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Soh J, Raventhiran S, Lee JH, Lim ZX, Goh J, Kennedy BK, Maier AB. The effect of glycine administration on the characteristics of physiological systems in human adults: A systematic review. GeroScience 2024; 46:219-239. [PMID: 37851316 PMCID: PMC10828290 DOI: 10.1007/s11357-023-00970-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023] Open
Abstract
Functional decline of physiological systems during ageing leads to age-related diseases. Dietary glycine increases healthy lifespan in model organisms and might decrease inflammation in humans, suggesting its geroprotective potential. This review summarises the evidence of glycine administration on the characteristics of eleven physiological systems in adult humans. Databases were searched using key search terms: 'glycine', 'adult', 'supplementation'/ 'administration'/ 'ingestion'/ 'treatment'. Glycine was administered to healthy and diseased populations (18 and 34 studies) for up to 14 days and 4 months, respectively. The nervous system demonstrated the most positive effects, including improved psychiatric symptoms from longer-term glycine administration in psychiatric populations. While longer-term glycine administration improved sleep in healthy populations, these studies had small sample sizes with a high risk of bias. Larger and long-term studies with more robust study designs in healthy populations to examine the effects of glycine administration on preventing, delaying or reversing the ageing process are warranted.
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Affiliation(s)
- Janjira Soh
- Centre for Healthy Longevity, National University Health System (NUHS), Singapore, Singapore
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Shivaanishaa Raventhiran
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Jasinda H Lee
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Zi Xiang Lim
- Centre for Healthy Longevity, National University Health System (NUHS), Singapore, Singapore
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Jorming Goh
- Centre for Healthy Longevity, National University Health System (NUHS), Singapore, Singapore
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Brian K Kennedy
- Centre for Healthy Longevity, National University Health System (NUHS), Singapore, Singapore
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Andrea B Maier
- Centre for Healthy Longevity, National University Health System (NUHS), Singapore, Singapore.
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Van Der Boechorstsraat 7, Amsterdam, 1081 BT, The Netherlands.
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Moriuchi K, Kawasaki K, Hayashi M, Ueda A, Yamanishi Y, Mogami H, Fujita K, Shiro R, Yo Y, Mandai M, Matsumura N. Plasma Antithrombin Activity during Long-Term Magnesium Sulfate Administration for Preeclampsia without Severe Hypertension. Healthcare (Basel) 2022; 10:healthcare10081581. [PMID: 36011238 PMCID: PMC9408047 DOI: 10.3390/healthcare10081581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022] Open
Abstract
In preeclampsia, plasma antithrombin activity is decreased, which leads to exacerbation of the disorder. We previously showed that long-term magnesium sulfate (MgSO4) administration prolonged the pregnancy period and may be able to improve pregnancy outcomes for patients with severe preeclampsia. The present study aimed to investigate the changes in plasma antithrombin activity during long-term MgSO4 administration for patients without severe hypertension. This multicenter retrospective study included patients with preeclampsia and superimposed preeclampsia without severe hypertension at diagnosis. The participants were divided into two groups: MgSO4 nontreatment group (three institutions) and MgSO4 treatment group (one institution). Antithrombin activity from time of diagnosis to delivery were compared between the two groups. In the MgSO4 nontreatment group (n = 16), antithrombin activity prior to delivery was significantly lower than at time of diagnosis (p = 0.015). In three cases, antithrombin activity was less than 60%. On the other hand, in the MgSO4 treatment group (n = 34), antithrombin activity did not change until just before delivery (p = 0.74). There were no cases in which antithrombin activity was decreased below 60%. Long-term MgSO4 administration for preeclampsia without severe hypertension may prevent a decrease in antithrombin activity and improve the disease state of preeclampsia.
