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Sontag F, Suvakov S, Garovic VD. Soluble urinary somatic angiotensin converting enzyme is overexpressed in patients with preeclampsia: a potential new marker for the disease? Hypertens Pregnancy 2022; 41:190-197. [PMID: 35997304 PMCID: PMC9771896 DOI: 10.1080/10641955.2022.2115060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 08/15/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim of this study was to identify and quantify urinary Angiotensin-Converting-Enzyme (ACE) in hypertensive disorders of pregnancy. METHODS Urine samples were analyzed by Western blot. Patients were classified into: normotensive pregnancy (N); preeclampsia and superimposed preeclampsia (PE+SPE); and gestational hypertension (GH). RESULTS Somatic ACE protein expression was higher in PE+SPE compared to N and GH. There was a positive correlation between ACE and urinary protein to creatinine ratio, systolic and diastolic blood pressures. CONCLUSION These results indicate ACE overexpression in the urine of preeclamptic patients and suggest that it may be a new marker for the disease.
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Affiliation(s)
- Fernando Sontag
- Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN USA
- Postgraduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS Brazil
- Postgraduate Program in Translational Medicine, Department of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Sonja Suvakov
- Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN USA
| | - Vesna D Garovic
- Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN USA
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Edvinsson C, Hansson E, Nielsen N, Erlandsson L, Hansson SR. Biomarkers of oxidative stress and angiogenic imbalance in a cohort of Intensive Care patients with preeclampsia – discriminators for severe disease. Pregnancy Hypertens 2022; 30:88-94. [DOI: 10.1016/j.preghy.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/29/2022] [Accepted: 08/05/2022] [Indexed: 11/25/2022]
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Kusuma GD, Georgiou HM, Perkins AV, Abumaree MH, Brennecke SP, Kalionis B. Mesenchymal Stem/Stromal Cells and Their Role in Oxidative Stress Associated with Preeclampsia. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2022; 95:115-127. [PMID: 35370491 PMCID: PMC8961706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Preeclampsia (PE) is a serious medically important disorder of human pregnancy, which features de novo pregnancy-induced hypertension and proteinuria. The severe form of PE can progress to eclampsia, a convulsive, life-threatening condition. When placental growth and perfusion are abnormal, the placenta experiences oxidative stress and subsequently secretes abnormal amounts of certain pro-angiogenic factors (eg, PlGF) as well as anti-angiogenic factors (eg, sFlt-1) that enter the maternal circulation. The net effect is damage to the maternal vascular endothelium, which subsequently manifests as the clinical features of PE. Other than delivery of the fetus and placenta, curative treatments for PE have not yet been forthcoming, which reflects the complexity of the clinical syndrome. A major source of reactive oxygen species that contributes to the widespread maternal vascular endothelium damage is the PE-affected decidua. The role of decidua-derived mesenchymal stem/stromal cells (MSC) in normotensive and pathological placenta development is poorly understood. The ability to respond to an environment of oxidative damage is a "universal property" of MSC but the biological mechanisms that MSC employ in response to oxidative stress are compromised in PE. In this review, we discuss how MSC respond to oxidative stress in normotensive and pathological conditions. We also consider the possibility of manipulating the oxidative stress response of abnormal MSC as a therapeutic strategy to treat preeclampsia.
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Affiliation(s)
- Gina D. Kusuma
- The University of Melbourne, Department of Obstetrics
and Gynaecology, Royal Women’s Hospital, Parkville, Victoria, Australia,Pregnancy Research Centre, Department of Maternal-Fetal
Medicine, Royal Women’s Hospital, Parkville, Victoria, Australia
| | - Harry M. Georgiou
- The University of Melbourne, Department of Obstetrics
and Gynaecology, Royal Women’s Hospital, Parkville, Victoria, Australia,Pregnancy Research Centre, Department of Maternal-Fetal
Medicine, Royal Women’s Hospital, Parkville, Victoria, Australia
| | - Anthony V. Perkins
- School of Medical Science, Menzies Health Institute
Queensland, Griffith University, Southport, Queensland, Australia
| | - Mohamed H. Abumaree
- Stem Cells and Regenerative Medicine Department, King
Abdullah International Medical Research Center, King Abdulaziz Medical City,
Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia,King Saud Bin Abdulaziz University for Health Sciences,
College of Science and Health Professions, King Abdulaziz Medical City, Ministry
of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Shaun P. Brennecke
- The University of Melbourne, Department of Obstetrics
and Gynaecology, Royal Women’s Hospital, Parkville, Victoria, Australia,Pregnancy Research Centre, Department of Maternal-Fetal
Medicine, Royal Women’s Hospital, Parkville, Victoria, Australia
| | - Bill Kalionis
- The University of Melbourne, Department of Obstetrics
and Gynaecology, Royal Women’s Hospital, Parkville, Victoria, Australia,Pregnancy Research Centre, Department of Maternal-Fetal
Medicine, Royal Women’s Hospital, Parkville, Victoria, Australia,To whom all correspondence should be addressed:
Dr. Bill Kalionis, Department of Maternal-Fetal Medicine Pregnancy Research
Centre Royal Women’s Hospital, Parkville, Victoria, Australia;
; ORCID iD:
https://orcid.org/0000-0002-0132-9858
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Aguilera N, Salas-Pérez F, Ortíz M, Álvarez D, Echiburú B, Maliqueo M. Rodent models in placental research. Implications for fetal origins of adult disease. Anim Reprod 2022; 19:e20210134. [PMID: 35493783 PMCID: PMC9037606 DOI: 10.1590/1984-3143-ar2021-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/21/2022] [Indexed: 11/22/2022] Open
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Wang M. The Role of IL-37 and IL-38 in Obstetrics Abnormalities. Front Med (Lausanne) 2021; 8:737084. [PMID: 34513891 PMCID: PMC8429600 DOI: 10.3389/fmed.2021.737084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/09/2021] [Indexed: 12/22/2022] Open
Abstract
There are two fairly common complications during pregnancy, i.e., gestational diabetes mellitus (GDM) and pre-eclampsia, which are independent, but are also closely linked in prevalence in pregnant women, with potential serious adverse consequences. IL-37 and IL-38, which belong to the IL-1 superfamily, participate in anti-inflammatory responses. Dysregulation of IL-37 and IL-38 has been observed in many auto-immune diseases. IL-37 is substantially reduced in the umbilical cords and placentas of GDM subjects, but IL-37 is significantly induced in the placentas of pre-eclampsia patients, suggesting there are differential regulatory roles of IL-37 in obstetrics, despite IL-37 being an anti-inflammatory mediator. Furthermore, IL-38 is substantially increased in the umbilical cords and placentas of GDM subjects, but minimal difference is observed in the placentas from pre-eclampsia patients. These data imply that IL-38 is also regulated independently within the diseased placentas. This review provides some insight for both basic scientists and medical practitioners to manage these patients effectively.
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Affiliation(s)
- Mei Wang
- Department of Obstetrics and Gynaecology, Gansu Provincial Hospital, Lanzhou, China
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6
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Christensen M, Petersen JL, Sivanandam P, Kronborg CS, Knudsen UB, Martensen PM. Reduction of serum-induced endothelial STAT3(Y705) activation is associated with preeclampsia. Pregnancy Hypertens 2021; 25:103-109. [PMID: 34098522 DOI: 10.1016/j.preghy.2021.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 04/28/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Preeclampsia is associated with maternal morbidity and mortality during pregnancy, and also an increased cardiovascular disease (CVD) risk later in life. During preeclampsia, alterations in secreted placental factors leading to systemic maternal endothelial dysfunction are evident. However, little is known about the associated endothelial intracellular signaling. STAT3 is a latent cytoplasmic transcription factor involved in endothelial cell differentiation, survival, and angiogenesis. We aimed to test if preeclampsia and preeclampsia-related placental factors could alter serum-induced STAT3(Y705) activation in endothelial cells. Furthermore, if altered serum-induced endothelial STAT3 (Y705) activation is related to post-preeclamptic CVD risk. STUDY DESIGN HUVECs were used as a model of maternal endothelium. Experiments entailed addition of 20% human pregnancy serum as well as addition of recombinant PlGF, sFLT1 and VEGF-A165a to the cells. MAIN OUTCOME MEASURES Levels of pSTAT3(Y705) related to STAT3 levels were evaluated by immunoblotting analysis. RESULTS Our results show that preeclamptic serum induces significantly lower STAT3(Y705) phosphorylation compared with uncomplicated pregnancy serum (P = 0.0089) in endothelial cells. Furthermore, STAT3(Y705) phosphorylation was not changed upon addition of PlGF, sFLT1, or VEGF-A165a together with pregnancy sera compared with sera alone. Finally, sera from women with previous preeclampsia and current hypertension and carotid atherosclerotic plaques show significantly lower STAT3(Y705) phosphorylation capabilities compared with healthy women with previous uncomplicated pregnancies 8-18 years after deliveries (P = 0.029). CONCLUSIONS Reduction in serum-induced endothelial STAT3(Y705) activation may play an important role in the preeclampsia-associated endothelial dysfunction. Additionally, reduced endothelial STAT3(Y705) phosphorylation may contribute to increased post-preeclamptic CVD risk 8-18 years after delivery.
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Affiliation(s)
- M Christensen
- Clinical Research Unit, Randers Regional Hospital, 8930 Randers NOE, Denmark; Institute of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark; Department of Molecular Biology and Genetics, Aarhus University, 8000 Aarhus C, Denmark
| | - J L Petersen
- Department of Molecular Biology and Genetics, Aarhus University, 8000 Aarhus C, Denmark
| | - P Sivanandam
- Department of Molecular Biology and Genetics, Aarhus University, 8000 Aarhus C, Denmark
| | - C S Kronborg
- Department of Oncology, Aarhus University Hospital, 8000 Aarhus C, Denmark
| | - U B Knudsen
- Institute of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark; Department of Gynaecology and Obstetrics, Horsens Regional Hospital, 8700 Horsens, Denmark
| | - P M Martensen
- Department of Molecular Biology and Genetics, Aarhus University, 8000 Aarhus C, Denmark.
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Feng C, Cheng L, Jin J, Liu X, Wang F. Long non-coding RNA MALAT1 regulates trophoblast functions through VEGF/VEGFR1 signaling pathway. Arch Gynecol Obstet 2021; 304:873-882. [PMID: 33547935 DOI: 10.1007/s00404-021-05987-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/22/2021] [Indexed: 02/05/2023]
Abstract
Preeclampsia, as one of the most serious pregnancy-specific diseases, manifested by high blood pressure and companied by proteinuria in pregnancy women after 20 gestational weeks. Although the underlying mechanism has been studied for decades, no unambiguous interpretation of this phenomenon was well recognized. Recent researches focused on long non-coding RNAs (lncRNAs) as key regulators of cancer cell proliferation, invasion, migration and angiogenesis. Tumor development and placenta implantation share several common biological behaviors. The expression of lncRNA MALAT1 was downregulated in the placenta of patients with severe preeclampsia. MALAT1 smart silencer significantly inhibited HTR-8/SVneo trophoblast cell proliferation, invasion, migration and tube formation in vitro. Moreover, MALAT1 inhibited the expression of angiogenic factors in umbilical vein endothelial cells co-cultured with trophoblasts. These results indicated that MALAT1 was involved in the pathogenesis of preeclampsia and might be a candidate biomarker as well as a therapeutic target for preeclampsia.
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Affiliation(s)
- Chun Feng
- Department of Obstetrics and Gynecology, Hubei Maternal and Child Health Hospital, Wuhan, 430070, Hubei, China
| | - Lin Cheng
- Department of Obstetrics and Gynecology, Zhongnan Hospital, Wuhan University, Wuhan, 430071, Hubei, China
| | - Jing Jin
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Xiaoxia Liu
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Fang Wang
- Department of Obstetrics and Gynecology, Zhongnan Hospital, Wuhan University, Wuhan, 430071, Hubei, China.
