFA biosynthesis enzymes (FADS1 and FADS2) and transporters (FATP1, FATP4 and FABP3) as compared to term NC. These changes were more pronounced toward the basal side and region around the cord insertion.
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Affiliation(s)
- Alka Rani
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Preeti Chavan-Gautam
- Interdisciplinary School of Health Science, Savitribai Phule Pune University, Pune, India
| | - Savita Mehendale
- Department of Obstetrics and Gynaecology, Bharati Vidyapeeth (Deemed to be University) Medical College and Bharati Hospital, Pune, India
| | - Girija Wagh
- Department of Obstetrics and Gynaecology, Bharati Vidyapeeth (Deemed to be University) Medical College and Bharati Hospital, Pune, India
| | | | - Sadhana Joshi
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune, India.
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Maternal Omega-3 Nutrition, Placental Transfer and Fetal Brain Development in Gestational Diabetes and Preeclampsia. Nutrients 2019; 11:nu11051107. [PMID: 31109059 PMCID: PMC6567027 DOI: 10.3390/nu11051107] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/10/2019] [Accepted: 05/14/2019] [Indexed: 02/07/2023] Open
Abstract
Omega-3 fatty acids, particularly docosahexaenoic fatty acid (DHA), are widely recognized to impact fetal and infant neurodevelopment. The impact of DHA on brain development, and its inefficient synthesis from the essential alpha-linolenic acid (ALA), has led to recommended DHA intakes of 250-375 mg eicosapentaenoic acid + DHA/day for pregnant and lactating women by the Dietary Guidelines for Americans. Despite these recommendations, the intake of omega-3s in women of child-bearing age in the US remains very low. The low maternal status of DHA prior to pregnancy could impair fetal neurodevelopment. This review focuses on maternal omega-3 status in conditions of gestational diabetes mellitus (GDM) and preeclampsia, and the subsequent impact on placental transfer and cord blood concentration of omega-3s. Both GDM and preeclampsia are associated with altered maternal omega-3 status, altered placental omega-3 metabolism, reduced cord blood omega-3 levels and have an impact on neurodevelopment in the infant and on brain health later in life. These findings indicate lower DHA exposure of the developing baby may be driven by lower placental transfer in both conditions. Thus, determining approaches which facilitate increased delivery of DHA during pregnancy and early development might positively impact brain development in infants born to mothers with these diseases.
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Chavan-Gautam P, Rani A, Freeman DJ. Distribution of Fatty Acids and Lipids During Pregnancy. Adv Clin Chem 2018; 84:209-239. [PMID: 29478515 DOI: 10.1016/bs.acc.2017.12.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Maternal fatty acid and lipid metabolism undergoes changes during pregnancy to facilitate fetal growth and development. Different types of fatty acids have different roles in maintaining a successful pregnancy and they are incorporated into different forms of lipids for the purpose of storage and transport. This chapter aims to provide an understanding of the distribution and metabolism of fatty acids and lipids in the maternal, placental, and fetal compartments. We further describe how this distribution is altered in maternal obesity, preterm birth, and pregnancy complications such as gestational diabetes mellitus, preeclampsia, and intrauterine growth restriction.
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Affiliation(s)
- Preeti Chavan-Gautam
- Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth Deemed University, Pune, Maharashtra, India.
| | - Alka Rani
- Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth Deemed University, Pune, Maharashtra, India
| | - Dilys J Freeman
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
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Burchakov DI, Kuznetsova IV, Uspenskaya YB. Omega-3 Long-Chain Polyunsaturated Fatty Acids and Preeclampsia: Trials Say "No," but Is It the Final Word? Nutrients 2017; 9:E1364. [PMID: 29244779 PMCID: PMC5748814 DOI: 10.3390/nu9121364] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 02/04/2023] Open
Abstract
Preeclampsia is a dangerous disorder of pregnancy, defined as hypertension with proteinuria. Its nature remains elusive, and measures of prevention and treatment are limited. Observational studies have suggested that preeclampsia is associated with low intake of omega-3 long-chain polyunsaturated fatty acids (LCPUFA). In recent decades, researchers studied LCPUFA supplementation as a measure to prevent preeclampsia. Most of these trials and later systematic reviews yielded negative results. However, these trials had several important limitations associated with heterogeneity and other issues. Recent research suggests that preeclampsia trials should take into consideration the gender of the fetus (and thus sexual dimorphism of placenta), the positive effect of smoking on preeclampsia prevalence, and the possibility that high doses of LCPUFA mid-term or later may promote the disorder instead of keeping it at bay. In this review, we discuss these issues and future prospects for LCPUFA in preeclampsia research.