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Affiliation(s)
- Kaori Moriuchi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, Osaka-Sayama 589-8511, Osaka, Japan
| | - Kaoru Kawasaki
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, Osaka-Sayama 589-8511, Osaka, Japan
- Correspondence: ; Tel.: +81-72-366-0221
| | - Maako Hayashi
- Department of Obstetrics and Gynecology, Japanese Red Cross Otsu Hospital, Otsu 520-8511, Shiga, Japan
| | - Akihiko Ueda
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto 606-8507, Sakyo, Japan
| | - Yukio Yamanishi
- Department of Obstetrics and Gynecology, Japanese Red Cross Wakayama Medical Center, Wakayama 640-8558, Wakayama, Japan
| | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto 606-8507, Sakyo, Japan
| | - Kohei Fujita
- Department of Obstetrics and Gynecology, Japanese Red Cross Otsu Hospital, Otsu 520-8511, Shiga, Japan
| | - Reona Shiro
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, Osaka-Sayama 589-8511, Osaka, Japan
| | - Yoshie Yo
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, Osaka-Sayama 589-8511, Osaka, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto 606-8507, Sakyo, Japan
| | - Noriomi Matsumura
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, Osaka-Sayama 589-8511, Osaka, Japan
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Saito S, Takagi K, Moriya J, Kobayashi T, Kanayama N, Sameshima H, Morikawa M, Sago H, Adachi T, Ohkuchi A, Takeda S, Masuyama H, Seki H. A randomized phase 3 trial evaluating antithrombin gamma treatment in Japanese patients with early-onset severe preeclampsia (KOUNO-TORI study): Study protocol. Contemp Clin Trials 2021; 107:106490. [PMID: 34174463 DOI: 10.1016/j.cct.2021.106490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality. Several studies have demonstrated the beneficial effects of antithrombin replacement in patients with preeclampsia. Here, we describe the study protocol of KOUNO-TORI (KW-3357 randOmized, mUlti-center, double-bliNd, placebO-controlled phase 3 sTudy in patients with early Onset pReeclampsIa) to evaluate recombinant human antithrombin gamma (rhAT-gamma) for the treatment of early-onset severe de novo preeclampsia. MATERIAL AND METHODS Patients with early-onset severe de novo preeclampsia who are ≥24 to <32 weeks pregnant at the time of registration and have an antithrombin activity of ≤100% at screening are included. The target population is selected based on a reanalysis of the data of a previous plasma-derived antithrombin phase 3 study. Primary endpoint is the prolongation of pregnancy from the initiation of rhAT-gamma treatment to the pregnancy termination. Secondary endpoints include gestational age in terms of achievement of 32- and 34-weeks'gestation, and gestational age in terms of achievement of 28 weeks' gestation for patients enrolled at <28 weeks' gestation. Maternal, fetal, and neonatal outcomes will be assessed. DISCUSSION As we have selected a specifically defined target population based on reanalysis of data of a previous plasma-derived antithrombin phase 3 study, the results of our study are expected to provide efficacy and safety data concerning rhAT-gamma treatment in Japanese patients. This study could help identify an effective novel treatment for such patients with early-onset severe preeclampsia for whom appropriate treatment is unavailable.
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Affiliation(s)
| | - Kenichi Takagi
- Clinical Development Center, R&D Division, Kyowa Kirin Co., Ltd., Tokyo, Japan
| | - Junji Moriya
- Biometrics Group, R&D Division, Kyowa Kirin Co., Ltd., Tokyo, Japan
| | | | | | | | - Mamoru Morikawa
- Department of Obstetrics and Gynecology, Kansai Medical University, Osaka, Japan
| | - Haruhiko Sago
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Tomoko Adachi
- Imperial Gift Foundation, Aiiku Maternal and Child Health Center, Aiiku Hospital, Tokyo, Japan
| | - Akihide Ohkuchi
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Hisashi Masuyama
- Department of Obstetrics and Gynecology, Okayama University Hospital, Okayama, Japan
| | - Hiroyuki Seki
- Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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Paidas MJ, Tita ATN, Macones GA, Saade GA, Ehrenkranz RA, Triche EW, Streisand JB, Lam GK, Magann EF, Lewis DF, Dombrowski MP, Werner EF, Branch DW, Habli MA, Grotegut CA, Silver RM, Longo SA, Amon E, Cleary KL, How HY, Novotny SR, Grobman WA, Whiteman VE, Wing DA, Scifres CM, Sibai BM. Prospective, randomized, double-blind, placebo-controlled evaluation of the Pharmacokinetics, Safety and Efficacy of Recombinant Antithrombin Versus Placebo in Preterm Preeclampsia. Am J Obstet Gynecol 2020; 223:739.e1-739.e13. [PMID: 32780999 DOI: 10.1016/j.ajog.2020.