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Schmidt LJ, Rieger O, Neznansky M, Hackelöer M, Dröge LA, Henrich W, Higgins D, Verlohren S. A machine-learning-based algorithm improves prediction of preeclampsia-associated adverse outcomes. Am J Obstet Gynecol 2022; 227:77.e1-77.e30. [PMID: 35114187 DOI: 10.1016/j.ajog.2022.01.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 12/31/2021] [Accepted: 01/06/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Preeclampsia presents a highly prevalent burden on pregnant women with an estimated incidence of 2% to 5%. Preeclampsia increases the maternal risk of death 20-fold and is one of the main causes of perinatal morbidity and mortality. Novel biomarkers, such as soluble fms-like tyrosine kinase-1 and placental growth factor in addition to a wide span of conventional clinical data (medical history, physical symptoms, laboratory parameters, etc.), present an excellent basis for the application of early-detection machine-learning models. OBJECTIVE This study aimed to develop, train, and test an automated machine-learning model for the prediction of adverse outcomes in patients with suspected preeclampsia. STUDY DESIGN Our real-world dataset of 1647 (2472 samples) women was retrospectively recruited from women who presented to the Department of Obstetrics at the Charité - Universitätsmedizin Berlin, Berlin, Germany, between July 2010 and March 2019. After standardization and data cleaning, we calculated additional features regarding the biomarkers soluble fms-like tyrosine kinase-1 and placental growth factor and sonography data (umbilical artery pulsatility index, middle cerebral artery pulsatility index, mean uterine artery pulsatility index), resulting in a total of 114 features. The target metric was the occurrence of adverse outcomes throughout the remaining pregnancy and 2 weeks after delivery. We trained 2 different models, a gradient-boosted tree and a random forest classifier. Hyperparameter training was performed using a grid search approach. All results were evaluated via a 10 × 10-fold cross-validation regimen. RESULTS We obtained metrics for the 2 naive machine-learning models. A gradient-boosted tree model was performed with a positive predictive value of 88%±6%, a negative predictive value of 89%±3%, a sensitivity of 66%±5%, a specificity of 97%±2%, an overall accuracy of 89%±3%, an area under the receiver operating characteristic curve of 0.82±0.03, an F1 score of 0.76±0.04, and a threat score of 0.61±0.05. The random forest classifier returned an equal positive predictive value (88%±6%) and specificity (97%±1%) while performing slightly inferior on the other available metrics. Applying differential cutoffs instead of a naive cutoff for positive prediction at ≥0.5 for the classifier's results yielded additional increases in performance. CONCLUSION Machine-learning techniques were a valid approach to improve the prediction of adverse outcomes in pregnant women at high risk of preeclampsia vs current clinical standard techniques. Furthermore, we presented an automated system that did not rely on manual tuning or adjustments.
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Affiliation(s)
- Leon J Schmidt
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Rieger
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mark Neznansky
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Max Hackelöer
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health at Charité -Universitätsmedizin Berlin, Berlin, Germany
| | - Lisa A Dröge
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - David Higgins
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charité BIH Innovation, BIH Digital Health Accelerator Program, Berlin, Germany.
| | - Stefan Verlohren
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health at Charité -Universitätsmedizin Berlin, Berlin, Germany.
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Valenzuela-Melgarejo FJ, Lagunas C, Carmona-Pastén F, Jara-Medina K, Delgado G. Supraphysiological Role of Melatonin Over Vascular Dysfunction of Pregnancy, a New Therapeutic Agent? Front Physiol 2021; 12:767684. [PMID: 34867473 PMCID: PMC8635235 DOI: 10.3389/fphys.2021.767684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/07/2021] [Indexed: 11/25/2022] Open
Abstract
Hypertension can be induced by the disruption of factors in blood pressure regulation. This includes several systems such as Neurohumoral, Renin-angiotensin-aldosterone, the Circadian clock, and melatonin production, which can induce elevation and non-dipping blood pressure. Melatonin has a supraphysiological role as a chronobiotic agent and modulates vascular system processes via pro/antiangiogenic factors, inflammation, the immune system, and oxidative stress regulation. An elevation of melatonin production is observed during pregnancy, modulating the placenta and fetus’s physiological functions. Their impairment production can induce temporal desynchronization of cell proliferation, differentiation, or invasion from trophoblast cells results in vascular insufficiencies, elevating the risk of poor fetal/placental development. Several genes are associated with vascular disease and hypertension during pregnancy via impaired inflammatory response, hypoxia, and oxidative stress, such as cytokines/chemokines IL-1β, IL-6, IL-8, and impairment expression in endothelial cells/VSMCs of HIF1α and eNOS genes. Pathological placentas showed differentially expressed genes (DEG), including vascular genes as CITED2, VEGF, PL-II, PIGF, sFLT-1, and sENG, oncogene JUNB, scaffolding protein CUL7, GPER1, and the pathways of SIRT/AMPK and MAPK/ERK. Additionally, we observed modification of subunits of NADPH oxidase and extracellular matrix elements, i.e., Glypican and Heparanase and KCa channel. Mothers with a low level of melatonin showed low production of proangiogenic factor VEGF, increasing the risk of preeclampsia, premature birth, and abortion. In contrast, melatonin supplementation can reduce systolic pressure, prevent oxidative stress, induce the activation of the antioxidants system, and lessen proteinuria and serum level of sFlt-1. Moreover, melatonin can repair the endothelial damage from preeclampsia at the placenta level, increasing PIGF, Nrf-2, HO-1 production and reducing critical markers of vascular injury during the pregnancy. Melatonin also restores the umbilical and uterine blood flow after oxidative stress and inhibits vascular inflammation and VCAM-1, Activin-A, and sEng production. The beneficial effects of melatonin over pathological pregnancies can be partially observed in normal pregnancies, suggesting the dual role of/over placental physiology could contribute to protection and have therapeutic applications in vascular pathologies of pregnancies in the future.