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Zhu YD, Liang CM, Hu YB, Li ZJ, Wang SF, Xiang HY, Huang K, Yan SQ, Zhu P, Liu P, Tao FB. Repeated measures of prenatal thallium exposure and placental inflammatory cytokine mRNA expression: The Ma'anshan birth cohort (MABC) study. CHEMOSPHERE 2020; 246:125721. [PMID: 31911326 DOI: 10.1016/j.chemosphere.2019.125721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 12/13/2019] [Accepted: 12/19/2019] [Indexed: 06/10/2023]
Abstract
Thallium (Tl), a ubiquitous environmental toxicant, can cross the placental barrier during pregnancy. However, the effects of prenatal Tl exposure on placental function are currently unclear. Based on the Ma'anshan Birth Cohort study, we examined whether long-term prenatal Tl exposure was associated with placental inflammation. Tl concentrations were quantified in serum samples (n = 7050) from 2515 pregnancy during each trimester, placental inflammatory cytokine mRNA expression was assessed in 2519 placenta tissues. Geometric mean values of serum Tl concentrations were 63.57, 63.63 and 48.71 ng/L for the first, second and third trimesters, respectively. After adjustment for potential confounders, serum Tl concentration was positively associated with CD68 (β: 0.30; 95% CI: 0.05, 0.56) in the first trimester and TNF-α (β: 0.12; 95% CI: 0.01, 0.23), IL-6 (β: 0.15; 95% CI: 0.05, 0.25) and CD68 (β: 0.25; 95% CI: 0.10, 0.39) in the third trimester, however was negatively associated with IL-4 (β: -0.21; 95% CI: -0.41, -0.01) and CD206 (β: -0.23; 95% CI: -0.45, -0.02) in the first trimester. Repeated measures analysis showed that TNF-α, IL-6 and CD68 increased by 0.11 (95% CI: 0.01, 0.21), 0.12 (0.15, 95% CI: 0.05, 0.25), 0.22 (95% CI: 0.10, 0.39), respectively, with each 1ln-transformed Tl increase in total samples. Gender-specific analyses revealed that these associations were largely driven by male offspring. In addition, immunohistochemistry revealed that nuclear NF-κB p65 expression increased in placenta tissue. The results of this prospective cohort study provide longitudinal evidence that prenatal Tl exposure induces a placental inflammatory response in the Chinese population.
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Affiliation(s)
- Yuan-Duo Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
| | - Chun-Mei Liang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
| | - Ya-Bin Hu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
| | - Zhi-Juan Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
| | - Su-Fang Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
| | - Hai-Yun Xiang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China.
| | - Shuang-Qin Yan
- Ma'anshan Maternal and Child Health (MCH) Clinic, Ma'anshan, China.
| | - Peng Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China.
| | - Ping Liu
- Department of Anatomy, University of Otago, Dunedin, New Zealand; Brain Health Research Centre, University of Otago, Dunedin, New Zealand.
| | - Fang-Biao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, China.
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Bawah AT, Tornyi H, Seini MM, Ngambire LT, Yeboah FA. Zonulin as marker of pregnancy induced hypertension: a case control study. Clin Hypertens 2020; 26:7. [PMID: 32313692 PMCID: PMC7158010 DOI: 10.1186/s40885-020-00139-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/03/2020] [Indexed: 12/20/2022] Open
Abstract
Background Zonulin has been implicated in many metabolic disorders including hypertension and obesity. However, there is insufficient information about the involvement of zonulin in pregnancy induced hypertension (PIH) which comprises preeclampsia (PE) and gestational hypertension (GH). This study was therefore aimed at finding the level of this biochemical marker of regulation of tight junctions among women with PIH. Methods A total of 88 women with PIH and 60 age and body mass index (BMI) matched healthy pregnant women controls were enrolled. Blood pressure at 11–13 weeks and after 20 weeks of gestation, body mass index (BMI) in addition to serum Zonulin levels and lipid profile were compared between the groups. Student’s t-test was used for comparisons of the mean between the two groups. Correlation analyses were performed using Pearson’s correlation and binary logistic regression was used to evaluate the factors associated with PIH. Results Zonulin level was significantly higher in the participants with PIH as compared to the normal pregnant controls 56.81 ± 7.72 ng/ml vs 40.4 ± 8.60 ng/ml p < 0.0001 and had strong positive correlation with PIH (OR = 1.805; CI1.139–1.275; p < 0.0001). However, the association between first trimester lipids and PIH was weak. Conclusion The results showed a strong positive correlation between zonulin and PIH, thus changes in intestinal permeability occur in early stages of pregnancy and may be involved in the pathogenesis of PIH.
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Affiliation(s)
- Ahmed Tijani Bawah
- 1Department of Medical Laboratory Sciences, University of Health and Allied Science, PMB 31, Ho, Ghana
| | - Henry Tornyi
- 1Department of Medical Laboratory Sciences, University of Health and Allied Science, PMB 31, Ho, Ghana
| | - Mohammed Mustapha Seini
- 2Department of Molecular Medicine, Kwame Nkrumah University Science and Technology, Kumasi, Ghana
| | - Lincoln Toamsoma Ngambire
- 1Department of Medical Laboratory Sciences, University of Health and Allied Science, PMB 31, Ho, Ghana
| | - Francis Agyemang Yeboah
- 2Department of Molecular Medicine, Kwame Nkrumah University Science and Technology, Kumasi, Ghana
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Rahman RA, Murthi P, Singh H, Gurungsinghe S, Leaw B, Mockler JC, Lim R, Wallace EM. Hydroxychloroquine Mitigates the Production of 8-Isoprostane and Improves Vascular Dysfunction: Implications for Treating Preeclampsia. Int J Mol Sci 2020; 21:E2504. [PMID: 32260307 PMCID: PMC7177667 DOI: 10.3390/ijms21072504] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 12/13/2022] Open
Abstract
In preeclampsia, widespread maternal endothelial dysfunction is often secondary to excessive generation of placental-derived anti-angiogenic factors, including soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng), along with proinflammatory cytokines such as tumour necrosis factor-α (TNF-α) and activin A, understanding of which offers potential opportunities for the development of novel therapies. The antimalarial hydroxychloroquine is an anti-inflammatory drug improving endothelial homeostasis in lupus. It has not been explored as to whether it can improve placental and endothelial function in preeclampsia. In this in vitro study, term placental explants were used to assess the effects of hydroxychloroquine on placental production of sFlt-1, sEng, TNF-α, activin A, and 8-isoprostane after exposure to hypoxic injury or oxidative stress. Similarly, human umbilical vein endothelial cells (HUVECs) were used to assess the effects of hydroxychloroquine on in vitro markers of endothelial dysfunction. Hydroxychloroquine had no effect on the release of sFlt-1, sEng, TNF-α, activin A, or 8-isoprostane from placental explants exposed to hypoxic injury or oxidative stress. However, hydroxychloroquine mitigated TNF-α-induced HUVEC production of 8-isoprostane and Nicotinanamide adenine dinucleotide phosphate (NADPH) oxidase expression. Hydroxychloroquine also mitigated TNF-α and preeclamptic serum-induced HUVEC monolayer permeability and rescued the loss of zona occludens protein zona occludens 1 (ZO-1). Although hydroxychloroquine had no apparent effects on trophoblast function, it may be a useful endothelial protectant in women presenting with preeclampsia.
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Affiliation(s)
- Rahana Abd Rahman
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Monash Medical Centre, Clayton, Victoria 3168, Australia; (S.G.); (J.C.M.); (R.L.)
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia; (H.S.); (B.L.)
- Department of Obstetrics and Gynaecology, Faculty of Medicine, National University of Malaysia, Kuala Lumpur 56000, Malaysia
| | - Padma Murthi
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia; (H.S.); (B.L.)
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria 3052, Australia
| | - Harmeet Singh
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia; (H.S.); (B.L.)
| | - Seshini Gurungsinghe
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Monash Medical Centre, Clayton, Victoria 3168, Australia; (S.G.); (J.C.M.); (R.L.)
| | - Bryan Leaw
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia; (H.S.); (B.L.)
| | - Joanne C. Mockler
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Monash Medical Centre, Clayton, Victoria 3168, Australia; (S.G.); (J.C.M.); (R.L.)
| | - Rebecca Lim
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Monash Medical Centre, Clayton, Victoria 3168, Australia; (S.G.); (J.C.M.); (R.L.)
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia; (H.S.); (B.L.)
| | - Euan M. Wallace
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Monash Medical Centre, Clayton, Victoria 3168, Australia; (S.G.); (J.C.M.); (R.L.)
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia; (H.S.); (B.L.)
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Preeclampsia – Prediction and Monitoring Factors. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2019. [DOI: 10.2478/sjecr-2018-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Preeclampsia is one of the leading causes of maternal and perinatal morbidity and mortality, usually characterized by hypertension and proteinuria. Despite high incidence of preeclampsia the pathophysiological basis of preeclampsia is still not clear and there are a number of mechanisms and signaling pathways that intertwine. It is very important to develop specific and reliable predictive algorithms in order to enable early initiation of therapy due to facts that incidence of preeclampsia has upward trend and that cause adverse maternal and fetal outcome. Some of the most commonly used methods for prediction of preeclampsia include uterine artery Doppler velocimetry, determination of some microRNA, such as miR-210, and assessment of various pro-angiogenic and anti-angiogenic factors from blood. Angiogenic factors that possibly have most important role in pathogenesis of preeclampsia are vascular endothelial growth factor (VEGF) and placental growth factor (PlGF), which promote angiogenesis, and soluble fms-like tyrosine kinase-1 (sFlt1) and soluble form of endoglin (s-Eng), which exhibit anti-angiogenic properties. Aggravating circumstance is that preeclampsia has heterogeneous origin, and due to this fact, the value of individual markers can vary significantly. There is a constant tendency for creating comprehensive algorithm for prediction of preeclampsia which would be sufficiently specific and sensitive, and in the same time cheap and available. In that sense, new clinical studies are needed to show the most effective combination of parameters in the predeclampsia prediction.
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12
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Williamson RD, McCarthy FP, Manna S, Groarke E, Kell DB, Kenny LC, McCarthy CM. L-(+)-Ergothioneine Significantly Improves the Clinical Characteristics of Preeclampsia in the Reduced Uterine Perfusion Pressure Rat Model. Hypertension 2019; 75:561-568. [PMID: 31865793 DOI: 10.1161/hypertensionaha.119.13929] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Preeclampsia is a multifactorial hypertensive disorder of pregnancy founded on abnormal placentation, and the resultant placental ischemic microenvironment is thought to play a crucial role in its pathophysiology. Placental ischemia because of fluctuations in the delivery of oxygen results in oxidative stress, and recent evidence suggests that mitochondrial dysfunction may be a prime mediator. However, large clinical trials of therapeutic antioxidants such as vitamins C and E for the treatment of preeclampsia have been disappointing. L-(+)-ergothioneine (ERG)-an unusual amino acid betaine derived from histidine-has important cytoprotective and antioxidant properties under conditions of high oxidative stress. In this study, we investigated the potential therapeutic effects of administration of ERG in the reduced uterine perfusion pressure (RUPP) rat model of preeclampsia. ERG (25 mg/kg per day) was administered to rats on gestational day 11. On gestational day 14, RUPP surgery was performed, and on gestational day 19, blood pressure (mean arterial pressure) and fetal growth were measured. Production of mitochondria-specific H2O2 was analyzed in vivo in kidney samples. ERG ameliorated the hypertension (129±3 versus 115±4 mm Hg; P=0.01; n=8) and significantly increased pup weight in RUPP rats. ERG also significantly decreased circulating levels of antiangiogenic sFlt-1 (soluble fms-like tyrosine kinase-1) in RUPP rats (1367±245 pg/mL; P=0.04). Mitochondria-specific H2O2 (0.022±0.003 versus 0.029±0.001; MitoP/B ratio, n=3; P=0.05) was also significantly decreased in kidney tissue in RUPP rats treated with ERG. These data support the potential use of ERG for the treatment of preeclampsia.
