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Snelson M, Vanuytsel T, Marques FZ. Breaking the Barrier: The Role of Gut Epithelial Permeability in the Pathogenesis of Hypertension. Curr Hypertens Rep 2024; 26:369-380. [PMID: 38662328 PMCID: PMC11324679 DOI: 10.1007/s11906-024-01307-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE OF THE REVIEW To review what intestinal permeability is and how it is measured, and to summarise the current evidence linking altered intestinal permeability with the development of hypertension. RECENT FINDINGS Increased gastrointestinal permeability, directly measured in vivo, has been demonstrated in experimental and genetic animal models of hypertension. This is consistent with the passage of microbial substances to the systemic circulation and the activation of inflammatory pathways. Evidence for increased gut permeability in human hypertension has been reliant of a handful of blood biomarkers, with no studies directly measuring gut permeability in hypertensive cohorts. There is emerging literature that some of these putative biomarkers may not accurately reflect permeability of the gastrointestinal tract. Data from animal models of hypertension support they have increased gut permeability; however, there is a dearth of conclusive evidence in humans. Future studies are needed that directly measure intestinal permeability in people with hypertension.
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Affiliation(s)
- Matthew Snelson
- Hypertension Research Laboratory, School of Biological Sciences, Monash University, Melbourne, Australia
- Victorian Heart Institute, Monash University, Melbourne, Australia
| | - Tim Vanuytsel
- Translational Research Center for Gastrointestinal Disorders, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Francine Z Marques
- Hypertension Research Laboratory, School of Biological Sciences, Monash University, Melbourne, Australia.
- Victorian Heart Institute, Monash University, Melbourne, Australia.
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Australia.
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Winkler K, Lorey C, Contini C, Augustinski V, Pütz G, Röthele E, Benner A, Fuchs H, Pecks U, Markfeld-Erol F, Kunze M. Comparison of double-filtration plasmapheresis (DFPP) versus heparin-mediated extracorporeal LDL-precipitation (HELP)-apheresis in early-onset preeclampsia. Pregnancy Hypertens 2024; 36:101128. [PMID: 38728925 DOI: 10.1016/j.preghy.2024.101128] [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: 01/29/2024] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVES Preeclampsia (PE) is a major cause of maternal and fetal mortality, and preterm birth. Previous studies indicate that lipid-apheresis may prolong pregnancy, namely heparin-mediated extracorporeal LDL-precipitation (HELP)- and dextran sulfate cellulose (DSC)-apheresis. We now report on double membrane plasmapheresis (DFPP) in early-onset preeclampsia (eoPE). STUDY DESIGN Open pilot study assessing the prolongation of pregnancy in PE by lipoprotein-apheresis (DRKS00004527). Two women with eoPE were treated by DFPP and compared to a historical cohort of 6 patients with eoPE treated by HELP-apheresis (NCT01967355). MAIN OUTCOME MEASURES Clinical outcome of mothers and babies and prolongation of pregnancies (time of admission to birth). RESULTS Patient 1 (33y; 22 + 5/7GW) received 4 DFPP. Delivery day 19; birthweight 270 g; weight at discharge 2134 g on day 132. Patient 2 (35y; 21 + 4/7GW) received 2 DFPP. Delivery day 19; birthweight 465 g; weight at discharge 2540 g on day 104. DFPP was well tolerated by both patients. CONCLUSIONS DFPP proved to be save and pregnancies remained stable as long as 19 days. Although babies were born very preterm both babies could finally be dismissed from hospital. No relevant clinical differences between DFPP and HELP-apheresis could be observed. Therefore, DFPP may extend the range of available apheresis techniques to prolong pregnancies in early-onset preeclampsia. However, further studies are necessary to gain more information. REGISTER: (DRKS00004527).