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Affiliation(s)
- Francisco J Valenzuela-Melgarejo
- Laboratory of Molecular Cell Biology, Department of Basic Sciences, Universidad del Bío-Bío, Campus Fernando May, Chillán, Chile
| | - Constanza Lagunas
- Laboratory of Molecular Cell Biology, Department of Basic Sciences, Universidad del Bío-Bío, Campus Fernando May, Chillán, Chile
| | - Fabiola Carmona-Pastén
- Laboratory of Molecular Cell Biology, Department of Basic Sciences, Universidad del Bío-Bío, Campus Fernando May, Chillán, Chile
| | - Kevins Jara-Medina
- Laboratory of Molecular Cell Biology, Department of Basic Sciences, Universidad del Bío-Bío, Campus Fernando May, Chillán, Chile
| | - Gustavo Delgado
- Laboratory of Molecular Cell Biology, Department of Basic Sciences, Universidad del Bío-Bío, Campus Fernando May, Chillán, Chile
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Poniedziałek-Czajkowska E, Mierzyński R. Could Vitamin D Be Effective in Prevention of Preeclampsia? Nutrients 2021; 13:nu13113854. [PMID: 34836111 PMCID: PMC8621759 DOI: 10.3390/nu13113854] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/21/2021] [Accepted: 10/26/2021] [Indexed: 12/23/2022] Open
Abstract
Prevention of preeclampsia (PE) remains one of the most significant problems in perinatal medicine. Due to the possible unpredictable course of hypertension in pregnancy, primarily PE and the high complication rate for the mother and fetus/newborn, it is urgent to offer pregnant women in high-risk groups effective methods of preventing the PE development or delaying its appearance. In addition, due to the association of PE with an increased risk of developing cardiovascular diseases (CVD) in later life, effective preeclampsia prevention could also be important in reducing their incidence. Ideal PE prophylaxis should target the pathogenetic changes leading to the development of PE and be safe for the mother and fetus, inexpensive and freely available. Currently, the only recognized method of PE prevention recommended by many institutions around the world is the use of a small dose of acetylsalicylic acid in pregnant women with risk factors. Unfortunately, some cases of PE are diagnosed in women without recognized risk factors and in those in whom prophylaxis with acetylsalicylic acid is not adequate. Hence, new drugs which would target pathogenetic elements in the development of preeclampsia are studied. Vitamin D (Vit D) seems to be a promising agent due to its beneficial effect on placental implantation, the immune system, and angiogenic factors. Studies published so far emphasize the relationship of its deficiency with the development of PE, but the data on the benefits of its supplementation to reduce the risk of PE are inconclusive. In the light of current research, the key issue is determining the protective concentration of Vit D in a pregnant woman. The study aims to present the possibility of using Vit D to prevent PE, emphasizing its impact on the pathogenetic elements of preeclampsia development.
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Nunes PR, Romao-Veiga M, Borges VTM, Matias ML, Ribeiro VR, Costa RAA, Peracoli MTS, Peracoli JC. Association between Adverse Maternal Clinical Outcomes and Imbalance of Cytokines and Angiogenic Factors in Preterm Preeclampsia. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:669-675. [PMID: 34670301 PMCID: PMC10183922 DOI: 10.1055/s-0041-1735157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Preeclampsia (PE) is a pregnancy-specific syndrome characterized by abnormal levels of cytokines and angiogenic factors, playing a role in the disease development. The present study evaluated whether immunological markers are associated with the gestational age and with the disease severity in preeclamptic women. METHODS Ninety-five women who developed PE were stratified for gestational age as preterm PE (< 37 weeks) and term PE (≥ 37 weeks of gestation) and compared for disease severity as well as plasma concentration of angiogenic factors and cytokines. The concentrations of placental growth factor (PlGF), vascular endothelial growth factor (VEGF), Fms-like soluble tyrosine kinase (sFlt-1) and soluble endoglin (sEng), as well as the cytokines, tumor necrosis factor-α (TNF-α) and interleukin 10 (IL-10), were determined by enzyme-linked immunosorbent assay (ELISA). RESULTS The comparison between preeclamptic groups showed a higher percentage of severe cases in preterm PE (82.1%) than in term PE (35.9%). Similarly, the concentrations of TNF-α, sFlt-1, and sEng, as well as TNF-α/IL-10 and sFlt-1/PlGF ratios were significantly higher in the preterm PE group. In contrast, concentrations of PlGF, VEGF, and IL-10 were significantly lower in women with preterm PE. Negative correlations between TNF-α and IL-10 (r = 0.5232) and between PlGF and sFlt1 (r = -0.4158) were detected in the preterm PE. CONCLUSION In pregnant women with preterm PE, there is an imbalance between immunological markers, with the predominance of anti-angiogenic factors and TNF-α, associated with adverse maternal clinical outcomes.