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Affiliation(s)
- Rachel D Williamson
- From the Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, Ireland (R.D.W., F.P.M., S.M., C.M.)
| | - Fergus P McCarthy
- From the Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, Ireland (R.D.W., F.P.M., S.M., C.M.)
| | - Samprikta Manna
- From the Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, Ireland (R.D.W., F.P.M., S.M., C.M.)
| | - Emer Groarke
- Clinical Biochemistry, Cork University Hospital, Ireland (E.G.)
| | - Douglas B Kell
- Department of Biochemistry, Faculty of Health and Life Sciences, Institute of Integrative Biology, University of Liverpool, United Kingdom (D.B.K.).,Novo Nordisk Foundation Centre for Biosustainability, Technical University of Denmark, Lyngby (D.B.K.)
| | - Louise C Kenny
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, United Kingdom (L.C.K.)
| | - Cathal M McCarthy
- From the Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, Ireland (R.D.W., F.P.M., S.M., C.M.).,Department of Pharmacology and Therapeutics, Western Gateway Building, University College Cork, Ireland (C.M.)
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13
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Zhou L, Sun H, Cheng R, Fan X, Lai S, Deng C. ELABELA, as a potential diagnostic biomarker of preeclampsia, regulates abnormally shallow placentation via APJ. Am J Physiol Endocrinol Metab 2019; 316:E773-E781. [PMID: 30860880 DOI: 10.1152/ajpendo.00383.2018] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Preeclampsia (PE) is a major cause of maternal mortality and morbidity worldwide. Although there has been great progress in the understanding of PE, the exact cause for the disease development is still unclear. Recently, studies showed that genetic deletion of ELABELA (ELA, also known as APELA) could induce PE-like symptoms in mice. However, the role of ELA in the disease development of PE remains elusive. Our objective was to measure the changes of ELA levels in maternal serum, urine, and placenta from preeclamptic pregnant women and healthy pregnant women and evaluate the correlation between ELA levels and the occurrence of PE. Additionally, we investigated the effect of ELA on the migration and proliferation of human trophoblast cells. ELA levels are significantly decreased in late-onset PE pregnancies compared with normal pregnancies. The mRNA and protein expressions of ELA and the apelin receptor (APLNR or APJ) in late-onset PE placental tissues are also decreased. Furthermore, our in vitro study showed that the addition of ELA significantly increased the invasion ability and proliferation of trophoblast cells, which were inhibited by the APJ-specific antagonist ML221. Our study identified ELA as significantly decreased in late-onset PE; therefore, it might play an important role in the pathogenesis of late-onset PE.
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Affiliation(s)
- Lu Zhou
- Jiangsu Key Laboratory for Biodiversity and Biotechnology, College of Life Sciences, Nanjing Normal University , Nanjing , China
- Department of Obstetrics and Gynecology, Maternal and Child Healthcare Hospital of Shenzhen City, Southern Medical University , Shenzhen , China
| | - Hang Sun
- Jiangsu Key Laboratory for Biodiversity and Biotechnology, College of Life Sciences, Nanjing Normal University , Nanjing , China
| | - Ran Cheng
- Jiangsu Key Laboratory for Biodiversity and Biotechnology, College of Life Sciences, Nanjing Normal University , Nanjing , China
| | - Xiujun Fan
- Laboratory for Reproductive Health, Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences , Shenzhen , China
| | - Shanshan Lai
- Jiangsu Key Laboratory for Biodiversity and Biotechnology, College of Life Sciences, Nanjing Normal University , Nanjing , China
| | - Cheng Deng
- Jiangsu Key Laboratory for Biodiversity and Biotechnology, College of Life Sciences, Nanjing Normal University , Nanjing , China
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14
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Cantonwine DE, McElrath TF, Trabert B, Xu X, Sampson J, Roberts JM, Hoover RN, Troisi R. Estrogen metabolism pathways in preeclampsia and normal pregnancy. Steroids 2019; 144:8-14. [PMID: 30685337 PMCID: PMC6681456 DOI: 10.1016/j.steroids.2019.01.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/08/2019] [Accepted: 01/22/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Experimental studies suggest that shallow uterine cytotrophoblastic invasion in preeclampsia may be associated with alterations in estrogen metabolism. The objective of this study was to examine the association of parent estrogens and their metabolites between preeclamptics and normotensive controls at three time points during pregnancy. Methods Parent estrogens and their metabolites were measured in urine by high-performance liquid chromatography-tandem mass spectrometry in 66 singleton preeclampsia cases and 137 matched controls. Percent change in geometric means were estimated by general linear models adjusted for gestational age at sampling, maternal age, parity, race, body mass index, and use of assisted reproductive technologies. Results Urinary estradiol concentrations were approximately 50% higher in early pregnancy in preeclampsia cases than controls, but similar late in pregnancy. There was an approximate 20% reduction in total 2-pathway metabolites and 4-pathway metabolites in cases compared with controls in mid- and later pregnancy that was slightly attenuated with adjustment for BMI, and a reduction in 16-pathways in mid-pregnancy but not later. Conclusion(s) Our findings show that estradiol concentrations were elevated in preeclampsia versus controls in early pregnancy. In mid-pregnancy, all three estrogen metabolism (2-, 4-, and 16-) pathways showed some reduction in preeclampsia that appeared to continue for the 2- and 4-pathways in late pregnancy. We hypothesize that this may indicate that there is a generalized reduction in estrogen metabolism in preeclampsia rather than a deficit of specific enzymes, such as those involved in the 2-hydroxylation pathway.
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Affiliation(s)
- David E Cantonwine
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, United States.
| | - Thomas F McElrath
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, United States
| | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD, United States
| | - Xia Xu
- Cancer Research Technology Program, Leidos Biomedical Research, Inc, Frederick National Laboratory for Cancer Research, Frederick, MD, United States
| | - Joshua Sampson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD, United States
| | - James M Roberts
- Magee-Womens Research Institute, Department of Obstetrics and Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, University of Pittsburgh, Pittsburgh, PA, United States
| | - Robert N Hoover
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD, United States
| | - Rebecca Troisi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD, United States
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15
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Sagrillo-Fagundes L, Bienvenue-Pariseault J, Legembre P, Vaillancourt C. An insight into the role of the death receptor CD95 throughout pregnancy: Guardian, facilitator, or foe. Birth Defects Res 2019; 111:197-211. [PMID: 30702213 DOI: 10.1002/bdr2.1470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 01/16/2019] [Indexed: 12/24/2022]
Abstract
The prototype death receptor CD95 (Fas) and its ligand, CD95L (FasL), have been thoroughly studied due to their role in immune homeostasis and elimination of infected and transformed cells. The fact that CD95 is present in female reproductive cells and modulated during embryogenesis and pregnancy has raised interest in its role in immune tolerance to the fetoplacental unit. CD95 has been shown to be critical for proper embryonic formation and survival. Moreover, altered expression of CD95 or its ligand causes autoimmunity and has also been directly involved in recurrent pregnancy losses and pregnancy disorders. The objective of this review is to summarize studies that evaluate the mechanisms involved in the activation of CD95 to provide an updated global view of its effect on the regulation of the maternal immune system. Modulation of the CD95 system components may be the immune basis of several common pregnancy disorders.
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Affiliation(s)
- Lucas Sagrillo-Fagundes
- Department of Environmental toxicology and Chemical Pharmacology, INRS - Institut Armand-Frappier and Center for Interdisciplinary Research on Well-Being, Health, Society and Environment, Laval, Quebec, Canada
| | - Josianne Bienvenue-Pariseault
- Department of Environmental toxicology and Chemical Pharmacology, INRS - Institut Armand-Frappier and Center for Interdisciplinary Research on Well-Being, Health, Society and Environment, Laval, Quebec, Canada
| | - Patrick Legembre
- Oncogenesis, Stress & Signaling Laboratory INSERM ERL440, Centre Eugène Marquis, Inserm U1242, Equipe Ligue Contre Le Cancer, Rennes, France
| | - Cathy Vaillancourt
- Department of Environmental toxicology and Chemical Pharmacology, INRS - Institut Armand-Frappier and Center for Interdisciplinary Research on Well-Being, Health, Society and Environment, Laval, Quebec, Canada
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16
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Sagrillo-Fagundes L, Assunção Salustiano EM, Ruano R, Markus RP, Vaillancourt C. Melatonin modulates autophagy and inflammation protecting human placental trophoblast from hypoxia/reoxygenation. J Pineal Res 2018; 65:e12520. [PMID: 30091210 DOI: 10.1111/jpi.12520] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/19/2018] [Accepted: 07/30/2018] [Indexed: 12/22/2022]
Abstract
Melatonin has been proposed as a possible treatment for the deleterious effects of hypoxia/reoxygenation (H/R), such as autophagy, inflammation, and apoptosis. Pathological pregnancies, such as preeclampsia, are associated with placental H/R, and decreased placental melatonin synthesis as well as lower melatonin levels in the placenta and maternal plasma. However, the effects of exogenous melatonin on inflammation and autophagy induced by pregnancy complications associated with H/R await investigation. This study aimed to determine as to whether melatonin protects human primary villous trophoblasts against H/R-induced autophagy, inflammation, and apoptosis. Human primary villous cytotrophoblasts were isolated and immunopurified from normal term placentas. These cells were then exposed or not to 1 mmol/L melatonin for 72 hour in normoxia (8% O2 ), thereby inducing differentiation into syncytiotrophoblast that was then exposed to H/R (0.5% O2 , for 4 hour) or normoxia. H/R decreased endogenous melatonin synthesis (by 68%) and interleukin (IL)-10 levels (by 72%), coupled to increased tumor necrosis factor (TNF) (by 114%), IL-6 (by 55%), and NFκB (by 399%), compared to normoxia. Melatonin treatment reversed the H/R effect, restoring IL-10, TNF, and IL-6 levels to those of the normoxia condition. Melatonin, as well as NFκB inhibition, enhanced autophagy activation, consequently increasing syncytiotrophoblast survival in H/R conditions. This study suggests that H/R, which is present in pregnancy complications, inhibits endogenous melatonin production, thereby contributing to reduced syncytiotrophoblast viability. Results indicate that exogenous melatonin treatment may afford protection against H/R-induced damage, thereby enhancing placental cell survival, and contributing to improved fetal outcomes.
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Affiliation(s)
- Lucas Sagrillo-Fagundes
- INRS-Institut Armand-Frappier and BioMed Research Centre, Laval, Quebec, Canada
- Center for Interdisciplinary Research on Well-Being, Health, Society and Environment, Université du Québec à Montréal, Montréal, Quebec, Canada
| | | | - Rodrigo Ruano
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Regina P Markus
- Department of Physiology, Institute of Bioscience, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Cathy Vaillancourt
- INRS-Institut Armand-Frappier and BioMed Research Centre, Laval, Quebec, Canada
- Center for Interdisciplinary Research on Well-Being, Health, Society and Environment, Université du Québec à Montréal, Montréal, Quebec, Canada
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17
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Geldenhuys J, Rossouw TM, Lombaard HA, Ehlers MM, Kock MM. Disruption in the Regulation of Immune Responses in the Placental Subtype of Preeclampsia. Front Immunol 2018; 9:1659. [PMID: 30079067 PMCID: PMC6062603 DOI: 10.3389/fimmu.2018.01659] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 07/04/2018] [Indexed: 01/21/2023] Open
Abstract
Preeclampsia is a pregnancy-specific disorder, of which one of its major subtypes, the placental subtype is considered a response to an ischemic placental environment, impacting fetal growth and pregnancy outcome. Inflammatory immune responses have been linked to metabolic and inflammatory disorders as well as reproductive failures. In healthy pregnancy, immune regulatory mechanisms prevent excessive systemic inflammation. However, in preeclampsia, the regulation of immune responses is disrupted as a result of aberrant activation of innate immune cells and imbalanced differentiation of T-helper cell subsets creating a cytotoxic environment in utero. Recognition events that facilitate immune interaction between maternal decidual T cells, NK cells, and cytotrophoblasts are considered an indirect cause of the incomplete remodeling of spiral arteries in preeclampsia. The mechanisms involved include the activation of immune cells and the subsequent secretion of cytokines and placental growth factors affecting trophoblast invasion, angiogenesis, and eventually placentation. In this review, we focus on the role of excessive systemic inflammation as the result of a dysregulated immune system in the development of preeclampsia. These include insufficient control of inflammation, failure of tolerance toward paternal antigens at the fetal-maternal interface, and subsequent over- or insufficient activation of immune mediators. It is also possible that external stimuli, such as bacterial endotoxin, may contribute to the excessive systemic inflammation in preeclampsia by stimulating the release of pro-inflammatory cytokines. In conclusion, a disrupted immune system might be a predisposing factor or result of placental oxidative stress or excessive inflammation in preeclampsia. Preeclampsia can thus be considered a hyperinflammatory state associated with defective regulation of the immune system proposed as a key element in the pathological events of the placental subtype of this disorder.