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Affiliation(s)
- Karl Winkler
- Institute for Clinical Chemistry and Laboratory Medicine, Medical Center - University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany.
| | - Cornelia Lorey
- Institute for Clinical Chemistry and Laboratory Medicine, Medical Center - University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany.
| | - Christine Contini
- Institute for Clinical Chemistry and Laboratory Medicine, Medical Center - University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany.
| | - Vivian Augustinski
- Institute for Clinical Chemistry and Laboratory Medicine, Medical Center - University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany.
| | - Gerhard Pütz
- Institute for Clinical Chemistry and Laboratory Medicine, Medical Center - University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany.
| | - Elvira Röthele
- Department of Medicine IV (Specialty Nephrology and Primary Care), Medical Center - University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany.
| | - Alexander Benner
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany.
| | - Hans Fuchs
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center - University of Freiburg, Mathildenstraße 1, 79106 Freiburg, Germany.
| | - Ulrich Pecks
- Department of Obstetrics and Gynecology, University Hospital of Würzburg, Josef-Schneider-Straße 4, Haus C15, 97080 Würzburg, Germany.
| | - Filiz Markfeld-Erol
- Department of Obstetrics and Gynecology, Medical Center - University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany.
| | - Mirjam Kunze
- Department of Obstetrics and Gynecology, Medical Center - University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany.
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Jaeger BR, Arron HE, Kalka-Moll WM, Seidel D. The potential of heparin-induced extracorporeal LDL/fibrinogen precipitation (H.E.L.P.)-apheresis for patients with severe acute or chronic COVID-19. Front Cardiovasc Med 2022; 9:1007636. [PMID: 36304538 PMCID: PMC9592739 DOI: 10.3389/fcvm.2022.1007636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
Patients with long COVID and acute COVID should benefit from treatment with H.E.L.P. apheresis, which is in clinical use for 37 years. COVID-19 can cause a severe acute multi-organ illness and, subsequently, in many patients the chronic illness long-COVID/PASC. The alveolar tissue and adjacent capillaries show inflammatory and procoagulatory activation with cell necrosis, thrombi, and massive fibrinoid deposits, namely, unsolvable microthrombi, which results in an obstructed gas exchange. Heparin-induced extracorporeal LDL/fibrinogen precipitation (H.E.L.P.) apheresis solves these problems by helping the entire macro- and microcirculation extracorporeally. It uses unfractionated heparin, which binds the spike protein and thereby should remove the virus (debris). It dissolves the forming microthrombi without bleeding risk. It removes large amounts of fibrinogen (coagulation protein), which immediately improves the oxygen supply in the capillaries. In addition, it removes the precursors of both the procoagulatory and the fibrinolytic cascade, thus de-escalating the entire hemostaseological system. It increases myocardial, cerebral, and pulmonary blood flow rates, and coronary flow reserve, facilitating oxygen exchange in the capillaries, without bleeding risks. Another factor in COVID is the “cytokine storm” harming microcirculation in the lungs and other organs. Intervention by H.E.L.P. apheresis could prevent uncontrollable coagulation and inflammatory activity by removing cytokines such as interleukin (IL)-6, IL-8, and TNF-α, and reduces C-reactive protein, and eliminating endo- and ecto-toxins, without touching protective IgM/IgG antibodies, leukocyte, or platelet function. The therapy can be used safely in combination with antiviral drugs, antibiotics, anticoagulants, or antihypertensive drugs. Long-term clinical experience with H.E.L.P. apheresis shows it cannot inflict harm upon patients with COVID-19.