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Affiliation(s)
- Priscila Rezeck Nunes
- Faculdade de Medicina, Universidade Estadual Paulista Julio de Mesquita Filho, Botucatu, SP, Brazil
| | - Mariana Romao-Veiga
- Faculdade de Medicina, Universidade Estadual Paulista Julio de Mesquita Filho, Botucatu, SP, Brazil
| | | | - Mariana Leticia Matias
- Faculdade de Medicina, Universidade Estadual Paulista Julio de Mesquita Filho, Botucatu, SP, Brazil
| | - Vanessa Rocha Ribeiro
- Faculdade de Medicina, Universidade Estadual Paulista Julio de Mesquita Filho, Botucatu, SP, Brazil
| | | | | | - Jose Carlos Peracoli
- Faculdade de Medicina, Universidade Estadual Paulista Julio de Mesquita Filho, Botucatu, SP, Brazil
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Biomarkers and the Prediction of Adverse Outcomes in Preeclampsia: A Systematic Review and Meta-analysis. Obstet Gynecol 2021; 137:72-81. [PMID: 33278298 DOI: 10.1097/aog.0000000000004149] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/20/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To systematically review the performance of soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and the sFlt-1/PlGF ratio in predicting adverse outcomes in women with preeclampsia. DATA SOURCES We performed a systematic search of MEDLINE, EMBASE, CINAHL, Cochrane, Scopus, ClinicalTrials.gov, and Emcare databases from 1989 to March 2019 to identify studies correlating sFlt-1, PlGF, and the sFlt-1/PlGF ratio with the occurrence of adverse outcomes in women with preeclampsia. METHODS OF STUDY SELECTION Two independent reviewers screened 3,194 studies using Covidence. Studies were included if they examined the performance of sFLT-1, PlGF, or the sFLT-1/PlGF ratio in predicting adverse outcomes in women with suspected or confirmed preeclampsia. TABULATION, INTEGRATION, AND RESULTS We extracted contingency tables with true-positive, false-positive, true-negative, and false-negative results. We calculated sensitivity, specificity, diagnostic odds ratios, and area under the summary receiver operating characteristic curve (area sROC) through a bivariate mixed-effects meta-analysis. Our literature search identified 3,194 articles, of which 33 (n=9,426 patients) were included. There was significant variation in the included studies with regard to the biomarkers and outcomes assessed. As such, few studies (n=4-8) were included in the meta-analysis component with significant heterogeneity between studies (I2=33-99). Nonetheless, both PlGF and the sFlt-1/PlGF ratio demonstrated area sROC values between 0.68 and 0.87 for the prediction of composite adverse maternal and perinatal outcomes, preterm birth and fetal growth restriction. CONCLUSION Placental growth factor and the sFlt-1/PlGF ratio show prognostic promise for adverse outcomes in preeclampsia, but study heterogeneity limits their clinical utility. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42019136207.
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Ukah UV, Payne BA, Hutcheon JA, Chappell LC, Seed PT, Conti-Ramsden FI, Ansermino JM, Magee LA, von Dadelszen P. Placental growth factor for the prognosis of women with preeclampsia (fullPIERS model extension): context matters. BMC Pregnancy Childbirth 2020; 20:668. [PMID: 33153436 PMCID: PMC7643272 DOI: 10.1186/s12884-020-03332-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/09/2020] [Indexed: 12/12/2022] Open
Abstract
Background The fullPIERS risk prediction model was developed to identify which women admitted with confirmed diagnosis of preeclampsia are at highest risk of developing serious maternal complications. The model discriminates well between women who develop (vs. those who do not) adverse maternal outcomes. It has been externally validated in several populations. We assessed whether placental growth factor (PlGF), a biomarker associated with preeclampsia risk, adds incremental value to the fullPIERS model. Methods Using a cohort of women admitted into tertiary hospitals in well-resourced settings (the USA and Canada), between May 2010 to February 2012, we evaluated the incremental value of PlGF added to fullPIERS for prediction of adverse maternal outcomes within 48 h after admission with confirmed preeclampsia. The discriminatory performance of PlGF and the fullPIERS model were assessed in this cohort using the area under the receiver’s operating characteristic curve (AUROC) while the extended model (fullPIERS +PlGF) was assessed based on net reclassification index (NRI) and integrated discrimination improvement (IDI) performances. Results In a cohort of 541 women delivered shortly (< 1 week) after presentation, 8.1% experienced an adverse maternal outcome within 48 h of admission. Prediction of adverse maternal outcomes was not improved by addition of PlGF to fullPIERS (NRI: -8.7, IDI − 0.06). Discriminatory performance (AUROC) was 0.67 [95%CI: 0.59–0.75] for fullPIERS only and 0.67 [95%CI: 0.58–0.76]) for fullPIERS extended with PlGF, a performance worse than previously documented in fullPIERS external validation studies (AUROC > 0.75). Conclusions While fullPIERS model performance may have been affected by differences in healthcare context between this study cohort and the model development and validation cohorts, future studies are required to confirm whether PlGF adds incremental benefit to the fullPIERS model for prediction of adverse maternal outcomes in preeclampsia in settings where expectant management is practiced.