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Affiliation(s)
- Janri Geldenhuys
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Theresa Marie Rossouw
- Department of Immunology, Institute for Cellular and Molecular Medicine, University of Pretoria, Pretoria, South Africa
| | - Hendrik Andries Lombaard
- Obstetrics and Gynecology, Rahima Moosa Mother and Child Hospital, Wits Obstetrics and Gynecology Clinical Research Division, Faculty of Health Sciences, School of Clinical Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - Marthie Magdaleen Ehlers
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Department of Medical Microbiology, Tshwane Academic Division, National Health Laboratory Service, Pretoria, South Africa
| | - Marleen Magdalena Kock
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Department of Medical Microbiology, Tshwane Academic Division, National Health Laboratory Service, Pretoria, South Africa
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18
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Williamson RD, McCarthy FP, Khashan AS, Totorika A, Kenny LC, McCarthy C. Exploring the role of mitochondrial dysfunction in the pathophysiology of pre-eclampsia. Pregnancy Hypertens 2018; 13:248-253. [PMID: 30177060 DOI: 10.1016/j.preghy.2018.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/29/2018] [Accepted: 06/15/2018] [Indexed: 02/08/2023]
Affiliation(s)
- Rachel D Williamson
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital, Cork, Ireland.
| | - Fergus P McCarthy
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital, Cork, Ireland; Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Ali S Khashan
- Department of Epidemiology and Public Health, University College Cork, Ireland
| | - Ainhoa Totorika
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital, Cork, Ireland
| | - Louise C Kenny
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, United Kingdom
| | - Cathal McCarthy
- Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork University Maternity Hospital, Cork, Ireland
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19
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The effect of oxidative stress induced by tert-butylhydroperoxide under distinct folic acid conditions: An in vitro study using cultured human trophoblast-derived cells. Reprod Toxicol 2018; 77:33-42. [PMID: 29425713 DOI: 10.1016/j.reprotox.2018.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 02/02/2018] [Accepted: 02/05/2018] [Indexed: 12/14/2022]
Abstract
Preeclampsia is a pregnancy disorder characterized by high maternal blood pressure, fetal growth restriction and intrauterine hypoxia. Folic acid is a vitamin required during pregnancy. In this work, we investigated the relationship between preeclampsia and the intake of distinct doses of folic acid during pregnancy. Considering that preeclampsia is associated with increased placental oxidative stress levels, we investigated the effect of oxidative stress induced by tert-butylhydroperoxide (TBH) in human trophoblast-derived cells cultured upon deficient/low, physiological and supra-physiological folic acid levels. The negative effect of TBH upon thiobarbituric acid reactive substances (TBARS), total, reduced and oxidized glutathione, cell viability, cell proliferation, culture growth and cell migration was more marked under folic acid excess. This study suggests more attention on the dose administered, and ultimately, on the overall folic acid levels during pregnancy, in the context of preeclampsia risk.
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20
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Khaliq OP, Murugesan S, Moodley J, Mackraj I. Differential expression of miRNAs are associated with the insulin signaling pathway in preeclampsia and gestational hypertension. Clin Exp Hypertens 2018; 40:744-751. [PMID: 29381395 DOI: 10.1080/10641963.2018.1431257] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The objective of this study was to determine microRNAs (miRNAs) expression levels in placental tissue and serum samples from preeclampsia (PE) and gestational hypertensive (GH) patients. STUDY DESIGN Using a targeted qPCR method, the selected miRNAs putatively involved in the PE and GH were examined from normotensive (n = 32), PE (n = 32) and GH (n = 28) in South African women. Western blot analysis of protein expressions of AKT and PI3K was performed in the placental tissue of all three groups. RESULTS qPCR results of serum miR-222 expression levels showed a significant decrease in PE compared to GH and normotensive groups. miR-29a expression levels were significantly increased in PE and GH groups compared to normotensives. Serum expression levels of miR-181a in GH showed a significant increase compared to the PE and normotensive groups. Placental tissue expression levels of miR-181a were significantly increased in PE and GH groups compared to normotensives. Western blot results of placental tissue showed a decrease in the expression levels of AKT-serine and threonine in the PE groups compared to the normotensives and a significantly higher expression in the GH groups compared to normotensives. Phosphatidyl-inositol-3 kinase (PI3K) expression levels were significantly decreased in PE and GH groups compared to normotensives. CONCLUSION The present study, interestingly, demonstrates the differential expression of circulating miRNA in GH and a correlation between the expression levels of miRNAs with AKT/PI3K in the insulin signaling pathway, reinforcing the presence of metabolic dysregulation in PE and GH.
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Affiliation(s)
- Olive P Khaliq
- a Department of Human Physiology, School of Laboratory Medicine and Medical Sciences , University of KwaZulu-Natal , Durban , South Africa
| | - Saravanakumar Murugesan
- a Department of Human Physiology, School of Laboratory Medicine and Medical Sciences , University of KwaZulu-Natal , Durban , South Africa
| | - Jagidesa Moodley
- b Department of Obstetrics and Gynaecology and Women's Health and HIV Research Group, Nelson R Mandela School of Medicine , University of KwaZulu-Natal , Durban , South Africa
| | - Irene Mackraj
- a Department of Human Physiology, School of Laboratory Medicine and Medical Sciences , University of KwaZulu-Natal , Durban , South Africa
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Vokalova L, van Breda SV, Ye XL, Huhn EA, Than NG, Hasler P, Lapaire O, Hoesli I, Rossi SW, Hahn S. Excessive Neutrophil Activity in Gestational Diabetes Mellitus: Could It Contribute to the Development of Preeclampsia? Front Endocrinol (Lausanne) 2018; 9:542. [PMID: 30298053 PMCID: PMC6161643 DOI: 10.3389/fendo.2018.00542] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/28/2018] [Indexed: 12/19/2022] Open
Abstract
Gestational diabetes mellitus is a transient form of glucose intolerance occurring during pregnancy. Pregnancies affected by gestational diabetes mellitus are at risk for the development of preeclampsia, a severe life threatening condition, associated with significant feto-maternal morbidity and mortality. It is a risk factor for long-term health in women and their offspring. Pregnancy has been shown to be associated with a subliminal degree of neutrophil activation and tightly regulated generation of neutrophil extracellular traps (NETs). This response is excessive in cases with preeclampsia, leading to the presence of large numbers of NETs in affected placentae. We have recently observed that circulatory neutrophils in cases with gestational diabetes mellitus similarly exhibit an excessive pro-NETotic phenotype, and pronounced placental presence, as detected by expression of neutrophil elastase. Furthermore, exogenous neutrophil elastase liberated by degranulating neutrophils was demonstrated to alter trophoblast physiology and glucose metabolism by interfering with key signal transduction components. In this review we examine whether additional evidence exists suggesting that altered neutrophil activity in gestational diabetes mellitus may contribute to the development of preeclampsia.
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Affiliation(s)
- Lenka Vokalova
- Department of Biomedicine, University and University Hospital Basel, Basel, Switzerland
- Institute of Physiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Shane V. van Breda
- Department of Biomedicine, University and University Hospital Basel, Basel, Switzerland
- Department of Rheumatology, Kantonsspital Aarau, Aarau, Switzerland
| | - Xi Lun Ye
- Department of Biomedicine, University and University Hospital Basel, Basel, Switzerland
| | - Evelyn A. Huhn
- Department of Obstetrics, University Women's Hospital Basel, Basel, Switzerland
| | - Nandor G. Than
- Systems Biology of Reproduction Momentum Research Group, Research Centre for Natural Sciences, Institute of Enzymology, Hungarian Academy of Sciences, Budapest, Hungary
| | - Paul Hasler
- Department of Rheumatology, Kantonsspital Aarau, Aarau, Switzerland
| | - Olav Lapaire
- Department of Obstetrics, University Women's Hospital Basel, Basel, Switzerland
| | - Irene Hoesli
- Department of Obstetrics, University Women's Hospital Basel, Basel, Switzerland
| | - Simona W. Rossi
- Department of Biomedicine, University and University Hospital Basel, Basel, Switzerland
- *Correspondence: Simona W. Rossi
| | - Sinuhe Hahn
- Department of Biomedicine, University and University Hospital Basel, Basel, Switzerland
- Sinuhe Hahn
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Verma S, Pillay P, Naicker T, Moodley J, Mackraj I. Placental hypoxia inducible factor -1α & CHOP immuno-histochemical expression relative to maternal circulatory syncytiotrophoblast micro-vesicles in preeclamptic and normotensive pregnancies. Eur J Obstet Gynecol Reprod Biol 2017; 220:18-24. [PMID: 29127866 DOI: 10.1016/j.ejogrb.2017.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 11/03/2017] [Accepted: 11/06/2017] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Preeclampsia (PE) occurs as a result placental hypoxia-induced oxidative and endoplasmic reticulum stress, and is associated with the activation of hypoxia inducible factor-1α (HIF-1α) and apoptotic CHOP pathways with the consequential shedding of syncytiotrophoblast microvesicles which may be central in mediating the maternal systemic immune response. The aim of this study was to immune-localise and morphometrically analyse CHOP and HIF-1α within the placenta of normotensive and pre-eclamptic pregnancies and concomitantly quantify syncytiotrophoblast released microvesicles in maternal circulation. STUDY DESIGN Placental tissue and plasma were obtained from normotensive and pre-eclamptic pregnant women. The expression of CHOP and HIF-1α was analysed using immunohistochemistry. Isolation and size distribution of the circulating maternal microvesicles was determined using nanoparticle tracking analysis. The concentration of syncytiotrophoblast microvesicles was determined using the placental alkaline phosphatase ELISA. RESULTS This study demonstrates a significant increase in immunohistochemical expression of HIF-1 α and CHOP in preeclampsia compared to the normotensive women (p<0.05). In keeping with this, a significant increase in the mean syncytiotrophoblast microvesicles concentration was observed in PE, compared to normotensives (p<0.05). A positive correlation between placental expression of CHOP and HIF-1α and STBMs was obtained. CONCLUSION This study demonstrates increased placental expression of HIF-1α and CHOP in preeclampsia compared to normotensive pregnancies which correlate to their increased syncytiotrophoblast microvesicles concentration in maternal circulation. These findings indicate that placental hypoxia and ER stress are interrelated contributory factors to the pathogenesis of PE and the consequential release of placental derived debris into the maternal circulation.
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Affiliation(s)
- S Verma
- Department of Physiology, University of KwaZulu-Natal, South Africa
| | - P Pillay
- Department of Physiology, University of KwaZulu-Natal, South Africa
| | - T Naicker
- Department of Optics and Imaging, University of KwaZulu-Natal, South Africa
| | - J Moodley
- Women's Health and HIV Research Group, University of KwaZulu-Natal, South Africa
| | - I Mackraj
- Department of Physiology, University of KwaZulu-Natal, South Africa.