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Affiliation(s)
- Beate Roxane Jaeger
- Lipidzentrum Nordrhein, Mülheim, Germany,*Correspondence: Beate Roxane Jaeger
| | - Hayley Emma Arron
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| | - Wiltrud M. Kalka-Moll
- Institut für infektiologische und mikrobiologische Beratung (Infactio), Bedburg, Germany
| | - Dietrich Seidel
- Institut tür Klinische Chemie und Laboratoriumsmedizin, Ludwig-Maximilians-Universität München, Munich, Germany
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Tong S, Kaitu’u-Lino TJ, Hastie R, Brownfoot F, Cluver C, Hannan N. Pravastatin, proton-pump inhibitors, metformin, micronutrients, and biologics: new horizons for the prevention or treatment of preeclampsia. Am J Obstet Gynecol 2022; 226:S1157-S1170. [PMID: 32946849 DOI: 10.1016/j.ajog.2020.09.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/25/2020] [Accepted: 09/10/2020] [Indexed: 12/14/2022]
Abstract
There has been increasing research momentum to identify new therapeutic agents for the prevention or treatment of preeclampsia, drugs that can affect the underlying disease pathophysiology. Molecular targets of candidate treatments include oxidative stress, antiangiogenic factors, and the angiotensin, nitric oxide, and proinflammatory pathways. The proposed treatments undergoing preclinical and clinical trial evaluation are thought to act on placental or endothelial disease or both. Most have adopted the pragmatic strategy of repurposing drugs. Of all the therapeutic agents proposed, pravastatin has received the most interest. There are preclinical studies showing that it has pleiotropic actions that favorably impact on multiple molecular targets and can resolve a preeclampsia phenotype in many animal models. An early phase clinical trial suggests that it may have therapeutic activity. Several large prevention trials are planned or ongoing and, when completed, could definitively address whether pravastatin can prevent preeclampsia. Proton-pump inhibitors, metformin, and sulfasalazine are other drugs with preclinical evidence of multiple molecular actions that could resolve the pathophysiology of preeclampsia. These agents are also currently being evaluated in clinical trials. There have been many recent preclinical studies identifying the potential of numerous natural compounds to treat preeclampsia, such as plant extracts and micronutrients that have potent anti-inflammatory or antioxidant activity. Recent preclinical studies have also proposed novel molecular-targeted strategies, such as monoclonal antibodies targeting tumor necrosis factor alpha, placental growth factor, and short interfering RNA technology, to silence the gene expression of soluble fms-like tyrosine kinase-1 or angiotensinogen. Other treatment approaches that have transitioned to human trials (ranging from single-arm to phase III trials that have been completed or are ongoing) include folic acid, nitric oxide donors (such as L-arginine), recombinant antithrombin III, digoxin immune antigen-binding fragment, and melatonin. There have been case series showing the removal of circulating soluble fms-like tyrosine kinase-1 may help stabilize the disease and prolong pregnancy. Interestingly, there are case reports suggesting that monoclonal antibody eculizumab (complement inhibitor) may have therapeutic potential. If new agents are discovered that are proven to be effective in preventing or treating preeclampsia, the potential to improve global maternal and perinatal health will be significant.
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Gubensek J, Ponikvar R, Premru Srsen T, Fabjan Vodusek V, Moertl MG, Lucovnik M. Therapeutic plasma exchange and dextran-sulfate plasma adsorption as extracorporeal treatments of extremely preterm preeclampsia with fetal growth restriction. J Clin Apher 2021; 36:595-605. [PMID: 33847403 DOI: 10.1002/jca.21899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 02/26/2021] [Accepted: 03/29/2021] [Indexed: 11/07/2022]
Abstract
AIM To evaluate effectiveness and safety of therapeutic plasma exchange (TPE) and dextran-sulfate plasma adsorption (DSA) for extracorporeal removal of soluble Fms-like tyrosine kinase-1 (sFlt-1) as part of expectant management of preeclampsia at extremely preterm gestational age. METHODS Retrospective case series of six patients with preeclampsia at <28 weeks of gestation, treated with DSA or TPE. Laboratory results, clinical characteristics and neonatal outcomes were collected from charts and National Perinatal Information System. RESULTS Fetal growth restriction (FGR) was diagnosed in all cases. Pregnancy was prolonged for a median of 14 (range 5-74) days from admission and 10 (3-73) days from first apheresis. A mixed effects model showed a decrease in sFlt-1 and sFlt-1/PlGF ratio during DSA/TPE (significant effect of time [before/after]), which was comparable between DSA and TPE (no effect of procedure type). Median absolute reduction in sFlt-1 was 42% (inter-quartile range [IQR] 13%-57%) during DSA and 34% (16%-40%) during TPE; for sFlt-1/PlGF ratio it was 29% (22%-36%) and 38% (29%-42%), respectively. All procedures were well tolerated by fetuses. Anaphylactoid reaction, often with angioedema, occurred in 4/6 patients undergoing DSA and was attributed to bradykinin activation. One patient developed wound hematoma after cesarean section, possibly attributed to depletion coagulopathy. CONCLUSIONS As potential novel treatment of early preeclampsia, a non-selective and widely available TPE was comparable to DSA regarding sFlt-1 reduction but was associated with fewer side-effects. Both seem to allow maternal stabilization and pregnancy prolongation even when early preeclampsia is complicated by FGR.
