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Core D, Vervaeke H, Leethy K, Cooper D, Zoorob D. Eclampsia, HELLP and PRES in a 16-week partial molar pregnancy. BMJ Case Rep 2024; 17:e258188. [PMID: 38890113 PMCID: PMC11191011 DOI: 10.1136/bcr-2023-258188] [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] [Accepted: 04/10/2024] [Indexed: 06/20/2024] Open
Abstract
Eclampsia spectrum disorders are a set of serious complications of pregnancy that commonly present after 20 weeks of gestation. There is an association between molar pregnancy, a gestational trophoblastic disease resulting from abnormal fertilisation and gametogenesis, and eclampsia spectrum disorders which can result in manifestation of pre-eclamptic symptomatology earlier than 20 weeks of gestation. We report a case of a gravida 1 para 0 in her mid 20s at 16-weeks gestation presenting with partial hydatidiform mole who developed eclampsia, haemolysis, elevated liver enzymes and low platelets syndrome and posterior reversible encephalopathy syndrome. Ultrasound findings were consistent with molar pregnancy and pathology confirmed partial molar pregnancy with triploid 69, XYY karyotype. This case highlights the early onset potential of eclampsia spectrum disorders in molar pregnancies while suggesting screening such patients for hypertensive disorders.
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Affiliation(s)
- Daniel Core
- Obstetrics and Gynecology, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Hayley Vervaeke
- Obstetrics and Gynecology, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Kenna Leethy
- Obstetrics and Gynecology, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Danielle Cooper
- Obstetrics and Gynecology, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Dani Zoorob
- Obstetrics and Gynecology, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
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Graham JJ, Longhi MS, Heneghan MA. T helper cell immunity in pregnancy and influence on autoimmune disease progression. J Autoimmun 2021; 121:102651. [PMID: 34020252 PMCID: PMC8221281 DOI: 10.1016/j.jaut.2021.102651] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/30/2021] [Accepted: 05/02/2021] [Indexed: 02/07/2023]
Abstract
Pregnancy presents the maternal immune system with a unique immunological challenge since it has to defend against pathogens while tolerating paternal allo-antigens expressed by fetal tissues. T helper (Th) cells play a central role in modulating immune responses and recent advances have defined distinct contributions of various Th cell subsets throughout each phase of human pregnancy, while dysregulation in Th responses show association with multiple obstetrical complications. In addition to localized decidual mechanisms, modulation of Th cell immunity during gestation is mediated largely by oscillations in sex hormone concentrations. Aberrant Th cell responses also underlie several autoimmune disorders while pregnancy-induced changes in the balance of Th cell immunity has been shown to exert favorable outcomes in the progression Th1 and Th17 driven autoimmune conditions only to be followed by post-partal exacerbations in disease.
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Affiliation(s)
- Jonathon J Graham
- Institute of Liver Studies, King's College Hospital, London, SE5 9RS, United Kingdom
| | - Maria Serena Longhi
- Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Michael A Heneghan
- Institute of Liver Studies, King's College Hospital, London, SE5 9RS, United Kingdom.
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Adu-Gyamfi EA, Czika A, Gorleku PN, Ullah A, Panhwar Z, Ruan LL, Ding YB, Wang YX. The Involvement of Cell Adhesion Molecules, Tight Junctions, and Gap Junctions in Human Placentation. Reprod Sci 2020; 28:305-320. [PMID: 33146876 DOI: 10.1007/s43032-020-00364-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023]
Abstract
Placentation is a major determinant of the success of pregnancy. It is regulated by several factors such as cell adhesion molecules, tight junctions, and gap junctions. The cell adhesion molecules are integrins, cadherins, immunoglobulins, nectins, and selectins. The tight junctions are composed of claudins, occludin, and junction adhesion molecule proteins while the gap junctions are composed of connexins of varying molecular weights. During placentation, some of these molecules regulate trophoblast proliferation, trophoblast fusion, trophoblast migration, trophoblast invasion, trophoblast-endothelium adhesion, glandular remodeling, and spiral artery remodeling. There is a dysregulated placental expression of some of these molecules during obstetric complications. We have, hereby, indicated the expression patterns of the subunits of each of these molecules in the various trophoblast subtypes and in the decidua, and have highlighted their involvement in physiological and pathological placentation. The available evidence points to the relevance of these molecules as distinguishing markers of the various trophoblast lineages and as potential therapeutic targets in the management of malplacentation-mediated diseases.
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Affiliation(s)
- Enoch Appiah Adu-Gyamfi
- Department of Reproductive Sciences, School of Basic Medicine, Chongqing Medical University, Chongqing, 400016, People's Republic of China.