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/20/2020] [Accepted: 08/06/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite expectant management, preeclampsia remote from term usually results in preterm delivery. Antithrombin, which displays antiinflammatory and anticoagulant properties, may have a therapeutic role in treating preterm preeclampsia, a disorder characterized by endothelial dysfunction, inflammation, and activation of the coagulation system. OBJECTIVE This randomized, placebo-controlled clinical trial aimed to evaluate whether intravenous recombinant human antithrombin could prolong gestation and therefore improve maternal and fetal outcomes. STUDY DESIGN We performed a double-blind, placebo-controlled trial at 23 hospitals. Women were eligible if they had a singleton pregnancy, early-onset or superimposed preeclampsia at 23 0/7 to 30 0/7 weeks' gestation, and planned expectant management. In addition to standard therapy, patients were randomized to receive either recombinant human antithrombin 250 mg loading dose followed by a continuous infusion of 2000 mg per 24 hours or an identical saline infusion until delivery. The primary outcome was days gained from randomization until delivery. The secondary outcome was composite neonatal morbidity score. A total of 120 women were randomized. RESULTS There was no difference in median gestational age at enrollment (27.3 weeks' gestation for the recombinant human antithrombin group [range, 23.1-30.0] and 27.6 weeks' gestation for the placebo group [range, 23.0-30.0]; P=.67). There were no differences in median increase in days gained (5.0 in the recombinant human antithrombin group [range, 0-75] and 6.0 for the placebo group [range, 0-85]; P=.95). There were no differences between groups in composite neonatal morbidity scores or in maternal complications. No safety issues related to recombinant human antithrombin were noted in this study, despite the achievement of supraphysiological antithrombin concentrations. CONCLUSION The administration of recombinant human antithrombin in preterm preeclampsia neither prolonged pregnancy nor improved neonatal or maternal outcomes.
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Affiliation(s)
| | - Allan T N Tita
- University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | | | | | | | | | | | - Garrett K Lam
- University of Tennessee College of Medicine, Memphis, TN
| | | | - David F Lewis
- University of South Alabama Children's and Women's Hospital, Mobile, AL
| | | | - Erika F Werner
- Women and Infants Hospital of Rhode Island, Providence, RI
| | | | | | | | | | | | - Erol Amon
- St. Louis University School of Medicine, St. Louis, MO
| | | | | | | | | | | | | | | | - Baha M Sibai
- University of Texas Health Sciences Center at Houston, Houston, TX
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Grimes S, Bombay K, Lanes A, Walker M, Corsi DJ. Potential biological therapies for severe preeclampsia: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2019; 19:163. [PMID: 31072315 PMCID: PMC6509856 DOI: 10.1186/s12884-019-2268-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/27/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Preeclampsia remains a significant danger to both mother and child and current prevention and treatment management strategies are limited. The objective of this systematic review was to investigate the current literature on evidence for the use of the regenerative capacity of mesenchymal stem cell (MSC) therapy, the anticoagulant activity of antithrombin (AT), or the free radical scavenging activity of alpha-1-microglobulin (A1M) as potential novel treatments for severe preeclampsia and Hemolysis, Elevated Liver enzymes, Low Platelet count (HELLP). METHOD We conducted a systematic review of potential biological therapies for preeclampsia. We screened MEDLINE and Embase from inception through May 2017 for studies using AT, A1M or MSCs as potential treatments for preeclampsia and/or HELLP. A meta-analysis was performed to pool data from randomized control trials (RCTs) with homogenous outcomes using the inverse variance method. The Newcastle-Ottawa Scale, the Cochrane risk of bias tool for RCTs, and SYRCLE's risk of bias tool for animal studies were used to investigate potential bias of studies. RESULTS The literature search retrieved a total of 1015 articles, however, only 17 studies met the selection criteria: AT (n = 9, 8 human and 1 animal); A1M (n = 4, 3 animal and 1 ex-vivo); and, MSCs (n = 4, 3 animal and 1 ex-vivo). A meta-analysis of AT therapy versus placebo and a meta-analysis for AT therapy with heparin versus heparin alone did not show significant differences between study groups. Animal and ex-vivo studies demonstrated significant benefits in relevant outcomes for A1M and MSCs versus control treatments. Most RCT studies were rated as having a low risk of bias across categories with some studies showing an unclear risk of bias in some categories. The two cohort studies both received a total of four out of nine stars (a rating of "poor" quality). Most animal studies had an unclear risk of bias across most categories, with some studies having a low risk of bias in some categories. CONCLUSIONS The findings of this review are strengthened by rigorous systematic search and review of the literature. Results of our meta-analyses do not currently warrant further exploration of AT as a treatment of preeclampsia in human trials. Results of animal and ex-vivo studies of A1M and MSCs were encouraging and supportive of initiating human investigations.