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Affiliation(s)
- Jakob Gubensek
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Rafael Ponikvar
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tanja Premru Srsen
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Vesna Fabjan Vodusek
- Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Miha Lucovnik
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Perinatology, Division of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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6
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Wind M, Gaasbeek AGA, Oosten LEM, Rabelink TJ, van Lith JMM, Sueters M, Teng YKO. Therapeutic plasma exchange in pregnancy: A literature review. Eur J Obstet Gynecol Reprod Biol 2021; 260:29-36. [PMID: 33713886 DOI: 10.1016/j.ejogrb.2021.02.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/24/2021] [Accepted: 02/25/2021] [Indexed: 01/13/2023]
Abstract
Therapeutic plasma exchange (TPE) is indicated as a treatment for a wide array of diseases, extensively addressed in the Guidelines of the American Society for Apheresis. In pregnancy, TPE is an uncommon event and application is largely based on extrapolation of efficacy and safety in a non-pregnant population. This review intends to describe the currently available experience of TPE in pregnancy to help clinicians recognise indications during pregnancy and to support current guideline recommendations with literature-based experiences. In order to identify the clinical indications for which TPE is applied in pregnant women, we performed a literature search including studies till November 2019, without a start date restriction. Data extraction included medical indication for TPE and safety of TPE in pregnant women. 279 studies were included for analysis. Nowadays, TPE is predominantly applied for thrombotic microangiopathies, lipid disorders and a variety of autoimmune diseases. The application of TPE during pregnancy remains largely empiric and relies on individual case reports in the absence of high-quality studies and definitive evidence-based guidelines. Safety profile of TPE during pregnancy appears to be comparable to application of TPE in non-pregnant patients. In conclusion, based on the limited evidence that we found in literature with a high risk of publication bias, TPE procedures can be used safely during pregnancy with the appropriate preparation and experience of a multidisciplinary team.
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Affiliation(s)
- M Wind
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.
| | - A G A Gaasbeek
- Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands
| | - L E M Oosten
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands
| | - T J Rabelink
- Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands
| | - J M M van Lith
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - M Sueters
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Y K O Teng
- Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands
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7
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Contini C, Pütz G, Pecks U, Winkler K. Apheresis as emerging treatment option in severe early onset preeclampsia. ATHEROSCLEROSIS SUPP 2019; 40:61-67. [PMID: 31818451 DOI: 10.1016/j.atherosclerosissup.2019.08.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Based on an early suggestion by Winkler et al. 2003 and a subsequent successful study by Wang et al. 2006 using lipid apheresis (LA) in 9 patients with preeclampsia to prolong pregnancies, the use of apheresis as therapeutic option in severe early onset preeclampsia has received increasing attention. Further studies using different LA systems also prolonged pregnancy and have been published in the last few years. Albeit using different LA systems and relying on different working hypothesis, all studies demonstrated a promising stabilisation against the disease's progression. Overall time from hospitalisation to the need for mandatory delivery was longer for those patients receiving apheresis compared to historical or matched control patients not receiving apheresis. These data will be reviewed and different hypotheses about the beneficial mechanism of action of apheresis will be discussed. Since up to now there is no curative treatment for preeclampsia other than observation and delivery, future work shall be encouraged.