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Romero R, Erez O, Hüttemann M, Maymon E, Panaitescu B, Conde-Agudelo A, Pacora P, Yoon BH, Grossman LI. Metformin, the aspirin of the 21st century: its role in gestational diabetes mellitus, prevention of preeclampsia and cancer, and the promotion of longevity. Am J Obstet Gynecol 2017; 217:282-302. [PMID: 28619690 DOI: 10.1016/j.ajog.2017.06.003] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/30/2017] [Accepted: 06/05/2017] [Indexed: 12/16/2022]
Abstract
Metformin is everywhere. Originally introduced in clinical practice as an antidiabetic agent, its role as a therapeutic agent is expanding to include treatment of prediabetes mellitus, gestational diabetes mellitus, and polycystic ovarian disease; more recently, experimental studies and observations in randomized clinical trials suggest that metformin could have a place in the treatment or prevention of preeclampsia. This article provides a brief overview of the history of metformin in the treatment of diabetes mellitus and reviews the results of metaanalyses of metformin in gestational diabetes mellitus as well as the treatment of obese, non-diabetic, pregnant women to prevent macrosomia. We highlight the results of a randomized clinical trial in which metformin administration in early pregnancy did not reduce the frequency of large-for-gestational-age infants (the primary endpoint) but did decrease the frequency of preeclampsia (a secondary endpoint). The mechanisms by which metformin may prevent preeclampsia include a reduction in the production of antiangiogenic factors (soluble vascular endothelial growth factor receptor-1 and soluble endoglin) and the improvement of endothelial dysfunction, probably through an effect on the mitochondria. Another potential mechanism whereby metformin may play a role in the prevention of preeclampsia is its ability to modify cellular homeostasis and energy disposition, mediated by rapamycin, a mechanistic target. Metformin has a molecular weight of 129 Daltons and therefore readily crosses the placenta. There is considerable evidence to suggest that this agent is safe during pregnancy. New literature on the role of metformin as a chemotherapeutic adjuvant in the prevention of cancer and in prolonging life and protecting against aging is reviewed briefly. Herein, we discuss the mechanisms of action and potential benefits of metformin.
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Stokholm J, Sevelsted A, Anderson UD, Bisgaard H. Preeclampsia Associates with Asthma, Allergy, and Eczema in Childhood. Am J Respir Crit Care Med 2017; 195:614-621. [PMID: 27626972 DOI: 10.1164/rccm.201604-0806oc] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
RATIONALE Preeclampsia reflects an unusual increase in systemic inflammation during pregnancy. OBJECTIVES We studied associations between preeclampsia and asthma, allergy, and eczema in Copenhagen Prospective Studies on Asthma in Childhood2000 (COPSAC2000) and in national registries. METHODS COPSAC2000 is a high-risk birth cohort of 411 Danish children. Asthma, allergy, and eczema were diagnosed prospectively, and lung function measured at age 1 month and 7 years. Sensitization was evaluated at age 6 months, 18 months, 4 years, and 6 years by skin prick tests and IgE measurements. The register-based cohort included 1.7 million children from Danish national registries in the 35-year period 1977-2012. Children born to mothers with preeclampsia were analyzed regarding risk of asthma, allergy, and eczema. MEASUREMENTS AND MAIN RESULTS In the COPSAC2000 cohort, 5.6% (n = 23) were diagnosed with preeclampsia. Preeclampsia was associated with increased risk of treatment with inhaled corticosteroids at age 7 years (adjusted odds ratio, 4.01 [95% confidence interval (CI), 1.11-14.43]; P = 0.0337), increased bronchial responsiveness to methacholine (adjusted β-coefficient log-μmol, -0.80 [95% CI, -1.55 to -0.06]; P = 0.0348), and allergic rhinitis (adjusted odds ratio, 4.83 [95% CI, 1.58-14.78]; P = 0.0057) in the 7-year-old children. Furthermore, the children had an increased risk of sensitization to both aeroallergens and food allergens, and increased amount of total IgE during childhood. In the registry-based cohort, 3.7% (n = 62,728) were born to mothers with preeclampsia. Preeclampsia was associated with increased risk of asthma, eczema, and aeroallergen and food allergy, especially pronounced after a duration of preeclampsia of 14 days or more. Maternal asthma increased the risk of preeclampsia. CONCLUSIONS Preeclampsia is a shared prenatal risk factor for asthma, eczema, and allergy in childhood pointing toward in utero immune programming of the child.
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Affiliation(s)
- Jakob Stokholm
- 1 Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,2 Department of Pediatrics, Naestved Hospital, Naestved, Denmark; and
| | - Astrid Sevelsted
- 1 Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik D Anderson
- 3 Department of Obstetrics and Gynecology, and.,4 Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Hans Bisgaard
- 1 Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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Sundheimer LW, Pisarska MD. Abnormal Placentation Associated with Infertility as a Marker of Overall Health. Semin Reprod Med 2017; 35:205-216. [PMID: 28658703 DOI: 10.1055/s-0037-1603570] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AbstractInfertility and fertility treatments utilized are associated with abnormal placentation leading to adverse pregnancy outcomes related to placentation, including preterm birth, low birth weight, placenta accrete, and placenta previa. This may be due to the underlying genetics predisposing to infertility or the epigenetic changes associated with the fertility treatments utilized, as specific disease states leading to infertility are at increased risk of adverse outcomes, including placental abruption, fetal loss, gestational diabetes mellitus, and outcomes related to placentation, as well as the treatments utilized including in vitro fertilization (IVF) and non-IVF fertility treatment. Placentation defects, leading to adverse maternal and fetal outcomes, which are more pronounced in the infertile population, occur due to changes in trophoblast invasion, vascular defects, changes in the environmental milieu, chronic inflammation, and oxidative stress. These similar processes are recognized as major contributors to lifelong risk of cardiovascular and metabolic disease for both the mother and her offspring. Thus, abnormal placentation, found to be more prevalent in the infertile population, may be the key to better understand how infertility affects overall and long-term health.
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Affiliation(s)
- Lauren W Sundheimer
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California.,Division of Reproductive Endocrinology and Infertility, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Margareta D Pisarska
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California.,Division of Reproductive Endocrinology and Infertility, UCLA David Geffen School of Medicine, Los Angeles, California
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Mechanistic Insight into Long Noncoding RNAs and the Placenta. Int J Mol Sci 2017; 18:ijms18071371. [PMID: 28653993 PMCID: PMC5535864 DOI: 10.3390/ijms18071371] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/19/2017] [Accepted: 06/21/2017] [Indexed: 02/07/2023] Open
Abstract
Long non-coding RNAs (lncRNAs) are classified as RNAs greater than 200 nucleotides in length that do not produce a protein product. lncRNAs are expressed with cellular and temporal specificity and have been shown to play a role in many cellular events, including the regulation of gene expression, post-transcriptional modifications and epigenetic modifications. Since lncRNAs were first discovered, there has been increasing evidence that they play important roles in the development and function of most organs, including the placenta. The placenta is an essential transient organ that facilitates communication and nutrient exchange between the mother and foetus. The placenta is of foetal origin and begins to form shortly after the embryo implants into the uterine wall. The placenta relies heavily on the successful differentiation and function of trophoblast cells, including invasion as well as the formation of the maternal/foetal interface. Here, we review the current literature surrounding the involvement of lncRNAs in the development and function of trophoblasts and the human placenta.
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Mitochondrial [dys]function; culprit in pre-eclampsia? Clin Sci (Lond) 2017; 130:1179-84. [PMID: 27252404 DOI: 10.1042/cs20160103] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 02/12/2016] [Indexed: 01/01/2023]
Abstract
Mitochondria are extensively identified for their bioenergetic capacities; however, recently these metabolic hubs are increasingly being appreciated as critical regulators of numerous cellular signalling systems. Mitochondrial reactive oxygen species have evolved as a mode of cross-talk between mitochondrial function and physiological systems, to sustain equipoise and foster adaption to cellular stress. Redox signalling mediated by exaggerated mitochondrial-ROS (reactive oxygen species) has been incriminated in a plethora of disease pathologies. Excessive production of mitochondrial ROS is intrinsically linked to mitochondrial dysfunction. Furthermore, mitochondrial dysfunction is a key facilitator of oxidative stress, inflammation, apoptosis and metabolism. These are key pathogenic intermediaries of pre-eclampsia, hence we hypothesize that mitochondrial dysfunction is a pathogenic mediator of oxidative stress in the pathophysiology of pre-eclampsia. We hypothesize that mitochondrial-targeted antioxidants may restrain production of ROS-mediated deleterious redox signalling pathways. If our hypothesis proves correct, therapeutic strategies directly targeting mitochondrial superoxide scavenging should be actively pursued as they may alleviate maternal vascular dysfunction and dramatically improve maternal and fetal health worldwide.
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McCarthy C, Kenny LC. Therapeutically targeting mitochondrial redox signalling alleviates endothelial dysfunction in preeclampsia. Sci Rep 2016; 6:32683. [PMID: 27604418 PMCID: PMC5015016 DOI: 10.1038/srep32683] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 08/15/2016] [Indexed: 12/24/2022] Open
Abstract
Aberrant placentation generating placental oxidative stress is proposed to play a critical role in the pathophysiology of preeclampsia. Unfortunately, therapeutic trials of antioxidants have been uniformly disappointing. There is provisional evidence implicating mitochondrial dysfunction as a source of oxidative stress in preeclampsia. Here we provide evidence that mitochondrial reactive oxygen species mediates endothelial dysfunction and establish that directly targeting mitochondrial scavenging may provide a protective role. Human umbilical vein endothelial cells exposed to 3% plasma from women with pregnancies complicated by preeclampsia resulted in a significant decrease in mitochondrial function with a subsequent significant increase in mitochondrial superoxide generation compared to cells exposed to plasma from women with uncomplicated pregnancies. Real-time PCR analysis showed increased expression of inflammatory markers TNF-α, TLR-9 and ICAM-1 respectively in endothelial cells treated with preeclampsia plasma. MitoTempo is a mitochondrial-targeted antioxidant, pre-treatment of cells with MitoTempo protected against hydrogen peroxide-induced cell death. Furthermore MitoTempo significantly reduced mitochondrial superoxide production in cells exposed to preeclampsia plasma by normalising mitochondrial metabolism. MitoTempo significantly altered the inflammatory profile of plasma treated cells. These novel data support a functional role for mitochondrial redox signaling in modulating the pathogenesis of preeclampsia and identifies mitochondrial-targeted antioxidants as potential therapeutic candidates.
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Affiliation(s)
- Cathal McCarthy
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Department of Obstetrics and Gynaecology, Cork University Hospital, Wilton, Cork, Ireland
| | - Louise C Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Department of Obstetrics and Gynaecology, Cork University Hospital, Wilton, Cork, Ireland
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Başaran B, Çelebioğlu B, Başaran A, Altınel S, Kutlucan L, Martin JN. Anesthetic practices for patients with preeclampsia or HELLP syndrome: A survey. J Turk Ger Gynecol Assoc 2016; 17:128-33. [PMID: 27651719 DOI: 10.5152/jtgga.2016.16094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/20/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Substantial controversy exists regarding anesthetic management for patients with preeclampsia or hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome. Experts, researchers, clinicians, and residents in Turkey were surveyed about their practices. MATERIAL AND METHODS Questionnaires were distributed to attendees at a national conference, and they were filled out immediately. Anonymous 10-item paper surveys were administered to both residents and non-residents. Descriptive statistics were used in the analysis. Agreement among ≥75% of the respondents was considered a majority opinion. Surveys with missing responses were used to analyze the non-response bias. The Chi-square test was used for comparisons. A historical cohort of obstetricians-gynecologists was used for comparison with anesthesiologists. RESULTS Of 339 surveys distributed, 288 were returned (84.9% response rate). Among the returned surveys, the completion rate was 96.1%. The job experience in years among clinicians and residents was 9±5 and 3±1, respectively. General anesthesia was still significantly preferred by 36.1% among patients with preeclampsia with platelet counts of ≥100,000/μL. Compared to obstetricians-gynecologists, anesthesiologists more often preferred general anesthesia. With platelet counts of <50,000/μL or eclampsia, most respondents preferred general anesthesia 94.4% for very low platelets and 89.5% for eclampsia. CONCLUSION A preferential trend toward general anesthesia for patients with preeclampsia or HELLP syndrome exists among anesthesiologists in Turkey, particularly for patients with severe thrombocytopenia and/or eclampsia. There exists a need for well-designed and well-executed prospective clinical trials to provide evidence for the best consensus practice.