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Affiliation(s)
- Sophia Grimes
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
| | - Kira Bombay
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
| | - Andrea Lanes
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Mark Walker
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario Canada
- Department of Obstetrics, Gynecology & Newborn Care, University of Ottawa, Ottawa, Ontario Canada
| | - Daniel J. Corsi
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario Canada
- OMNI Research Group, Centre for Practice Changing Research, Ottawa Hospital Research Institute, L1242, Box 241, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
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Cluver C, Walker SP, Mol BW, Hall D, Hiscock R, Brownfoot FC, Kaitu’u-Lino TJ, Tong S. A double blind, randomised, placebo-controlled trial to evaluate the efficacy of metformin to treat preterm pre-eclampsia (PI2 Trial): study protocol. BMJ Open 2019; 9:e025809. [PMID: 31023758 PMCID: PMC6503454 DOI: 10.1136/bmjopen-2018-025809] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Pre-eclampsia is a major complication of pregnancy, globally responsible for 60 000 maternal deaths per year, and far more fetal losses. There is no definitive treatment other than delivery. A therapeutic that could quench the disease process would be useful to treat preterm pre-eclampsia, as it could allow these pregnancies to safely continue to a gestation where fetal outcomes are significantly improved. We have published preclinical data to show that metformin, a drug known to be safe in pregnancy and commonly used to treat gestational diabetes, has potent biological effects making it another promising candidate to treat pre-eclampsia. Here, we describe a phase II clinical trial to examine whether administering extended-release metformin may be effective in treating women with preterm pre-eclampsia (PI2 Trial). METHODS The PI2 Trial is a phase II, double blind, randomised controlled trial that aims to recruit 150 women with preterm pre-eclampsia (gestational age 26+0 to 31+6 weeks) who are being managed expectantly. Participants will be randomised to receive either 3 g of metformin or placebo daily. The primary outcome is time from randomisation until delivery. A delay in delivery of 5 days is assumed to be clinically relevant. The secondary outcomes will be a maternal composite and neonatal composite outcome. All other outcomes will be exploratory. We will record adverse events. ETHICS AND DISSEMINATION This study has ethical approval (Protocol number M16/09/037 Federal Wide Assurance Number 00001372, Institutional Review Board Number IRB0005239), is registered with the Pan African Clinical Trial Registry (PACTR201608001752102) and the South African Medicine Control Council (20170322). Data will be presented at international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER PACTR201608001752102; Pre-results.
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Affiliation(s)
- Catherine Cluver
- Department of Obstetrics and Gynaecology, Stellenbosch University Faculty of Science, Cape Town, Western Cape, South Africa
- Translational Obstetrics Group, University of Melbourne, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Susan P Walker
- Translational Obstetrics Group, University of Melbourne, Mercy Hospital for Women, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, School of Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Hall
- Department of Obstetrics and Gynaecology, Stellenbosch University Faculty of Science, Matieland, Western Cape, South Africa
| | - Richard Hiscock
- Department of Anaesthetics, University of Melbourne, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Fiona C Brownfoot
- Translational Obstetrics Group, University of Melbourne, Mercy Hospital for Women, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Tu’uhevaha J Kaitu’u-Lino
- Translational Obstetrics Group and Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen Tong
- Translational Obstetrics Group, University of Melbourne, Mercy Hospital for Women, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Melbourne, Victoria, Australia
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Morikawa M, Umazume T, Hosokawa-Miyanishi A, Watari H, Kobayashi T, Seki H, Saito S. Relationship between antithrombin activity and interval from diagnosis to delivery among pregnant women with early-onset pre-eclampsia. Int J Gynaecol Obstet 2019; 145:62-69. [PMID: 30714139 DOI: 10.1002/ijgo.12780] [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: 03/27/2018] [Revised: 09/18/2018] [Accepted: 01/25/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine the cutoff of antithrombin activity for predicting the interval from diagnosis of early-onset pre-eclampsia to delivery. METHODS At Hokkaido University Hospital, Japan, data were retrospectively assessed on antithrombin activity measured at both diagnosis of pre-eclampsia and delivery among women with singleton pregnancy and pre-eclampsia (defined by combined gestational hypertension and proteinuria) between 2009 and 2017. The timing of delivery was determined by maternal and fetal well-being. RESULTS Among 2904 singleton deliveries, antithrombin activity was measured for 94 (3.2%) women diagnosed with pre-eclampsia. The median (range) interval was significantly longer for 38 (40%) women with early-onset than for 56 (60%) women with late-onset pre-eclampsia (6.5 [0-27] vs 1 [0-29] days, respectively; P<0.001). In the early-onset group, median antithrombin activity at diagnosis was significantly lower for 19 women with an interval of less than 7 days (72% [60%-92%]) than for 19 women with a longer interval (≥7 days) (84% [59%-110%]; P=0.012). Antithrombin activity of 78% at diagnosis of early-onset pre-eclampsia was optimal for predicting a delivery interval of less than 7 days. CONCLUSION A cutoff of 78% antithrombin activity at diagnosis of early-onset pre-eclampsia might be used as a predictor of delivery within 7 days.