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Affiliation(s)
- U Vivian Ukah
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, H3A 1A2, Canada.
| | - Beth A Payne
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer A Hutcheon
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Lucy C Chappell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Paul T Seed
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Frances Inez Conti-Ramsden
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - J Mark Ansermino
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Anaesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Laura A Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
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Awe O, Sinkway JM, Chow RP, Wagener Q, Schulz EV, Yu JY, Nietert PJ, Wagner CL, Lee KH. Differential regulation of a placental SAM68 and sFLT1 gene pathway and the relevance to maternal vitamin D sufficiency. Pregnancy Hypertens 2020; 22:196-203. [PMID: 33068876 PMCID: PMC7688503 DOI: 10.1016/j.preghy.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/04/2020] [Accepted: 09/05/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The goal of this study was to determine if an axis of placental gene expression associated with early onset and severe preeclampsia (EOSPE) was operative in term pregnancy and correlated with vitamin D sufficiency. METHODS qPCR analysis of NKX2-5, SAM68, sFLT1 and membrane bound VEGFR1/FLT1 mRNA expression was conducted in placentas from 43 subjects enrolled in a vitamin D3 pregnancy supplementation trial. Pair-wise rank order correlations between patient-specific gene expression levels were calculated, and their relationship to maternal 25(OH)D status was assessed by a two-sample Wilcoxon test. Additionally, we probed the mechanistic link between SAM68 and sFLT1 using siRNA depletion in a human trophoblast cell line model. RESULTS Positive and highly significant correlations were found between SAM68 vs. sFLT1 and SAM68 vs. FLT1 expression levels, as were significant and differential correlations between the expression of these genes and perinatal 25(OH)D status. The variability when stratified by race/ethnicity was qualitatively distinct from those previously observed in EOSPE. Mechanistic studies confirmed a functional role for SAM68 protein in the regulation of sFLT1 expression. NKX2-5 expression was not significantly correlated with sFLT1 or SAM68 expression in these samples, suggesting that its expression may be significant at earlier stages of pregnancy or be restricted to pathological settings. CONCLUSIONS These data further support our overarching hypothesis that SAM68 expression is a key determinant of VEGFR1 isoform expression in the placenta, and provide additional insights into how this gene pathway may be differentially deployed or modified in normal and pathological pregnancies.
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Affiliation(s)
- Oyindamola Awe
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States
| | - James M Sinkway
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Rebecca P Chow
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Quentell Wagener
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Elizabeth V Schulz
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Jeremy Y Yu
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Carol L Wagner
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Kyu-Ho Lee
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, United States; Regenerative Medicine and Cell Biology Department, Medical University of South Carolina, Charleston, SC 29425, United States; Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC 29425, United States.
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Mirkovic L, Tulic I, Stankovic S, Soldatovic I. Prediction of adverse maternal outcomes of early severe preeclampsia. Pregnancy Hypertens 2020; 22:144-150. [PMID: 32979729 DOI: 10.1016/j.preghy.2020.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/04/2020] [Accepted: 09/12/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Assess soluble FMS-like tyrosine kinase-1/placental growth factor ratio (sFlt-1/PlGF) diagnostic accuracy for predicting adverse maternal outcome in patients with early severe preeclampsia, and whether its predictive performance is superior to full preeclampsia integrated estimate of risk score (PIERS). STUDY DESIGN Prospective study enrolled patients with early severe preeclampsia (defined by American College of Obstetricians and Gynaecologists 2013 guidelines) admitted to the Clinic for Obstetrics and Gynaecology, Clinical Center of Serbia intensive care unit. Patients underwent delivery to terminate preeclampsia within 48 h of admission. PIERS was generated and blood samples taken at admission. Multiple pregnancies and gestational ages outside 24-34 weeks were excluded. sFlt-1 and PlGF serum concentrations were measured using Elecsys® assays and cobas e 601 analyser. Maternal complications were recorded for seven days post-delivery. MAIN OUTCOME MEASURES Diagnostic accuracy (sensitivity and specificity), and predictive performance (receiver operating characteristic area under curve [AUC]) vs. PIERS, of sFlt-1/PlGF for predicting adverse maternal outcome. RESULTS Of 89 patients enrolled, 61 were evaluable. Median frequency of adverse maternal outcomes within seven days of delivery was two. Median sFlt-1/PlGF and PIERS were 521·0 and 5·0%, respectively. sFlt-1/PlGF showed greater correlation with complication number than PIERS (Spearman's rho: 0·728 [p < 0·001] and 0·134 [p = 0·304], respectively). AUC for sFlt-1/PlGF and PIERS were 0·853 and 0·628, respectively. A 377·0 sFlt-1/PlGF cut-off was optimal for predicting complications (75·0% sensitivity; 92·3% specificity). CONCLUSIONS sFlt-1/PlGF correlated more closely with number of adverse maternal outcomes than PIERS, and was a superior predictor of maternal complications.
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Affiliation(s)
- Ljiljana Mirkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade, Serbia.
