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Scioscia M, Siwetz M, Robillard PY, Brizzi A, Huppertz B. Placenta and maternal endothelium during preeclampsia: Disruption of the glycocalyx explains increased inositol phosphoglycans and angiogenic factors in maternal blood. J Reprod Immunol 2023; 160:104161. [PMID: 37857160 DOI: 10.1016/j.jri.2023.104161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/10/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023]
Abstract
The etiology of the pregnancy syndrome preeclampsia is still unclear, while most hypotheses center on the placenta as the major contributor of the syndrome. Especially changes of the placental metabolism, including the use of glucose to produce energy, are important features. As an example, inositol phosphoglycan P-type molecules, second messengers involved in the glucose metabolism of all cells, can be retrieved from maternal urine of preeclamptic women, even before the onset of clinical symptoms. Alterations in the placental metabolism may subsequently lead to negative effects on the plasma membrane of the placental syncytiotrophoblast. This in turn may have deleterious effects on the glycocalyx of this layer and a disruption of this layer in all types of preeclampsia. The interruption of the glycocalyx in preeclampsia may result in changes of inositol phosphoglycan P-type signaling pathways and the release of these molecules as well as the release of soluble receptors such as sFlt-1 and sEndoglin. The release of placental factors later affects the maternal endothelium and disrupts the endothelial glycocalyx as well. This in turn may pave the way for edema, endothelial dysfunction, coagulation, all typical symptoms of preeclampsia.
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Affiliation(s)
- Marco Scioscia
- Department of Obstetrics and Gynecology, Mater Dei Hospital, Via SF Hahnemann 10, 70125 Bari, Italy.
| | - Monika Siwetz
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria
| | - Pierre-Yves Robillard
- Centre d'Études Périnatales Océan Indien, Centre Hospitalier Universitaire Sud Réunion, Saint-Pierre, La Réunion, France; Service de Néonatologie, Centre Hospitalier Universitaire Sud Réunion, Saint-Pierre, La Réunion, France, Centre Hospitalier Universitaire Sud Réunion, Saint-Pierre, La Réunion, France
| | - Agostino Brizzi
- General and Locoregional Anesthesia Department, Santa Maria Clinic, Via A de Ferrariis, 22, 70124 Bari, Italy
| | - Berthold Huppertz
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria
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Watkins OC, Yong HEJ, Sharma N, Chan SY. A review of the role of inositols in conditions of insulin dysregulation and in uncomplicated and pathological pregnancy. Crit Rev Food Sci Nutr 2020; 62:1626-1673. [PMID: 33280430 DOI: 10.1080/10408398.2020.1845604] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Inositols, a group of 6-carbon polyols, are highly bioactive molecules derived from diet and endogenous synthesis. Inositols and their derivatives are involved in glucose and lipid metabolism and participate in insulin-signaling, with perturbations in inositol processing being associated with conditions involving insulin resistance, dysglycemia and dyslipidemia such as polycystic ovary syndrome and diabetes. Pregnancy is similarly characterized by substantial and complex changes in glycemic and lipidomic regulation as part of maternal adaptation and is also associated with physiological alterations in inositol processing. Disruptions in maternal adaptation are postulated to have a critical pathophysiological role in pregnancy complications such as gestational diabetes and pre-eclampsia. Inositol supplementation has shown promise as an intervention for the alleviation of symptoms in conditions of insulin resistance and for gestational diabetes prevention. However, the mechanisms behind these affects are not fully understood. In this review, we explore the role of inositols in conditions of insulin dysregulation and in pregnancy, and identify priority areas for research. We particularly examine the role and function of inositols within the maternal-placental-fetal axis in both uncomplicated and pathological pregnancies. We also discuss how inositols may mediate maternal-placental-fetal cross-talk, and regulate fetal growth and development, and suggest that inositols play a vital role in promoting healthy pregnancy.