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Affiliation(s)
- Mamoru Morikawa
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takeshi Umazume
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ami Hosokawa-Miyanishi
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hidemichi Watari
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takao Kobayashi
- Department of Obstetrics and Gynecology, Hamamatsu Medical Center, Hamamatsu, Japan
| | - Hiroyuki Seki
- Center for Maternal Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Shigeru Saito
- Department of Obstetrics and Gynecology, University of Toyama, Graduate School of Medicine, Toyama, Japan
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Cluver CA, Hannan NJ, van Papendorp E, Hiscock R, Beard S, Mol BW, Theron GB, Hall DR, Decloedt EH, Stander M, Adams KT, Rensburg M, Schubert P, Walker SP, Tong S. Esomeprazole to treat women with preterm preeclampsia: a randomized placebo controlled trial. Am J Obstet Gynecol 2018; 219:388.e1-388.e17. [PMID: 30055127 DOI: 10.1016/j.ajog.2018.07.019] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/17/2018] [Accepted: 07/20/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Preterm preeclampsia has a high rate of fetal death or disability. There is no treatment to slow the disease, except delivery. Preclinical studies have identified proton pump inhibitors as a possible treatment. OBJECTIVE The purpose of this study was to examine whether esomeprazole could prolong pregnancy in women who have received a diagnosis of preterm preeclampsia. STUDY DESIGN We performed a double-blind, randomized controlled trial at Tygerberg Hospital in South Africa. Women with preterm preeclampsia (gestational age 26 weeks+0 days to 31 weeks+6 days) were assigned randomly to 40-mg daily esomeprazole or placebo. The primary outcome was a prolongation of gestation of 5 days. Secondary outcomes were maternal and neonatal outcomes. We compared circulating markers of endothelial dysfunction that was associated with preeclampsia and performed pharmacokinetic studies. RESULTS Between January 2016 and April 2017, we recruited 120 participants. One participant was excluded because of incorrect randomization, which left 59 participants in the esomeprazole and 60 participants in the placebo group. Median gestational age at enrolment was 29+4 weeks gestation. There were no between-group differences in median time from randomization to delivery: 11.4 days (interquartile range, 3.6-19.7 days) in the esomeprazole group and 8.3 days (interquartile range, 3.8-19.6 days) in the placebo group (3 days longer in the esomeprazole arm; 95% confidence interval, -2.9-8.8; P=.31). There were no placental abruptions in the esomeprazole group and 6 (10%) in the placebo group (P=.01, P=.14 adjusted). There were no differences in other maternal or neonatal outcomes or markers of endothelial dysfunction. Esomeprazole and its metabolites were detected in maternal blood among those treated with esomeprazole, but only trace amounts in the umbilical cord blood. CONCLUSION Daily esomeprazole (40 mg) did not prolong gestation in pregnancies with preterm preeclampsia or decrease circulating soluble fms-like tyrosine kinase 1 concentrations. Higher levels in the maternal circulation may be needed for clinical effect.
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Preeclampsia: A review of the pathogenesis and possible management strategies based on its pathophysiological derangements. Taiwan J Obstet Gynecol 2018; 56:593-598. [PMID: 29037542 DOI: 10.1016/j.tjog.2017.08.004] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2017] [Indexed: 11/22/2022] Open
Abstract
This review is divided into three parts. The first part briefly describes the pathogenesis of preeclampsia. This is followed by reviewing previously reported management strategies of the disease based on its pathophysiological derangements. Finally, the author defines the safe and acceptable methods/medications that may be used to 'prevent' preeclampsia (in high risk patients) and those that may be used to 'treat' preeclampsia (meant to prolong the pregnancy in patients with established preeclampsia). The review concludes that multi-center trials are required to include multiple drugs in the same management protocol.
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Changing the guard. Thromb Res 2016; 141:196-7. [PMID: 27143030 DOI: 10.1016/j.thromres.2016.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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