| | - Ivan Tulic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sanja Stankovic
- Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia
| | - Ivan Soldatovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Mecoli CA, Perin J, Van Eyk JE, Zhu J, Fu Q, Allmon AG, Rao Y, Zeger S, Wigley FM, Hummers LK, Shah AA. Vascular biomarkers and digital ulcerations in systemic sclerosis: results from a randomized controlled trial of oral treprostinil (DISTOL-1). Clin Rheumatol 2020; 39:1199-1205. [PMID: 31858338 PMCID: PMC8211019 DOI: 10.1007/s10067-019-04863-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 11/01/2019] [Accepted: 11/20/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Although there is abundant evidence of vascular perturbation from studies of peripheral blood in systemic sclerosis (SSc), there are few data about the ability to use biomarkers of vascular injury and growth factors to predict vascular outcomes and response to therapy. We sought to explore the association between candidate vascular biomarkers and digital ulcerations (DU) in a clinical trial context. METHODS We examined 19 circulating vascular, angiogenic, and inflammatory biomarkers in 124 patients with scleroderma and DU who participated in a randomized controlled trial of oral treprostinil diolamine (ClinicalTrials.gov identifier NCT00775463). Correlation, regression, and random forest analyses were conducted to assess biomarker relationships in response to drug treatment. RESULTS Over the 20-week trial, 82 (66%) patients had their cardinal ulcer completely heal, 54 (44%) developed new ulcers, and 72 (58%) had complete healing of all ulcers; mean change in ulcer burden comparing week 20 with baseline was - 0.36 ± 1.70. Nineteen biomarkers were analyzed for their association and ability to predict clinical DU outcomes. After adjusting for multiple comparisons, no individual biomarker (baseline level, week 20 level, or change over time) was significantly associated with any of the clinical outcomes, suggesting that traditional vascular, angiogenic or inflammatory drivers are not predictive of ulcer fate. CONCLUSIONS The lack of strong response to any of the vascular, angiogenic, or inflammatory markers suggest that these pathways are not primary drivers in the development of DU clinical outcomes in a SSc population with prevalent DU. KEY POINTS • Currently we lack robust biomarkers to predict vascular outcomes or response to therapy in scleroderma patients with Raynaud's phenomenon.• Longitudinal assessment of vascular biomarkers in a clinical trial setting provides a unique opportunity to define biomarkers that predict vascular outcomes.• In a randomized controlled trial of oral treprostinil diolamine for treatment of scleroderma-associated digital ulcers, biomarkers involved in several vascular, inflammatory, and angiogenic pathways did not predict short-term clinical response to therapy or digital ulcer outcomes.• Further study of these and other biomarkers should be considered in Raynaud's clinical trials in scleroderma patients without prevalent digital ulcers.
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Affiliation(s)
- Christopher A Mecoli
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - Jamie Perin
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E3650, Baltimore, MD, 21205, USA
| | - Jennifer E Van Eyk
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
- Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., Advanced Health Sciences Pavilion, 9th Floor, Los Angeles, CA, 90048, USA
| | - Jie Zhu
- Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., Advanced Health Sciences Pavilion, 9th Floor, Los Angeles, CA, 90048, USA
| | - Qin Fu
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
- Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., Advanced Health Sciences Pavilion, 9th Floor, Los Angeles, CA, 90048, USA
| | - Andrew G Allmon
- United Therapeutics, 1040 Spring Street, Silver Spring, MD, 20910, USA
| | - Youlan Rao
- United Therapeutics, 1040 Spring Street, Silver Spring, MD, 20910, USA
| | - Scott Zeger
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E3650, Baltimore, MD, 21205, USA
| | - Fredrick M Wigley
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - Laura K Hummers
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - Ami A Shah
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA.
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Frampton GK, Jones J, Rose M, Payne L. Placental growth factor (alone or in combination with soluble fms-like tyrosine kinase 1) as an aid to the assessment of women with suspected pre-eclampsia: systematic review and economic analysis. Health Technol Assess 2018; 20:1-160. [PMID: 27918253 DOI: 10.3310/hta20870] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Pre-eclampsia (PE) prediction based on blood pressure, presence of protein in the urine, symptoms and laboratory test abnormalities can result in false-positive diagnoses. This may lead to unnecessary antenatal admissions and preterm delivery. Blood tests that measure placental growth factor (PlGF) or the ratio of soluble fms-like tyrosine kinase 1 (sFlt-1) to PlGF could aid prediction of PE if either were added to routine clinical assessment or used as a replacement for proteinuria testing. OBJECTIVES To evaluate the diagnostic accuracy and cost-effectiveness of PlGF-based tests for patients referred to secondary care with suspected PE in weeks 20-37 of pregnancy. DESIGN Systematic reviews and an economic analysis. DATA SOURCES Bibliographic databases including MEDLINE, EMBASE, Web of Science and The Cochrane Library and Database of Abstracts of Reviews of Effects were searched up to July 2015 for English-language references. Conferences, websites, systematic reviews and confidential company submissions were also accessed. REVIEW METHODS Systematic reviews of test accuracy and economic studies were conducted to inform an economic analysis. Test accuracy studies were required to include women with suspected PE and report quantitatively the accuracy of PlGF-based tests; their risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria. The economic studies review had broad eligibility criteria to capture any types of economic analysis; critical appraisal employed standard checklists consistent with National Institute for Health and Care Excellence criteria. Study selection, critical appraisal and data extraction in both reviews were performed by two reviewers. ECONOMIC ANALYSIS An independent economic analysis was conducted based on a decision tree model, using the best evidence available. The model evaluates costs (2014, GBP) from a NHS and Personal Social Services perspective. Given the short analysis time horizon, no discounting was undertaken. RESULTS Four studies were included in the systematic review of test accuracy: two on Alere's Triage® PlGF test (Alere, Inc., San Diego, CA, USA) for predicting PE requiring delivery within a specified time and two on Roche Diagnostics' Elecsys® sFlt-1 to PlGF ratio test (Roche Diagnostics GmbH, Mannheim, Germany) for predicting PE within a specified time. Three studies were included in the systematic review of economic studies, and two confidential company economic analyses were assessed separately. Study heterogeneity precluded meta-analyses of test accuracy or cost-analysis outcomes, so narrative syntheses were conducted to inform the independent economic model. The model predicts that, when supplementing routine clinical assessment for rule-out and rule-in of PE, the two tests would be cost-saving in weeks 20-35 of gestation, and marginally cost-saving in weeks 35-37, but with minuscule impact on quality of life. Length of neonatal intensive care unit stay was the most influential parameter in sensitivity analyses. All other sensitivity analyses had negligible effects on results. LIMITATIONS No head-to-head comparisons of the tests were identified. No studies investigated accuracy of PlGF-based tests when used as a replacement for proteinuria testing. Test accuracy studies were found to be at high risk of clinical review bias. CONCLUSIONS The Triage and Elecsys tests would save money if added to routine clinical assessment for PE. The magnitude of savings is uncertain, but the tests remain cost-saving under worst-case assumptions. Further research is required to clarify how the test results would be interpreted and applied in clinical practice. STUDY REGISTRATION This study is registered as PROSPERO CRD42015017670. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Geoff K Frampton