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Affiliation(s)
- Betül Başaran
- Department of Anesthesiology, Konya Training and Research Hospital, Konya, Turkey
| | - Bilge Çelebioğlu
- Department of Anesthesiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ahmet Başaran
- Department of Obstetrics and Gynecology, Konya Training and Research Hospital, Konya, Turkey
| | - Seher Altınel
- Department of Anesthesiology, Ankara Gazi Mustafa Kemal State Hospital, Ankara, Turkey
| | - Leyla Kutlucan
- Department of Anesthesiology, Konya Training and Research Hospital, Konya, Turkey
| | - James N Martin
- Department of Obstetrics and Gynecology, The University of Mississippi Medical Center, Jackson, USA
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Meeme A, Buga GA, Mammen M, Namugowa AV. Angiogenic imbalance as a contributor to the pathophysiology of preeclampsia among black African women. J Matern Fetal Neonatal Med 2016; 30:1335-1341. [DOI: 10.1080/14767058.2016.1212832] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ilekis JV, Tsilou E, Fisher S, Abrahams VM, Soares MJ, Cross JC, Zamudio S, Illsley NP, Myatt L, Colvis C, Costantine MM, Haas DM, Sadovsky Y, Weiner C, Rytting E, Bidwell G. Placental origins of adverse pregnancy outcomes: potential molecular targets: an Executive Workshop Summary of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Am J Obstet Gynecol 2016; 215:S1-S46. [PMID: 26972897 DOI: 10.1016/j.ajog.2016.03.001] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 02/11/2016] [Accepted: 03/01/2016] [Indexed: 12/26/2022]
Abstract
Although much progress is being made in understanding the molecular pathways in the placenta that are involved in the pathophysiology of pregnancy-related disorders, a significant gap exists in the utilization of this information for the development of new drug therapies to improve pregnancy outcome. On March 5-6, 2015, the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health sponsored a 2-day workshop titled Placental Origins of Adverse Pregnancy Outcomes: Potential Molecular Targets to begin to address this gap. Particular emphasis was given to the identification of important molecular pathways that could serve as drug targets and the advantages and disadvantages of targeting these particular pathways. This article is a summary of the proceedings of that workshop. A broad number of topics were covered that ranged from basic placental biology to clinical trials. This included research in the basic biology of placentation, such as trophoblast migration and spiral artery remodeling, and trophoblast sensing and response to infectious and noninfectious agents. Research findings in these areas will be critical for the formulation of the development of future treatments and the development of therapies for the prevention of a number of pregnancy disorders of placental origin that include preeclampsia, fetal growth restriction, and uterine inflammation. Research was also presented that summarized ongoing clinical efforts in the United States and in Europe that has tested novel interventions for preeclampsia and fetal growth restriction, including agents such as oral arginine supplementation, sildenafil, pravastatin, gene therapy with virally delivered vascular endothelial growth factor, and oxygen supplementation therapy. Strategies were also proposed to improve fetal growth by the enhancement of nutrient transport to the fetus by modulation of their placental transporters and the targeting of placental mitochondrial dysfunction and oxidative stress to improve placental health. The roles of microRNAs and placental-derived exosomes, as well as messenger RNAs, were also discussed in the context of their use for diagnostics and as drug targets. The workshop discussed the aspect of safety and pharmacokinetic profiles of potential existing and new therapeutics that will need to be determined, especially in the context of the unique pharmacokinetic properties of pregnancy and the hurdles and pitfalls of the translation of research findings into practice. The workshop also discussed novel methods of drug delivery and targeting during pregnancy with the use of macromolecular carriers, such as nanoparticles and biopolymers, to minimize placental drug transfer and hence fetal drug exposure. In closing, a major theme that developed from the workshop was that the scientific community must change their thinking of the pregnant woman and her fetus as a vulnerable patient population for which drug development should be avoided, but rather be thought of as a deprived population in need of more effective therapeutic interventions.
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Affiliation(s)
- John V Ilekis
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Department of Health and Human Services, Bethesda, MD.
| | - Ekaterini Tsilou
- Obstetric and Pediatric Pharmacology and Therapeutics Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Department of Health and Human Services, Bethesda, MD.
| | - Susan Fisher
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA
| | - Vikki M Abrahams
- Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine; New Haven, CT
| | - Michael J Soares
- Institute of Reproductive Health and Regenerative Medicine and Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS
| | - James C Cross
- Comparative Biology and Experimental Medicine, University of Calgary Health Sciences Centre, Calgary, Alberta, Canada
| | - Stacy Zamudio
- Department of Obstetrics and Gynecology, Hackensack University Medical Center, Hackensack, NJ
| | - Nicholas P Illsley
- Department of Obstetrics and Gynecology, Hackensack University Medical Center, Hackensack, NJ
| | - Leslie Myatt
- Center for Pregnancy and Newborn Research, University of Texas Health Science Center, San Antonio, TX
| | - Christine Colvis
- Therapeutics Discovery Program, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD
| | - Maged M Costantine
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX
| | - David M Haas
- Department of Obstetrics and Gynecology Indiana University, Indianapolis, IN
| | | | - Carl Weiner
- University of Kansas Medical Center, Kansas City, KS
| | - Erik Rytting
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX
| | - Gene Bidwell
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS
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Reyna-Villasmil E, Mejía-Montilla J, Santos-Bolívar J, Torres-Cepeda D, Reyna-Villasmil N, Fernández-Ramírez A. Angiopoyetina-1 plasmática en el segundo trimestre como predictor del desarrollo de preeclampsia. PERINATOLOGÍA Y REPRODUCCIÓN HUMANA 2016. [DOI: 10.1016/j.rprh.2016.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Immunology of hepatic diseases during pregnancy. Semin Immunopathol 2016; 38:669-685. [PMID: 27324237 DOI: 10.1007/s00281-016-0573-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/18/2016] [Indexed: 02/06/2023]
Abstract
The mother's immune system has to adapt to pregnancy accepting the semi-allograft fetus and preventing harmful effects to the developing child. Aberrations in feto-maternal immune adaptation may result in disease of the mother, such as liver injury. Five pregnancy-associated liver disorders have been described so far, however, little is known concerning immune alterations promoting the respective disease. These liver disorders are pre-eclampsia, hemolysis, elevated liver enzymes, low platelet count (HELLP), acute fatty liver, hyperemesis gravidarum, and intrahepatic cholestasis of pregnancy. On the other hand, pre-existing autoimmune liver injury of the mother can be affected by pregnancy. This review intends to summarize current knowledge linking feto-maternal immunology and liver inflammation with a special emphasis on novel potential biomarkers.
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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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LaMarca B, Amaral LM, Harmon AC, Cornelius DC, Faulkner JL, Cunningham MW. Placental Ischemia and Resultant Phenotype in Animal Models of Preeclampsia. Curr Hypertens Rep 2016; 18:38. [PMID: 27076345 PMCID: PMC5127437 DOI: 10.1007/s11906-016-0633-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Preeclampsia is new onset (or worsening of preexisting) hypertension that occurs during pregnancy. It is accompanied by chronic inflammation, intrauterine growth restriction, elevated anti-angiogenic factors, and can occur with or without proteinuria. Although the exact etiology is unknown, it is thought that preeclampsia begins early in gestation with reduced uterine spiral artery remodeling leading to decreased vasculogenesis of the placenta as the pregnancy progresses. Soluble factors, stimulated by the ischemic placenta, shower the maternal vascular endothelium and are thought to cause endothelial dysfunction and to contribute to the development of hypertension during pregnancy. Due to the difficulty in studying such soluble factors in pregnant women, various animal models have been designed. Studies from these models have contributed to a better understanding of how factors released in response to placental ischemia may lead to increased blood pressure and reduced fetal weight during pregnancy. This review will highlight various animal models and the major findings indicating the importance of placental ischemia to lead to the pathophysiology observed in preeclamptic patients.
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Affiliation(s)
- Babbette LaMarca
- Departments of Pharmacology, Physiology, & Ob/Gyn, Center for Excellence in Cardiovascular and Renal Research, University of Mississippi Medical Center, Jackson, MS, 39216, USA.
| | - Lorena M Amaral
- Departments of Pharmacology, Physiology, & Ob/Gyn, Center for Excellence in Cardiovascular and Renal Research, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Ashlyn C Harmon
- Departments of Pharmacology, Physiology, & Ob/Gyn, Center for Excellence in Cardiovascular and Renal Research, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Denise C Cornelius
- Departments of Pharmacology, Physiology, & Ob/Gyn, Center for Excellence in Cardiovascular and Renal Research, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Jessica L Faulkner
- Departments of Pharmacology, Physiology, & Ob/Gyn, Center for Excellence in Cardiovascular and Renal Research, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Mark W Cunningham
- Departments of Pharmacology, Physiology, & Ob/Gyn, Center for Excellence in Cardiovascular and Renal Research, University of Mississippi Medical Center, Jackson, MS, 39216, USA
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Harmon AC, Cornelius DC, Amaral LM, Faulkner JL, Cunningham MW, Wallace K, LaMarca B. The role of inflammation in the pathology of preeclampsia. Clin Sci (Lond) 2016; 130:409-19. [PMID: 26846579 PMCID: PMC5484393 DOI: 10.1042/cs20150702] [Citation(s) in RCA: 340] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Preeclampsia (PE) affects 5-7% of all pregnancies in the United States and is the leading cause of maternal and prenatal morbidity. PE is associated with hypertension after week 20 of gestation, decreased renal function and small-for-gestational-age babies. Women with PE exhibit chronic inflammation and production of autoantibodies. It is hypothesized that during PE, placental ischaemia occurs as a result of shallow trophoblast invasion which is associated with an immune imbalance where pro-inflammatory CD4(+) T-cells are increased and T regulatory cells (Tregs) are decreased. This imbalance leads to chronic inflammation characterized by oxidative stress, pro-inflammatory cytokines and autoantibodies. Studies conducted in our laboratory have demonstrated the importance of this immune imbalance in causing hypertension in response to placental ischaemia in pregnant rats. These studies confirm that increased CD4(+) T-cells and decreased Tregs during pregnancy leads to elevated inflammatory cytokines, endothelin (ET-1), reactive oxygen species (ROS) and agonistic autoantibodies to the angiotensin II (Ang II), type 1 receptor (AT1-AA). All of these factors taken together play an important role in increasing the blood pressure during pregnancy. Specifically, this review focuses on the decrease in Tregs, and their associated regulatory cytokine interleukin (IL)-10, which is seen in response to placental ischaemia during pregnancy. This study will also examine the effect of regulatory immune cell repopulation on the pathophysiology of PE. These studies show that restoring the balance of the immune system through increasing Tregs, either by adoptive transfer or by infusing IL-10, reduces the blood pressure and pathophysiology associated with placental ischaemia in pregnant rats.
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Affiliation(s)
- Ashlyn C Harmon
- Departments of Pharmacology, Physiology, & Ob/Gyn, Center for Excellence in Cardiovascular and Renal Research, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
| | - Denise C Cornelius
- Departments of Pharmacology, Physiology, & Ob/Gyn, Center for Excellence in Cardiovascular and Renal Research, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
| | - Lorena M Amaral
- Departments of Pharmacology, Physiology, & Ob/Gyn, Center for Excellence in Cardiovascular and Renal Research, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
| | - Jessica L Faulkner
- Departments of Pharmacology, Physiology, & Ob/Gyn, Center for Excellence in Cardiovascular and Renal Research, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
| | - Mark W Cunningham
- Departments of Pharmacology, Physiology, & Ob/Gyn, Center for Excellence in Cardiovascular and Renal Research, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
| | - Kedra Wallace
- Departments of Pharmacology, Physiology, & Ob/Gyn, Center for Excellence in Cardiovascular and Renal Research, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A
| | - Babbette LaMarca
- Departments of Pharmacology, Physiology, & Ob/Gyn, Center for Excellence in Cardiovascular and Renal Research, University of Mississippi Medical Center, Jackson, MS 39216, U.S.A.