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Affiliation(s)
- Oliver C Watkins
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hannah E J Yong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Neha Sharma
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shiao-Yng Chan
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
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Increased BMI has a linear association with late-onset preeclampsia: A population-based study. PLoS One 2019; 14:e0223888. [PMID: 31622409 PMCID: PMC6797165 DOI: 10.1371/journal.pone.0223888] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/01/2019] [Indexed: 12/12/2022] Open
Abstract
Background To investigate the ongoing controversy on the effect of BMI (body mass index) on EOP (early onset preeclampsia) vs LOP (late onset), especially focusing on diabetes and maternal booking/pre-pregnancy BMI as possible independent variables. Methods 18 year-observational cohort study (2001–2018). The study population consisted of all consecutive births delivered at the Centre Hospitalier Universitaire Hospitalier Sud Reunion’s maternity (ap. 4,300 birth per year, only level 3 maternity in the south of Reunion Island, sole allowed to follow and deliver all preeclampsia cases of the area). History of pregnancies, deliveries and neonatal outcomes have been collected in standardized fashion into an epidemiological perinatal data base. Results Chronic hypertension and, history of preeclampsia in multigravidas, were the strongest risk factors for EOP. Primiparity, age over 35 years and BMI ≥ 35 kg/m² were rather associated with LOP. In a multivariate analysis with EOP or LOP as outcome variables compared with controls (normotensive), maternal age and pre-pregnancy BMI were independent risk factors for both EOP and LOP (p < 0.001). However, analyzing by increment of 5 (years of age, kg/m² for BMI) rising maternal ages and incidence of preeclampsia were strictly parallel for EOP and LOP, while increment of BMI was only associated with LOP. Controlling for maternal ages and booking/pre-pregnancy BMI, diabetes was not an independent risk factor neither for EOP or LOP. Conclusions Metabolic factors, other than diabetes, associated with pre-pregnancy maternal corpulence are specifically associated with LOP. This may be a direction for future researches on the maternal preeclamptic syndrome. This may explain the discrepancy we are facing nowadays where high-income countries report 90% of their preeclampsia being LOP, while it is only 60–70% in medium-low income countries.
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Scioscia M, Noventa M, Cavallin F, Straface G, Pontrelli G, Fattizzi N, Libera M, Rademacher TW, Robillard PY. Exploring strengths and limits of urinary D-chiro inositol phosphoglycans (IPG-P) as a screening test for preeclampsia: A systematic review and meta-analysis. J Reprod Immunol 2019; 134-135:21-27. [PMID: 31382126 DOI: 10.1016/j.jri.2019.07.005] [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: 04/09/2019] [Revised: 05/30/2019] [Accepted: 07/25/2019] [Indexed: 12/24/2022]
Abstract
Preeclampsia is a severe complication of human pregnancy as it leads to significant maternal and perinatal mortality and morbidity worldwide. A prompt recognition of women that develop this syndrome can improve clinical management, increase surveillance and, finally, improve outcomes. Different methods (based on history, ultrasound, serum and urinary biomarkers) were proposed a screening tests for this disease but their performance showed limited results. Urinary inositol phosphoglycans P-type (IPG-P) were shown to identify in advance most of the women who will develop preeclampsia in case-control and longitudinal studies, so we undertook a systematic review and meta-analysis of published studies. Seven studies met the entry criteria so were evaluated. All case-control studies showed excellent statistical performances in a quality statistical assessment. The meta-analysis considered three longitudinal, prospective studies that showed high sensitivity and specificity with ranges of 0.82- 0.99 and 0.90-1.00, respectively. Univariate measures of accuracy revealed a positive and negative likelihood ratio respectively of 3.61 (95% CI 1.56-5.67) and -2.35 (95% CI -3.79 to -0.91). By univariate approach, we found a pooled logarithm of diagnostic odds ratio of 6.15 (95% CI 2.64-9.67). A limitation of this analysis is that, although conducted in different settings (UK, Italy, France, South Africa, and Mauritius) and different clinical groups, they were based on a single academic group. According to our findings, IPG-P test showed very encouraging results as a rapid noninvasive screening test for preeclampsia. Further studies are needed to verify and to validate the reported findings.
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Affiliation(s)
- Marco Scioscia
- Department of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Padua, Italy.