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Affiliation(s)
- Denis I Burchakov
- Clinic of Obstetrics and Gynecology n.a. V.F. Snegirev, Department of Obstetrics and Gynecology No. 1, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8-2 Trubetskaya st., 119991 Moscow, Russia.
| | - Irina V Kuznetsova
- Clinic of Obstetrics and Gynecology n.a. V.F. Snegirev, Department of Obstetrics and Gynecology No. 1, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8-2 Trubetskaya st., 119991 Moscow, Russia.
| | - Yuliya B Uspenskaya
- Clinic of Obstetrics and Gynecology n.a. V.F. Snegirev, Department of Obstetrics and Gynecology No. 1, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8-2 Trubetskaya st., 119991 Moscow, Russia.
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Brien M, Berthiaume L, Rudkowska I, Julien P, Bilodeau JF. Placental dimethyl acetal fatty acid derivatives are elevated in preeclampsia. Placenta 2017; 51:82-88. [PMID: 28292473 DOI: 10.1016/j.placenta.2017.01.129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/13/2017] [Accepted: 01/31/2017] [Indexed: 12/31/2022]
Abstract
Preeclampsia (PE) was shown to affect the placental content and the transfer of polyunsaturated fatty acids (PUFA) to the fetus. Plasmalogens, a type of phospholipids with a vinyl-ether link at the sn-1 position, play an antioxidant role and are specifically enriched in PUFA at the sn-2 position. In this study, we characterized plasmalogen-derived dimethyl acetal (DMA) fatty acid derivatives, 16:0 DMA, 18:0 DMA, 9c-/11c-18:1 DMA and PUFA in the placenta of normotensive (n = 20) and PE (n = 20) pregnancies, according to the sampling site: peri-insertion or periphery. Phospholipid fatty acids from the placenta and maternal erythrocytes were identified by gas chromatography mass spectrometry and quantified by flame ionization detection. We found elevated total DMA in the PE placenta by 18% when compared to normotensive controls (p = 0.026). Moreover, the 16:0 DMA account for more than 55% of DMA fatty acids measured in the placenta, and its level is significantly higher in PE than controls (p = 0.018). Also, we found elevated placental PUFA, 20:5(n-3), 22:5(n-3) and a low level of 20:4(n-3) in PE compared to controls. Placental DMA was highly correlated with n-6 and n-3 PUFA in both, normotensive and PE pregnancies. In sum, elevated DMA fatty acids in the PE placenta could be an indirect defensive mechanism against oxidative stress and poor placental fatty acid transfer in PE.
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Affiliation(s)
- M Brien
- Axe endocrinologie et néphrologie, Centre de recherche du CHU de Québec-Université Laval, et Centre de recherche en endocrinologie, métabolisme et inflammation (CREMI), Université Laval, Québec G1V 4G2, Canada
| | - L Berthiaume
- Axe endocrinologie et néphrologie, Centre de recherche du CHU de Québec-Université Laval, et Centre de recherche en endocrinologie, métabolisme et inflammation (CREMI), Université Laval, Québec G1V 4G2, Canada
| | - I Rudkowska
- Axe endocrinologie et néphrologie, Centre de recherche du CHU de Québec-Université Laval, et Centre de recherche en endocrinologie, métabolisme et inflammation (CREMI), Université Laval, Québec G1V 4G2, Canada; Département de Kinésiologie, Faculté de médecine, Université Laval, Québec G1K 7P4, Canada
| | - P Julien
- Axe endocrinologie et néphrologie, Centre de recherche du CHU de Québec-Université Laval, et Centre de recherche en endocrinologie, métabolisme et inflammation (CREMI), Université Laval, Québec G1V 4G2, Canada; Département de médecine, Faculté de médecine, Université Laval, Québec G1K 7P4, Canada
| | - J F Bilodeau
- Axe endocrinologie et néphrologie, Centre de recherche du CHU de Québec-Université Laval, et Centre de recherche en endocrinologie, métabolisme et inflammation (CREMI), Université Laval, Québec G1V 4G2, Canada; Département de médecine, Faculté de médecine, Université Laval, Québec G1K 7P4, Canada.
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Rani A, Wadhwani N, Chavan-Gautam P, Joshi S. Altered development and function of the placental regions in preeclampsia and its association with long-chain polyunsaturated fatty acids. WILEY INTERDISCIPLINARY REVIEWS-DEVELOPMENTAL BIOLOGY 2016; 5:582-97. [DOI: 10.1002/wdev.238] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 03/18/2016] [Accepted: 03/29/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Alka Rani
- Department of Nutritional Medicine; Interactive Research School for Health Affairs, Bharati Vidyapeeth University; Pune India
| | - Nisha Wadhwani
- Department of Nutritional Medicine; Interactive Research School for Health Affairs, Bharati Vidyapeeth University; Pune India
| | - Preeti Chavan-Gautam
- Department of Nutritional Medicine; Interactive Research School for Health Affairs, Bharati Vidyapeeth University; Pune India
| | - Sadhana Joshi
- Department of Nutritional Medicine; Interactive Research School for Health Affairs, Bharati Vidyapeeth University; Pune India
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