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Başaran A, Başaran M, Topatan B, Martin JN. Effect of chorionic villus sampling on the occurrence of preeclampsia and gestational hypertension: An updated systematic review and meta-analysis. J Turk Ger Gynecol Assoc 2016; 17:65-72. [PMID: 27403071 DOI: 10.5152/jtgga.2016.16026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 03/22/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To perform a meta-analysis for an assessment of the risk of preeclampsia or gestational hypertension following chorionic villus sampling (CVS). DATA SOURCE PubMed was systematically searched from its inception through January 2016. MATERIAL AND METHODS Nine reports were identified. A pre-specified scale was used to assess their quality. TABULATION INTEGRATION AND RESULTS We performed pooling into three subgroups with respect to the control group: A) Patients with no invasive prenatal diagnostic procedure served as a control group for comparison. The odds ratios for gestational hypertension (0.76, 95% CI 0.46-1.26), preeclampsia (0.83, 95% CI 0.42-1.67), and severe preeclampsia (0.49, 95% CI 0.04-5.78) or when hypertension categories were pooled (0.80, 95% CI 0.46-1.41) were not significantly different. B) Patients with midtrimester diagnostic amniocentesis and patients with no invasive prenatal diagnostic procedure were combined as a control group for comparison. The odds ratios for preeclampsia (1, 95% CI 0.46-2.18), severe preeclampsia (0.83, 95% CI 0.14-4.85), and pooled hypertension categories (1.07, 95% CI 0.63-1.84) were not significantly different. C) Patients with midtrimester diagnostic amniocentesis served as a control group. There was a significant difference in the odds ratio for preeclampsia between the CVS and amniocentesis groups (2.47, 95% CI 1.14-5.33). There was a marginal difference in the odds ratio for combined pregnancy-induced hypertension categories between the CVS and amniocentesis groups (1.61, 95% CI 1.02-2.53). CONCLUSION The available data do not indicate an increased risk of preeclampsia or gestational hypertension following first trimester CVS. The heterogeneity and retrospective design of existing studies are limiting factors for our analysis and findings.
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Affiliation(s)
- Ahmet Başaran
- Department of Obstetrics and Gynecology, Konya Training and Research Hospital, Konya, Turkey
| | - Mustafa Başaran
- Department of Obstetrics and Gynecology, Konya Training and Research Hospital, Konya, Turkey
| | - Betül Topatan
- Department of Anesthesiology, Konya Training and Research Hospital, Konya, Turkey
| | - James N Martin
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Moraes D, Munhoz TP, Pinheiro da Costa BE, Hentschke MR, Sontag F, Silveira Lucas L, Gadonski G, Antonello IC, Poli-de-Figueiredo CE. Immature platelet fraction in hypertensive pregnancy. Platelets 2015; 27:333-7. [DOI: 10.3109/09537104.2015.1101060] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Daniela Moraes
- Programa de Pos-Graduaçao em Medicina e Ciencias da Saude (Nefrologia), Faculdade de Medicina, Instituto de Pesquisas Biomedicas, Hospital São Lucas – Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
- Laboratorio de Patologia Clinica –Hospital São Lucas Hospital /Faculdade de Farmácia Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Terezinha Paz Munhoz
- Laboratorio de Patologia Clinica –Hospital São Lucas Hospital /Faculdade de Farmácia Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Bartira E. Pinheiro da Costa
- Programa de Pos-Graduaçao em Medicina e Ciencias da Saude (Nefrologia), Faculdade de Medicina, Instituto de Pesquisas Biomedicas, Hospital São Lucas – Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Marta Ribeiro Hentschke
- Programa de Pos-Graduaçao em Medicina e Ciencias da Saude (Nefrologia), Faculdade de Medicina, Instituto de Pesquisas Biomedicas, Hospital São Lucas – Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Fernando Sontag
- Programa de Pos-Graduaçao em Medicina e Ciencias da Saude (Nefrologia), Faculdade de Medicina, Instituto de Pesquisas Biomedicas, Hospital São Lucas – Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Luiza Silveira Lucas
- Programa de Pos-Graduaçao em Medicina e Ciencias da Saude (Nefrologia), Faculdade de Medicina, Instituto de Pesquisas Biomedicas, Hospital São Lucas – Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Giovani Gadonski
- Programa de Pos-Graduaçao em Medicina e Ciencias da Saude (Nefrologia), Faculdade de Medicina, Instituto de Pesquisas Biomedicas, Hospital São Lucas – Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Ivan Carlos Antonello
- Programa de Pos-Graduaçao em Medicina e Ciencias da Saude (Nefrologia), Faculdade de Medicina, Instituto de Pesquisas Biomedicas, Hospital São Lucas – Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Carlos E. Poli-de-Figueiredo
- Programa de Pos-Graduaçao em Medicina e Ciencias da Saude (Nefrologia), Faculdade de Medicina, Instituto de Pesquisas Biomedicas, Hospital São Lucas – Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
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Abstract
Preeclampsia (PE) is a serious pregnancy-related condition that causes severe maternal and fetal morbidity and mortality. Within the recent years, there has been an increasing focus in predicting PE at the end of the first trimester of pregnancy. In this review, literature published between 2011 and 2015 was evaluated. In a total of six biomarker algorithms, for first and early second trimester, the prediction of preeclampsia is discussed. In addition, one randomized clinical trial was included. Several algorithms were based on placental biomarkers such as pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PLGF), and soluble FMS-like tyrosine kinase 1 (s-FLT-1). The algorithms containing these biomarkers showed a high prediction rate (PR) for early onset PE, ranging from 44 to 92 % at 5 % false positive rate (FPR). New biomarkers suggest an alternative model based on free HbF and the heme scavenger alpha-1-microglobulin (A1M) with a prediction rate of 69 % at an FPR of 5 %. Interestingly, this model performs well without uterine artery Doppler pulsatility index (UtAD-PI), which is an advantage particularly if the screening method were to be implemented in developing countries. The randomized clinical trial showed a clear reduction in early onset PE as well as reducing preterm PE if identified high-risk pregnancies were treated with low-dose aspirin. In conclusion, PE prediction is now possible through several prediction algorithms and prophylaxis is beneficial in high-risk cases.
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Affiliation(s)
- Ulrik Dolberg Anderson
- Departments of Clinical Sciences Lund and Obstetrics and Gynecology, Lund University and Skåne University Hospital Malmö/Lund, Lund, Sweden,
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40
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Petitbarat M, Durigutto P, Macor P, Bulla R, Palmioli A, Bernardi A, De Simoni MG, Ledee N, Chaouat G, Tedesco F. Critical Role and Therapeutic Control of the Lectin Pathway of Complement Activation in an Abortion-Prone Mouse Mating. THE JOURNAL OF IMMUNOLOGY 2015; 195:5602-7. [DOI: 10.4049/jimmunol.1501361] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 10/14/2015] [Indexed: 11/19/2022]
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41
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Implication du stress oxydant dans la physiopathologie de la pré-éclampsie : mise au point. ACTA ACUST UNITED AC 2015; 43:751-6. [DOI: 10.1016/j.gyobfe.2015.09.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 09/15/2015] [Indexed: 11/19/2022]
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42
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Southcombe JH, Redman CWG, Sargent IL, Granne I. Interleukin-1 family cytokines and their regulatory proteins in normal pregnancy and pre-eclampsia. Clin Exp Immunol 2015; 181:480-90. [PMID: 25693732 DOI: 10.1111/cei.12608] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2015] [Indexed: 12/18/2022] Open
Abstract
Maternal systemic inflammation is a feature of pre-eclampsia, a condition in pregnancy characterized by hypertension and proteinuria. Pre-eclampsia is caused by the placenta; many placental factors contribute to the syndrome's progression, and proinflammatory cytokines have been identified previously as one such mediator. The interleukin (IL)-1 family of cytokines are key regulators of the inflammatory network, and two naturally occurring regulatory molecules for IL-1 family cytokines, IL-1RA and sST2, have been found previously to be elevated in maternal blood from women with pre-eclampsia. Here we investigate more recently identified IL-1 family cytokines and regulatory molecules, IL-1RAcP, IL-37, IL-18BP, IL-36α/β/γ/Ra and IL-38 in pre-eclampsia. Pregnant women have more circulating IL-18BP and IL-36Ra than non-pregnant women, and sIL-1RAcP is elevated from women with pre-eclampsia compared to normal pregnancies. The placenta expresses all the molecules, and IL-37 and IL-18BP are up-regulated significantly in pre-eclampsia placentas compared to those from normal pregnancies. Together, these changes contribute to the required inhibition of maternal systemic cytotoxic immunity in normal pregnancy; however, in pre-eclampsia the same profile is not seen. Interestingly, the increased circulating levels of sIL-1RAcP and increased placental IL-18BP and IL-37, the latter of which we show to be induced by hypoxic damage to the placenta, are all factors which are anti-inflammatory. While the placenta is often held responsible for the damage and clinical symptoms of pre-eclampsia by the research community, here we show that the pre-eclampsia placenta is also trying to prevent inflammatory damage to the mother.
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Affiliation(s)
- J H Southcombe
- Nuffield Department of Obstetrics and Gynaecology, Level 3 Women's Centre, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU, UK
| | - C W G Redman
- Nuffield Department of Obstetrics and Gynaecology, Level 3 Women's Centre, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU, UK
| | - I L Sargent
- Nuffield Department of Obstetrics and Gynaecology, Level 3 Women's Centre, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU, UK
| | - I Granne
- Nuffield Department of Obstetrics and Gynaecology, Level 3 Women's Centre, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU, UK
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43
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Hahn S, Lapaire O, Than NG. Biomarker development for presymptomatic molecular diagnosis of preeclampsia: feasible, useful or even unnecessary? Expert Rev Mol Diagn 2015; 15:617-29. [PMID: 25774007 PMCID: PMC4673513 DOI: 10.1586/14737159.2015.1025757] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The past decade saw the advent of a number of promising biomarkers to detect pregnancies at risk for preeclampsia (PE), the foremost being those associated with an imbalance of angiogenic factors. In late pregnancy, these are useful for the detection of imminent cases of PE, while earlier they were more predictive for early- than late-onset PE. This suggests that there may be fundamental differences between the underlying pathology of these two PE forms. Therefore, it is possible that such a biological premise may limit the development of biomarkers that will permit the efficacious detection of both early- and late-onset PE via an analysis of first-trimester maternal blood samples. Consequently, a significant increase in our understanding of the underlying pathology of PE, using a variety of approaches ranging from systems biology to animal models, will be necessary in order to overcome this obstacle.
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Affiliation(s)
- Sinuhe Hahn
- Laboratory for Prenatal Medicine, Department of Biomedicine, University Hospital Basel, Hebelstrasse 20, CH 4031 Basel, Switzerland
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44
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Kusuma G, Manuelpillai U, Abumaree M, Pertile M, Brennecke S, Kalionis B. Mesenchymal stem cells reside in a vascular niche in the decidua basalis and are absent in remodelled spiral arterioles. Placenta 2015; 36:312-21. [DOI: 10.1016/j.placenta.2014.12.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 12/11/2014] [Accepted: 12/16/2014] [Indexed: 12/20/2022]
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Khan GH, Galazis N, Docheva N, Layfield R, Atiomo W. Overlap of proteomics biomarkers between women with pre-eclampsia and PCOS: a systematic review and biomarker database integration. Hum Reprod 2015; 30:133-48. [PMID: 25351721 PMCID: PMC4262466 DOI: 10.1093/humrep/deu268] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 08/29/2014] [Accepted: 09/19/2014] [Indexed: 01/12/2023] Open
Abstract
STUDY QUESTION Do any proteomic biomarkers previously identified for pre-eclampsia (PE) overlap with those identified in women with polycystic ovary syndrome (PCOS). SUMMARY ANSWER Five previously identified proteomic biomarkers were found to be common in women with PE and PCOS when compared with controls. WHAT IS KNOWN ALREADY Various studies have indicated an association between PCOS and PE; however, the pathophysiological mechanisms supporting this association are not known. STUDY DESIGN, SIZE, DURATION A systematic review and update of our PCOS proteomic biomarker database was performed, along with a parallel review of PE biomarkers. The study included papers from 1980 to December 2013. PARTICIPANTS/MATERIALS, SETTING, METHODS In all the studies analysed, there were a total of 1423 patients and controls. The number of proteomic biomarkers that were catalogued for PE was 192. MAIN RESULTS AND THE ROLE OF CHANCE Five proteomic biomarkers were shown to be differentially expressed in women with PE and PCOS when compared with controls: transferrin, fibrinogen α, β and γ chain variants, kininogen-1, annexin 2 and peroxiredoxin 2. In PE, the biomarkers were identified in serum, plasma and placenta and in PCOS, the biomarkers were identified in serum, follicular fluid, and ovarian and omental biopsies. LIMITATIONS, REASONS FOR CAUTION The techniques employed to detect proteomics have limited ability in identifying proteins that are of low abundance, some of which may have a diagnostic potential. The sample sizes and number of biomarkers identified from these studies do not exclude the risk of false positives, a limitation of all biomarker studies. The biomarkers common to PE and PCOS were identified from proteomic analyses of different tissues. WIDER IMPLICATIONS OF THE FINDINGS This data amalgamation of the proteomic studies in PE and in PCOS, for the first time, discovered a panel of five biomarkers for PE which are common to women with PCOS, including transferrin, fibrinogen α, β and γ chain variants, kininogen-1, annexin 2 and peroxiredoxin 2. If validated, these biomarkers could provide a useful framework for the knowledge infrastructure in this area. To accomplish this goal, a well co-ordinated multidisciplinary collaboration of clinicians, basic scientists and mathematicians is vital. STUDY FUNDING/COMPETING INTERESTS No financial support was obtained for this project. There are no conflicts of interest.