| | - Marco Noventa
- Department of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Padua, Italy
| | | | - Gianluca Straface
- Department of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Padua, Italy
| | - Giovanni Pontrelli
- Department of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Padua, Italy
| | - Nicola Fattizzi
- Department of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Padua, Italy
| | - Marco Libera
- Department of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Padua, Italy
| | - Thomas W Rademacher
- Division of Infection and Immunity, University College London Medical School, London, United Kingdom, Middlesex University, London, United Kingdom
| | - Pierre-Yves Robillard
- Service de Réanimation Néonatale, Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre, France
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Stojanovska V, Dijkstra DJ, Vogtmann R, Gellhaus A, Scherjon SA, Plösch T. A double-hit pre-eclampsia model results in sex-specific growth restriction patterns. Dis Model Mech 2019; 12:dmm.035980. [PMID: 30683649 PMCID: PMC6398487 DOI: 10.1242/dmm.035980] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 01/09/2019] [Indexed: 12/29/2022] Open
Abstract
Pre-eclampsia is a multifactorial pregnancy-associated disorder characterized by angiogenic dysbalance and systemic inflammation; however, animal models that combine these two pathophysiological conditions are missing. Here, we introduce a novel double-hit pre-eclampsia mouse model that mimics the complex multifactorial conditions present during pre-eclampsia and allows for the investigation of early consequences for the fetus. Adenoviral overexpression of soluble fms-like tyrosine kinase (sFlt-1) and lipopolysaccharide (LPS) administration at mid-gestation in pregnant mice resulted in hypertension and albuminuria comparable to that of the manifestation in humans. A metabolomics analysis revealed that pre-eclamptic dams have increased plasma concentrations of phosphadytilcholines. The fetuses of both sexes were growth restricted; however, in males a brain-sparing effect was seen as compensation for this growth restriction. According to the plasma metabolomics, male fetuses showed changes in amino acid metabolism, while female fetuses showed pronounced alterations in lipid metabolism. Our results show that combined exposure to sFlt-1 and LPS mimics the clinical symptoms of pre-eclampsia and affects fetal growth in a sex-specific manner, with accompanying metabolome changes.
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Affiliation(s)
- Violeta Stojanovska
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
| | - Dorieke J Dijkstra
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
| | - Rebekka Vogtmann
- Department of Gynecology and Obstetrics, University Hospital Duisburg-Essen, 45147 Essen, Germany
| | - Alexandra Gellhaus
- Department of Gynecology and Obstetrics, University Hospital Duisburg-Essen, 45147 Essen, Germany
| | - Sicco A Scherjon
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
| | - Torsten Plösch
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands
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L'Omelette AD, Dawonauth L, Rademacher L, Robillard PY, Scioscia M, Jankee S, Lee Kwai Yan MY, Razgia JB, Rademacher TW. New insights into early and late onset subgroups of preeclampsia from longitudinal versus cross-sectional analysis of urinary inositol-phosphoglycan P-Type. J Reprod Immunol 2017; 125:64-71. [PMID: 29253795 DOI: 10.1016/j.jri.2017.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/14/2017] [Accepted: 11/28/2017] [Indexed: 12/24/2022]
Abstract
Most pre-eclampsia (PE) studies have used cross-sectional data to derive conclusions regarding the pathophysiology of the condition. This has led to the concept that there exists early (<34 weeks) and late-onset (>34 weeks) disease according to gestational age at diagnosis. Survival time models have predicted that if the pregnancy was to continue indefinitely, all women would develop PE. In this study we have performed a longitudinal analysis of the urinary biomarker, inositol phosphoglycan (IPG), in a cohort of women giving birth in Mauritius (n-920). We have analysed the PE data in the traditional cross-sectional manner for n = 77 women who developed PE and also then looked at the longitudinal data for 71/77 of the same women. The data allows us to use longitudinal values to calculate a date of onset (first presence of biomarker in urine) and compare that to date of clinical diagnosis (cross sectional). We find two populations for both analysis consistent with an early and late stage subgroup. The calculated date of onset had subgroups (early and late) at 28.4 ± 0.41 weeks and 35.37 ± 0.26 weeks and for clinical date of diagnosis, 32.3 ± 0.59 weeks and 37.04 ± 0.62 weeks, respectively. The presence of the same biomarker in both subgroups and its ability to predict clinical onset 2-4 weeks prior to clinical diagnosis suggest that both groups may have similar aetiology.
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Affiliation(s)
| | - Lalita Dawonauth
- Department of Medicine, Faculty of Science, University of Mauritius, Réduit, Mauritius
| | | | - Pierre-Yves Robillard
- Service de Néonatologie, Centre Hospitalier Universitaire Sud Réunion, La Réunion, Saint Pierre, France
| | - Marco Scioscia
- Department of Obstetrics and Gynecology, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Sarojini Jankee
- Department of Medicine, Faculty of Science, University of Mauritius, Réduit, Mauritius
| | - Man Yoon Lee Kwai Yan
- Department of Medicine, Faculty of Science, University of Mauritius, Réduit, Mauritius
| | - Jeeawoody B Razgia
- Department of Medicine, Faculty of Science, University of Mauritius, Réduit, Mauritius
| | - Thomas W Rademacher
- Division of Infection and Immunity, University College London Medical School, London, United Kingdom; Middlesex University, London, United Kingdom
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