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | - Jeremy Jones
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | - Micah Rose
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | - Liz Payne
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
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Ding G, Liping L, Moli D, Wuliyeti A, Shaohe Z, Huijuan W, Chen P, Chen C, Guiqin B. A study of the association between the sFlt-1/PIGF ratio and preeclampsia in Xinjiang Uygur Autonomous Region of China. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2018; 46:S281-S286. [PMID: 30831776 DOI: 10.1080/21691401.2018.1491480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM It was previously reported that the ratio of soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) can predict the clinical onset of preeclampsia. This study seeks to validate the association between ratios of sFlt-1/PlGF with preeclampsia and to identify the contribution of ethnicity across diverse populations of the Xinjiang Uygur Autonomous Region. METHODS Pregnant women were classified into those with preeclampsia (n = 136) and healthy controls (n = 350). Serum levels of sFlt-1 and PlGF were quantified using a Roche serum instrument in both patients and controls. RESULTS Compared to healthy controls, women with preeclampsia had significantly higher levels of sFlt-1 (7303.81 pg/ml vs. 2508.69 pg/ml, p < .001) and ratios of sFlt-1/PlGF (241.68 vs. 14.29, p < .001), whereas levels of PIGF were decreased (241.68 vs. 14.29, p < .001). These three values varied greatly across nationalities, and non-Han Chinese subjects (including Uygur, Kazak, Hui) were more likely to experience severe preeclampsia than Han Chinese subjects. CONCLUSIONS This is the first study to demonstrate that the ratio of sFlt-1/PlGF can both predict and serve as a diagnostic factor for preeclampsia in pregnant women from different populations within the Xinjiang region of China.
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Affiliation(s)
- Guifeng Ding
- a The First Affiliated Hospital of Medical College of Xi'an Jiaotong University , Xi'an , China.,b The Xinjiang Uygur Autonomous Region Maternal and Child Health Care Hospital , Urumqi , China
| | - Liu Liping
- b The Xinjiang Uygur Autonomous Region Maternal and Child Health Care Hospital , Urumqi , China
| | - Duan Moli
- b The Xinjiang Uygur Autonomous Region Maternal and Child Health Care Hospital , Urumqi , China
| | - Aibibula Wuliyeti
- b The Xinjiang Uygur Autonomous Region Maternal and Child Health Care Hospital , Urumqi , China
| | - Zhou Shaohe
- c The National Engineering Research Center for Miniaturized Detection Systems, Northwest University , Xi'an , China
| | - Wang Huijuan
- c The National Engineering Research Center for Miniaturized Detection Systems, Northwest University , Xi'an , China
| | - Peng Chen
- c The National Engineering Research Center for Miniaturized Detection Systems, Northwest University , Xi'an , China.,d Institution of Basic Medical Science, Xi'an Medical University , Xi'an , China
| | - Chao Chen
- c The National Engineering Research Center for Miniaturized Detection Systems, Northwest University , Xi'an , China
| | - Bai Guiqin
- a The First Affiliated Hospital of Medical College of Xi'an Jiaotong University , Xi'an , China
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12
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Beňovská M, Opluštilová A, Pinkavová J, Hodická Z, Čermáková Z. The New Possibilities in Early Diagnosis of Preeclampsia by Soluble fms-Like Tyrosine Kinase-1 and Placental Growth Factor in 16–20 Weeks Gestation. Lab Med 2017; 49:112-117. [DOI: 10.1093/labmed/lmx076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Miroslava Beňovská
- Department of Clinical Biochemistry, The University Hospital Brno, Czech Republic
- Department of Laboratory Methods, Faculty of Medicine, Masaryk University, Czech Republic
| | - Aneta Opluštilová
- Department of Clinical Biochemistry, The University Hospital Brno, Czech Republic
| | - Jana Pinkavová
- Department of Clinical Biochemistry, The University Hospital Brno, Czech Republic
| | - Zuzana Hodická
- Department of Gynecology and Obstetrics, The University Hospital Brno and Faculty of Medicine, Masaryk University, Czech Republic
| | - Zdeňka Čermáková
- Department of Clinical Biochemistry, The University Hospital Brno, Czech Republic
- Department of Laboratory Methods, Faculty of Medicine, Masaryk University, Czech Republic
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13
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Ukah UV, Hutcheon JA, Payne B, Haslam MD, Vatish M, Ansermino JM, Brown H, Magee LA, von Dadelszen P. Placental Growth Factor as a Prognostic Tool in Women With Hypertensive Disorders of Pregnancy: A Systematic Review. Hypertension 2017; 70:1228-1237. [PMID: 29084878 PMCID: PMC5680987 DOI: 10.1161/hypertensionaha.117.10150] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 08/21/2017] [Accepted: 09/27/2017] [Indexed: 12/19/2022]
Abstract
Supplemental Digital Content is available in the text. The PlGF (placental growth factor) has been largely demonstrated to be associated with the diagnosis of the hypertensive disorders of pregnancy (HDPs); however, it is unclear how useful it is for the prognosis of the condition. Our objective was to provide a summary of important findings of its prognostic ability by systematically reviewing studies that examined the ability of the PlGF, either independently or combined with other factors, to predict maternal and fetal complications resulting from the HDPs. We included studies published before January 30, 2017, reporting on the use of the PlGF as a prognostic test for women with confirmed HDPs or suspected preeclampsia. Of the 220 abstracts identified through MEDLINE, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature), 17 studies were eligible for our review. Prognostic performance was evaluated by sensitivity, specificity, likelihood ratios, and area under the receiver operating characteristic curve. PlGF showed moderate-to-high evidence (likelihood ratios of ≥5 or ≤0.2 or area under the receiver operating characteristic curves ≥0.70) for identifying women at the highest risk of preterm delivery or neonatal outcomes (10/12 studies) but showed no clinically useful performance for the prediction of adverse maternal outcomes. PlGF may aid in the management of women with HDPs to avert fetal complications. Future studies should determine an optimum threshold for the marker to guide delivery and should examine whether its use for predicting adverse maternal outcomes in women with HDPs can be improved.