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Affiliation(s)
- Christine Contini
- Institute of Clinical Chemistry and Laboratory Medicine, Medical Center - University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany.
| | - Gerhard Pütz
- Institute of Clinical Chemistry and Laboratory Medicine, Medical Center - University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany
| | - Ulrich Pecks
- Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Karl Winkler
- Institute of Clinical Chemistry and Laboratory Medicine, Medical Center - University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Germany
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8
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Fang F, Huang XJ, Guo YZ, Hong X, Wu HM, Liu R, Chen DJ. Selective and Regenerable Surface Based on β-Cyclodextrin for Low-Density Lipoprotein Adsorption. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2018; 34:8163-8169. [PMID: 29921121 DOI: 10.1021/acs.langmuir.8b00883] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Cyclodextrins (CDs) are a family of cyclic oligosaccharides, whose unique hydrophilic outer surface and lipophilic central cavity facilitate the formation of inclusion complexes with various biomolecules, such as cholesterol and phospholipids, via multi-interactions. Low-density lipoprotein (LDL) is the main carrier of cholesterol in bloodstream and is associated with the progression of atherosclerosis. The surface of LDL is composed of a shell of phospholipids monolayer containing most of the free unesterified cholesterol as well as the single copy of apolipoprotein B-100. To date, various LDL adsorbents have been fabricated to interact with the biomolecules on LDL surface. Owing to its elegant structure, CD is considered to be a promising choice for preparation of more economical and effective LDL-adsorbing materials. Therefore, in this study, interaction between β-CD and LDL in solution was investigated by dynamic light scattering, circular dichroism, and ultraviolet spectroscopy. Further, a supramolecular surface based on β-CD was simply prepared by self-assembled monolayer on gold surface. The effect of hydrogen bond and the cavity of β-CD on the interaction between β-CD and LDL was particularly explored by surface plasmon resonance (SPR) analysis. The SPR results showed that such β-CD-modified surface exhibited good selectivity and could be largely regenerated by sodium dodecyl sulfate wash. This study may extend the understanding of the interaction between LDL and LDL adsorbent or the design and development of more efficient and lower-cost LDL adsorbents in the future.
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Affiliation(s)
- Fei Fang
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering , Zhejiang University , Hangzhou 310027 , China
| | - Xiao-Jun Huang
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering , Zhejiang University , Hangzhou 310027 , China
| | - Yi-Zong Guo
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering , Zhejiang University , Hangzhou 310027 , China
| | - Xiao Hong
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering , Zhejiang University , Hangzhou 310027 , China
| | - Hui-Min Wu
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering , Zhejiang University , Hangzhou 310027 , China
| | - Rong Liu
- Institute of Textiles and Clothing , The Hong Kong Polytechnic University , Hung Hom, Kowloon , Hong Kong 999077 , China
| | - Da-Jing Chen
- Medical School , Hangzhou Normal University , Hangzhou 311121 , China
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Winkler K, Contini C, König B, Krumrey B, Pütz G, Zschiedrich S, Pecks U, Stavropoulou D, Prömpeler H, Kunze M, Markfeld-Erol F. Treatment of very preterm preeclampsia via heparin-mediated extracorporeal LDL-precipitation (H.E.L.P.) apheresis: The Freiburg preeclampsia H.E.L.P.-Apheresis study. Pregnancy Hypertens 2018; 12:136-143. [PMID: 29858106 DOI: 10.1016/j.preghy.2018.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 02/02/2018] [Accepted: 04/11/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Soluble Fms-like tyrosine kinase-1 (sFlt-1) is thought to be causative in the pathogenesis of preeclampsia (PE) and specific removal of sFlt-1 via dextran sulfate cellulose (DSC)-apheresis was suggested as cure to allow prolongation of pregnancy in preterm PE. However, in addition a deranged lipoprotein metabolism may impact endothelial and placental function in PE. Lipoprotein-apheresis by heparin-mediated extracorporeal LDL-precipitation (H.E.L.P.) was previously applied and has been shown to alleviate symptoms in PE. This clinical trial reevaluates the clinical efficacy of H.E.L.P.-apheresis in PE considering sFlt-1. STUDY DESIGN Open pilot study assessing the prolongation by H.E.L.P.-apheresis in 6 women (30-41 years) with very preterm PE (24+4 to 27+0 gestational weeks (GW)) (NCT01967355) compared to a historic control-group matched for GW at admission (<28 GW; n = 6). Clinical outcome of mothers and babies, and pre- and post H.E.L.P.-apheresis levels of sFlt-1 and PlGF were monitored. MAIN OUTCOME MEASURES In apheresis patients (2-6 treatments), average time from admission to birth was 15.0 days (6.3 days in controls; p = 0.027). Lung maturation was induced in all treated cases, and all children were released in healthy condition. Apheresis reduced triglycerides and LDL-cholesterol by more than 40%. Although H.E.L.P.-apheresis induced a transient peak baseline levels did not change and rather stabilized sFlt-1 levels at pre-apheresis levels throughout treatments, with sFlt-1/PLGF ratio remaining unaffected. CONCLUSIONS H.E.L.P.-apheresis proved again to be safe and prolongs pregnancies in PE. However, without changing sFlt-1 levels below baseline lowering lipids or other yet undefined factors appear to be of more relevance than reducing sFlt-1.