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, Box 197, No. 1 Yixueyuan Rd, Chongqing, 400016, People's Republic of China.
| | - Armin Czika
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, Box 197, No. 1 Yixueyuan Rd, Chongqing, 400016, People's Republic of China
| | - Philip Narteh Gorleku
- Department of Medical Imaging, School of Medical Sciences, University of Cape Coast, Cape Coast, Republic of Ghana
| | - Amin Ullah
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, Box 197, No. 1 Yixueyuan Rd, Chongqing, 400016, People's Republic of China
| | - Zulqarnain Panhwar
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, Box 197, No. 1 Yixueyuan Rd, Chongqing, 400016, People's Republic of China
| | - Ling-Ling Ruan
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, Box 197, No. 1 Yixueyuan Rd, Chongqing, 400016, People's Republic of China
| | - Yu-Bin Ding
- Department of Reproductive Sciences, School of Basic Medicine, Chongqing Medical University, Chongqing, 400016, People's Republic of China.
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, Box 197, No. 1 Yixueyuan Rd, Chongqing, 400016, People's Republic of China.
| | - Ying-Xiong Wang
- Department of Reproductive Sciences, School of Basic Medicine, Chongqing Medical University, Chongqing, 400016, People's Republic of China.
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, Box 197, No. 1 Yixueyuan Rd, Chongqing, 400016, People's Republic of China.
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Abstract
PURPOSE OF REVIEW Preeclampsia and chronic kidney disease have a complex, bidirectional relationship. Women with kidney disease, with even mild reductions in glomerular filtrate rate, have an increased risk of developing preeclampsia. Preeclampsia, in turn, has been implicated in the subsequent development of albuminuria, chronic kidney disease, and end-stage kidney disease. We will discuss observational evidence and mechanisms linking the two disease processes. RECENT FINDINGS Preeclampsia is characterized by an imbalance in angiogenic factors that causes systemic endothelial dysfunction. Chronic kidney disease may predispose to the development of preeclampsia due to comorbid conditions, such as hypertension, but is also associated with impaired glycocalyx integrity and alterations in the complement and renin-angiotensin-aldosterone systems. Preeclampsia may lead to kidney disease by causing acute kidney injury, endothelial damage, and podocyte loss. Preeclampsia may be an important sex-specific risk factor for chronic kidney disease. Understanding how chronic kidney disease increases the risk of preeclampsia from a mechanistic standpoint may open the door to future biomarkers and therapeutics for all women.
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Cross-Talk between Oxidative Stress and Inflammation in Preeclampsia. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:8238727. [PMID: 31781353 PMCID: PMC6875353 DOI: 10.1155/2019/8238727] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 09/09/2019] [Indexed: 01/09/2023]
Abstract
The occurrence of hypertensive syndromes during pregnancy leads to high rates of maternal-fetal morbidity and mortality. Amongst them, preeclampsia (PE) is one of the most common. This review aims to describe the relationship between oxidative stress and inflammation in PE, aiming to reinforce its importance in the context of the disease and to discuss perspectives on clinical and nutritional treatment, in this line of research. Despite the still incomplete understanding of the pathophysiology of PE, it is well accepted that there are placental changes in pregnancy, associated with an imbalance between the production of reactive oxygen species and the antioxidant defence system, characterizing the placental oxidative stress that leads to an increase in the production of proinflammatory cytokines. Hence, a generalized inflammatory process occurs, besides the presence of progressive vascular endothelial damage, leading to the dysfunction of the placenta. There is no consensus in the literature on the best strategies for prevention and treatment of the disease, especially for the control of oxidative stress and inflammation. In view of the above, it is evident the important connection between oxidative stress and inflammatory process in the pathogenesis of PE, being that this disease is capable of causing serious implications on both maternal and fetal health. Reports on the use of anti-inflammatory and antioxidant compounds are analysed and still considered controversial. As such, the field is open for new basic and clinical research, aiming the development of innovative therapeutic approaches to prevent and to treat PE.
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Yin Y, Feng Y, Zhao H, Zhao Z, Yua H, Xu J, Che H. SIRT1 inhibits releases of HMGB1 and HSP70 from human umbilical vein endothelial cells caused by IL-6 and the serum from a preeclampsia patient and protects the cells from death. Biomed Pharmacother 2017; 88:449-458. [DOI: 10.1016/j.biopha.2017.01.087] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 01/04/2017] [Accepted: 01/14/2017] [Indexed: 12/29/2022] Open
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