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Affiliation(s)
- U Vivian Ukah
- From the Department of Obstetrics and Gynaecology (U.V.U., J.A.H.), Department of Anesthesiology, Pharmacology, and Therapeutics (B.P., J.M.A.), School of Population and Public Health (M.D.H.), and Woodward Library (H.B.), University of British Columbia, Vancouver, Canada; Healthy Starts Theme, BC Children's Hospital Research Institute, Vancouver, Canada (U.V.U., J.A.H., B.P., J.M.A.); Nuffield Department of Obstetrics and Gynaecology, University of Oxford, United Kingdom (M.V.); and School of Life Course Sciences, King's College London, United Kingdom (L.A.M., P.v.D.).
| | - Jennifer A Hutcheon
- From the Department of Obstetrics and Gynaecology (U.V.U., J.A.H.), Department of Anesthesiology, Pharmacology, and Therapeutics (B.P., J.M.A.), School of Population and Public Health (M.D.H.), and Woodward Library (H.B.), University of British Columbia, Vancouver, Canada; Healthy Starts Theme, BC Children's Hospital Research Institute, Vancouver, Canada (U.V.U., J.A.H., B.P., J.M.A.); Nuffield Department of Obstetrics and Gynaecology, University of Oxford, United Kingdom (M.V.); and School of Life Course Sciences, King's College London, United Kingdom (L.A.M., P.v.D.)
| | - Beth Payne
- From the Department of Obstetrics and Gynaecology (U.V.U., J.A.H.), Department of Anesthesiology, Pharmacology, and Therapeutics (B.P., J.M.A.), School of Population and Public Health (M.D.H.), and Woodward Library (H.B.), University of British Columbia, Vancouver, Canada; Healthy Starts Theme, BC Children's Hospital Research Institute, Vancouver, Canada (U.V.U., J.A.H., B.P., J.M.A.); Nuffield Department of Obstetrics and Gynaecology, University of Oxford, United Kingdom (M.V.); and School of Life Course Sciences, King's College London, United Kingdom (L.A.M., P.v.D.)
| | - Matthew D Haslam
- From the Department of Obstetrics and Gynaecology (U.V.U., J.A.H.), Department of Anesthesiology, Pharmacology, and Therapeutics (B.P., J.M.A.), School of Population and Public Health (M.D.H.), and Woodward Library (H.B.), University of British Columbia, Vancouver, Canada; Healthy Starts Theme, BC Children's Hospital Research Institute, Vancouver, Canada (U.V.U., J.A.H., B.P., J.M.A.); Nuffield Department of Obstetrics and Gynaecology, University of Oxford, United Kingdom (M.V.); and School of Life Course Sciences, King's College London, United Kingdom (L.A.M., P.v.D.)
| | - Manu Vatish
- From the Department of Obstetrics and Gynaecology (U.V.U., J.A.H.), Department of Anesthesiology, Pharmacology, and Therapeutics (B.P., J.M.A.), School of Population and Public Health (M.D.H.), and Woodward Library (H.B.), University of British Columbia, Vancouver, Canada; Healthy Starts Theme, BC Children's Hospital Research Institute, Vancouver, Canada (U.V.U., J.A.H., B.P., J.M.A.); Nuffield Department of Obstetrics and Gynaecology, University of Oxford, United Kingdom (M.V.); and School of Life Course Sciences, King's College London, United Kingdom (L.A.M., P.v.D.)
| | - J Mark Ansermino
- From the Department of Obstetrics and Gynaecology (U.V.U., J.A.H.), Department of Anesthesiology, Pharmacology, and Therapeutics (B.P., J.M.A.), School of Population and Public Health (M.D.H.), and Woodward Library (H.B.), University of British Columbia, Vancouver, Canada; Healthy Starts Theme, BC Children's Hospital Research Institute, Vancouver, Canada (U.V.U., J.A.H., B.P., J.M.A.); Nuffield Department of Obstetrics and Gynaecology, University of Oxford, United Kingdom (M.V.); and School of Life Course Sciences, King's College London, United Kingdom (L.A.M., P.v.D.)
| | - Helen Brown
- From the Department of Obstetrics and Gynaecology (U.V.U., J.A.H.), Department of Anesthesiology, Pharmacology, and Therapeutics (B.P., J.M.A.), School of Population and Public Health (M.D.H.), and Woodward Library (H.B.), University of British Columbia, Vancouver, Canada; Healthy Starts Theme, BC Children's Hospital Research Institute, Vancouver, Canada (U.V.U., J.A.H., B.P., J.M.A.); Nuffield Department of Obstetrics and Gynaecology, University of Oxford, United Kingdom (M.V.); and School of Life Course Sciences, King's College London, United Kingdom (L.A.M., P.v.D.)