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Affiliation(s)
- Gulafshana Hafeez Khan
- Division of Human Development, School of Clinical Sciences, University of Nottingham, Queen's Medical Centre, D Floor, East Block, Nottingham, UK
| | - Nicolas Galazis
- Division of Human Development, School of Clinical Sciences, University of Nottingham, Queen's Medical Centre, D Floor, East Block, Nottingham, UK
| | - Nikolina Docheva
- Division of Human Development, School of Clinical Sciences, University of Nottingham, Queen's Medical Centre, D Floor, East Block, Nottingham, UK
| | - Robert Layfield
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - William Atiomo
- Division of Human Development, School of Clinical Sciences, University of Nottingham, Queen's Medical Centre, D Floor, East Block, Nottingham, UK
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46
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Quach K, Grover SA, Kenigsberg S, Librach CL. A combination of single nucleotide polymorphisms in the 3'untranslated region of HLA-G is associated with preeclampsia. Hum Immunol 2014; 75:1163-70. [PMID: 25454622 DOI: 10.1016/j.humimm.2014.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 10/09/2014] [Accepted: 10/09/2014] [Indexed: 12/01/2022]
Abstract
Reduced expression of human leukocyte antigen-G (HLA-G) has been linked to onset of preeclampsia. Associations have also been reported between preeclampsia and single nucleotide polymorphisms (SNP) in the 3'-untranslated region (UTR) of the HLA-G gene. However, there are conflicting results between studies. This studied examined whether a SNP, by itself or in combination with other SNPs, in the 3'UTR of the HLA-G gene is associated with an increased risk of preeclampsia. Placenta samples were obtained from 47 preeclamptic and 68 control cases. DNA was extracted, and the 3'UTR was sequenced and analyzed for nine polymorphisms using different genetic models of inheritance. Four of these polymorphisms have never been analyzed for an association with preeclampsia. Disputing existing reports, preeclamptic cases were suggestively associated with a G/G-genotype at SNP +3187 (p<0.05). Several SNP combinations were more prevalent in preeclampsia cases. Following corrections for multiple testing, one SNP combination (+3027C/C and +3187G/G) was significantly more prevalent in preeclampsia cases using co-dominant, additive, and dominant models (p<0.001). Taken together with the current literature, the data suggests that HLA-G 3'UTR SNP-pair associations, and not individual SNPs, could be useful in a predictive test for the susceptibility to preeclampsia.
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Affiliation(s)
- K Quach
- The Create Fertility Centre, 790 Bay Street, Suite 1100, Toronto M5G 1N8, Canada.
| | - S A Grover
- The Create Fertility Centre, 790 Bay Street, Suite 1100, Toronto M5G 1N8, Canada
| | - S Kenigsberg
- The Create Fertility Centre, 790 Bay Street, Suite 1100, Toronto M5G 1N8, Canada
| | - C L Librach
- The Create Fertility Centre, 790 Bay Street, Suite 1100, Toronto M5G 1N8, Canada; Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre and Women's College Hospital, 2075 Bayview Avenue, Toronto M4N 3M5, Canada; Department of Obstetrics and Gynecology, University of Toronto, 563 Spadina Crescent, Toronto M5S 2J7, Canada
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47
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Hanson MA, Gluckman PD. Early developmental conditioning of later health and disease: physiology or pathophysiology? Physiol Rev 2014; 94:1027-76. [PMID: 25287859 PMCID: PMC4187033 DOI: 10.1152/physrev.00029.2013] [Citation(s) in RCA: 715] [Impact Index Per Article: 71.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Extensive experimental animal studies and epidemiological observations have shown that environmental influences during early development affect the risk of later pathophysiological processes associated with chronic, especially noncommunicable, disease (NCD). This field is recognized as the developmental origins of health and disease (DOHaD). We discuss the extent to which DOHaD represents the result of the physiological processes of developmental plasticity, which may have potential adverse consequences in terms of NCD risk later, or whether it is the manifestation of pathophysiological processes acting in early life but only becoming apparent as disease later. We argue that the evidence suggests the former, through the operation of conditioning processes induced across the normal range of developmental environments, and we summarize current knowledge of the physiological processes involved. The adaptive pathway to later risk accords with current concepts in evolutionary developmental biology, especially those concerning parental effects. Outside the normal range, effects on development can result in nonadaptive processes, and we review their underlying mechanisms and consequences. New concepts concerning the underlying epigenetic and other mechanisms involved in both disruptive and nondisruptive pathways to disease are reviewed, including the evidence for transgenerational passage of risk from both maternal and paternal lines. These concepts have wider implications for understanding the causes and possible prevention of NCDs such as type 2 diabetes and cardiovascular disease, for broader social policy and for the increasing attention paid in public health to the lifecourse approach to NCD prevention.
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Affiliation(s)
- M A Hanson
- Academic Unit of Human Development and Health, University of Southampton, and NIHR Nutrition Biomedical Research Centre, University Hospital, Southampton, United Kingdom; and Liggins Institute and Gravida (National Centre for Growth and Development), University of Auckland, Auckland, New Zealand
| | - P D Gluckman
- Academic Unit of Human Development and Health, University of Southampton, and NIHR Nutrition Biomedical Research Centre, University Hospital, Southampton, United Kingdom; and Liggins Institute and Gravida (National Centre for Growth and Development), University of Auckland, Auckland, New Zealand
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48
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Krauspenhar B, Sontag F, Ronchi FA, Casarini DE, Poli-de-Figueiredo CE, Pinheiro da Costa BE. Angiotensin Converting Enzyme 90 kDa isoform: Biomarker for diagnosis of preeclampsia? Med Hypotheses 2014; 83:526-9. [PMID: 25257705 DOI: 10.1016/j.mehy.2014.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 09/10/2014] [Indexed: 10/24/2022]
Abstract
Preeclampsia (PE), one of the leading gestational hypertensive diseases, is characterized by increased blood pressure (⩾140/90mmHg) and pathological proteinuria after 20weeks gestation. It is a complex, multifactorial syndrome with an unestablished etiology and cure. The search continues for a biomarker that could assist in the early prediction or diagnosis of PE, reducing the rate of maternal and fetal mortality. Based on the findings of Casarini et al. that suggest the 90kDa isoform of the Angiotensin Converting Enzyme (ACE) as a possible marker of hypertension, we hypothesized that this isoform may be present in pregnant women with PE, since they present a transient and spontaneous model of systemic arterial hypertension in pregnancy. We believe, therefore, that pregnant women with pure PE (PPE) express the ACE 90kDa isoform in urine, as well as having elevated isoform enzymatic activity, during pregnancy only. Postpartum, with the normalization of blood pressure, the protein isoform would no longer be expressed. Pregnant women with superimposed preeclampsia (SPE) would present the ACE 90kDa isoform both during and after the gestation period, and its enzymatic activity would remain high as they are chronically hypertensive. It is expected that normotensive pregnant women do not present this isoform in their urine as elevated blood pressure levels do not occur. Both normotensive and PPE affected pregnant women with a family history of hypertension, will possibly express the ACE 90kDa isoform before pregnancy and may become hypertensive, only after some years, through the influence of environmental factors and/or other diseases. If our hypothesis is confirmed, it will allow differentiation of PPE and SPE sooner than 12weeks postpartum, which is currently the estimated period for confirmation of the specific diagnosis. Furthermore, it could be an early biomarker for predicting the disease, enabling the physician to choose the best clinical management. In addition, it would minimize the use of other methods as the biological sample for obtaining the marker is urine, a practical and effective test with good reproducibility. Finally, test results would enable a greater understanding of the mechanisms involved in gestational hypertension.
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Affiliation(s)
- Bruna Krauspenhar
- Graduate Program in Medicine and Health Sciences (Nephrology), School of Medicine, Institute of Biomedical Research, São Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
| | - Fernando Sontag
- Graduate Program in Medicine and Health Sciences (Nephrology), School of Medicine, Institute of Biomedical Research, São Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernanda A Ronchi
- Nephrology Division, Department of Medicine, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Dulce E Casarini
- Nephrology Division, Department of Medicine, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Carlos Eduardo Poli-de-Figueiredo
- Graduate Program in Medicine and Health Sciences (Nephrology), School of Medicine, Institute of Biomedical Research, São Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Bartira E Pinheiro da Costa
- Graduate Program in Medicine and Health Sciences (Nephrology), School of Medicine, Institute of Biomedical Research, São Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
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49
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Giurgescu C, Sanguanklin N, Engeland CG, White-Traut RC, Park C, Mathews HL, Janusek LW. Relationships among psychosocial factors, biomarkers, preeclampsia, and preterm birth in African American women: a pilot. Appl Nurs Res 2014; 28:e1-6. [PMID: 25282477 DOI: 10.1016/j.apnr.2014.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 08/24/2014] [Accepted: 09/03/2014] [Indexed: 11/16/2022]
Abstract
AIM To explore the relationships among psychosocial factors (optimism, uncertainty, social support, coping, psychological distress), biomarkers (cortisol, cytokines), preeclampsia, and preterm birth in African American women. METHODS Forty-nine pregnant African American women completed psychosocial questionnaires and had blood collected for biomarkers between 26 and 36 weeks of gestation. Birth outcomes were obtained from birth records. RESULTS Women reporting higher levels of social support had lower levels of pro-inflammatory cytokines (IL-2, IL-5, and IL-6). Surprisingly, compared with low-risk pregnant women, women diagnosed with preeclampsia reported more optimism and less avoidance, and had lower levels of cortisol and IFN-γ. Similarly, compared to women with full-term birth, women with preterm birth reported higher levels of optimism and lower levels of avoidance, and had lower levels of IL-10. CONCLUSION Psychosocial factors influence inflammation and pregnancy outcomes. Close assessment and monitoring of psychosocial factors may contribute to improved pregnancy outcomes.
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Affiliation(s)
| | | | | | | | - Chang Park
- College of Nursing, University of Illinois at Chicago
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50
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miR455 is linked to hypoxia signaling and is deregulated in preeclampsia. Cell Death Dis 2014; 5:e1408. [PMID: 25188518 PMCID: PMC4540200 DOI: 10.1038/cddis.2014.368] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 07/01/2014] [Accepted: 07/24/2014] [Indexed: 12/18/2022]
Abstract
Preeclampsia is a severe pregnancy-related disorder and a leading cause of maternal and fetal mortality worldwide. Early identification of patients with an increased risk for preeclampsia is thus one of the most important goals in obstetrics. Here we identify two related human microRNAs as potential biomarkers to detect at-risk pregnancies. We demonstrate that miR455-3P and miR455-5P are significantly downregulated in placentas from preeclampsia patients, whereas other placenta-specific microRNAs remain unaffected. microRNA target prediction and validation revealed a potential link of miR455-3P to hypoxia signaling. Together with our observation that expression levels of miR455-3P and miR455-5P are upregulated during trophoblast differentiation, our results suggest a model in which miR455-3P represses a hypoxia response that might otherwise prevent cytotrophoblasts from syncytiotrophoblast differentiation. In summary, our work reveals aberrant hypoxia signaling in preeclampsia that can be explained by deregulated expression of miR455. As miR455 has been found in circulating blood, the development of noninvasive prenatal tests enabling early diagnosis of preeclampsia may be possible.
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