| | - Laura A Magee
- From the Department of Obstetrics and Gynaecology (U.V.U., J.A.H.), Department of Anesthesiology, Pharmacology, and Therapeutics (B.P., J.M.A.), School of Population and Public Health (M.D.H.), and Woodward Library (H.B.), University of British Columbia, Vancouver, Canada; Healthy Starts Theme, BC Children's Hospital Research Institute, Vancouver, Canada (U.V.U., J.A.H., B.P., J.M.A.); Nuffield Department of Obstetrics and Gynaecology, University of Oxford, United Kingdom (M.V.); and School of Life Course Sciences, King's College London, United Kingdom (L.A.M., P.v.D.)
| | - Peter von Dadelszen
- From the Department of Obstetrics and Gynaecology (U.V.U., J.A.H.), Department of Anesthesiology, Pharmacology, and Therapeutics (B.P., J.M.A.), School of Population and Public Health (M.D.H.), and Woodward Library (H.B.), University of British Columbia, Vancouver, Canada; Healthy Starts Theme, BC Children's Hospital Research Institute, Vancouver, Canada (U.V.U., J.A.H., B.P., J.M.A.); Nuffield Department of Obstetrics and Gynaecology, University of Oxford, United Kingdom (M.V.); and School of Life Course Sciences, King's College London, United Kingdom (L.A.M., P.v.D.)
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Weel IC, Baergen RN, Romão-Veiga M, Borges VT, Ribeiro VR, Witkin SS, Bannwart-Castro C, Peraçoli JC, De Oliveira L, Peraçoli MT. Association between Placental Lesions, Cytokines and Angiogenic Factors in Pregnant Women with Preeclampsia. PLoS One 2016; 11:e0157584. [PMID: 27315098 PMCID: PMC4912084 DOI: 10.1371/journal.pone.0157584] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 06/01/2016] [Indexed: 11/29/2022] Open
Abstract
Preeclampsia (PE) is considered the leading cause of maternal and perinatal morbidity and mortality. The placenta seems to play an essential role in this disease, probably due to factors involved in its formation and development. The present study aimed to investigate the association between placental lesions, cytokines and angiogenic factors in pregnant women with preeclampsia (PE). We evaluated 20 normotensive pregnant women, 40 with early-onset PE and 80 with late-onset PE. Placental samples were analyzed for histopathology, immunohistochemistry and determination of granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-10 (IL-10), transforming growth factor-beta 1 (TGF-β1), tumor necrosis factor-alpha (TNF-α), placental growth factor (PlGF), vascular endothelial growth factor (VEGF), fms-like tyrosine-kinase-1 (Flt-1) and endoglin (Eng) levels. Higher percentages of increased syncytial knots and increased perivillous fibrin deposits, and greater levels of TNF-α, TGF-β1and Flt-1 were detected in placentas from early-onset PE. Levels of IL-10, VEGF and PlGF were decreased in PE versus normotensive placentas. Both the TNF-α/IL-10 and sFlt-1/PlGF ratios were higher in placental homogenate of early-onset PE than late-onset PE and control groups. The more severe lesions and the imbalance between TNF-α/IL-10 and PlGF/sFlt-1 in placentas from early-onset PE allows differentiation of early and late-onset PE and suggests higher placental impairment in early-onset PE.
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Affiliation(s)
- Ingrid C. Weel
- Department of Gynaecology and Obstetrics, Botucatu Medical School, São Paulo State University, 18618–970, Botucatu, São Paulo, Brazil
| | - Rebecca N. Baergen
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College – New York Presbyterian Hospital, New York, United States of America
| | - Mariana Romão-Veiga
- Department of Gynaecology and Obstetrics, Botucatu Medical School, São Paulo State University, 18618–970, Botucatu, São Paulo, Brazil
| | - Vera T. Borges
- Department of Gynaecology and Obstetrics, Botucatu Medical School, São Paulo State University, 18618–970, Botucatu, São Paulo, Brazil
| | - Vanessa R. Ribeiro
- Department of Microbiology and Immunology, Institute of Biosciences, São Paulo State University, 18618–970, Botucatu, São Paulo, Brazil
| | - Steven S. Witkin
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, United States of America
| | - Camila Bannwart-Castro
- Department of Gynaecology and Obstetrics, Botucatu Medical School, São Paulo State University, 18618–970, Botucatu, São Paulo, Brazil
| | - Jose C. Peraçoli
- Department of Gynaecology and Obstetrics, Botucatu Medical School, São Paulo State University, 18618–970, Botucatu, São Paulo, Brazil
| | - Leandro De Oliveira
- Department of Gynaecology and Obstetrics, Botucatu Medical School, São Paulo State University, 18618–970, Botucatu, São Paulo, Brazil
| | - Maria T. Peraçoli
- Department of Microbiology and Immunology, Institute of Biosciences, São Paulo State University, 18618–970, Botucatu, São Paulo, Brazil
- * E-mail:
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15
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Leffert L. What’s new in obstetric anesthesia? Focus on preeclampsia. Int J Obstet Anesth 2015; 24:264-71. [DOI: 10.1016/j.ijoa.2015.03.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 03/22/2015] [Indexed: 12/11/2022]
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