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Affiliation(s)
- K Winkler
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Freiburg, Freiburg, Germany.
| | - C Contini
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - B König
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - B Krumrey
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - G Pütz
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - S Zschiedrich
- Renal Division, Department of Medicine, University Hospital Freiburg, Germany
| | - U Pecks
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein Campus, Kiel, Germany
| | - D Stavropoulou
- Department of Neonatology, Children's Hospital, University of Freiburg, Germany
| | - H Prömpeler
- Department of Gynecology and Obstetrics, University Medical Center Freiburg, Germany
| | - M Kunze
- Department of Gynecology and Obstetrics, University Medical Center Freiburg, Germany
| | - F Markfeld-Erol
- Department of Gynecology and Obstetrics, University Medical Center Freiburg, Germany
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10
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Contini C, Jansen M, König B, Markfeld-Erol F, Kunze M, Zschiedrich S, Massing U, Merfort I, Prömpeler H, Pecks U, Winkler K, Pütz G. Lipoprotein turnover and possible remnant accumulation in preeclampsia: insights from the Freiburg Preeclampsia H.E.L.P.-apheresis study. Lipids Health Dis 2018. [PMID: 29540222 PMCID: PMC5853053 DOI: 10.1186/s12944-018-0698-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Preeclampsia is a life-threatening disease in pregnancy, and its complex pathomechanisms are poorly understood. In preeclampsia, lipid metabolism is substantially altered. In late onset preeclampsia, remnant removal disease like lipoprotein profiles have been observed. Lipid apheresis is currently being explored as a possible therapeutic approach to prolong preeclamptic pregnancies. Here, apheresis-induced changes in serum lipid parameters are analyzed in detail and their implications for preeclamptic lipid metabolism are discussed. Methods In the Freiburg H.E.L.P.-Apheresis Study, 6 early onset preeclamptic patients underwent repeated apheresis treatments. Serum lipids pre- and post-apheresis and during lipid rebound were analyzed in depth via ultracentrifugation to yield lipoprotein subclasses. Results The net elimination of Apolipoprotein B and plasma lipids was lower than theoretically expected. Lipids returned to previous pre-apheresis levels before the next apheresis even though apheresis was repeated within 2.9 ± 1.2 days. Apparent fractional catabolic rates and synthetic rates were substantially elevated, with fractional catabolic rates for Apolipoprotein B / LDL-cholesterol being 0.7 ± 0.3 / 0.4 ± 0.2 [day− 1] and synthetic rates being 26 ± 8 / 17 ± 8 [mg*kg− 1*day− 1]. The distribution of LDL-subclasses after apheresis shifted to larger buoyant LDL, while intermediate-density lipoprotein-levels remained unaffected, supporting the notion of an underlying remnant removal disorder in preeclampsia. Conclusion Lipid metabolism seems to be highly accelerated in preeclampsia, likely outbalancing remnant removal mechanisms. Since cholesterol-rich lipoprotein remnants are able to accumulate in the vessel wall, remnant lipoproteins may contribute to the severe endothelial dysfunction observed in preeclampsia. Trial registration ClinicalTrails.gov, NCT01967355.
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Affiliation(s)
- Christine Contini
- Institute of Clinical Chemistry and Laboratory Medicine, Medical Center - University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Martin Jansen
- Institute of Clinical Chemistry and Laboratory Medicine, Medical Center - University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Brigitte König
- Institute of Clinical Chemistry and Laboratory Medicine, Medical Center - University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Filiz Markfeld-Erol
- Department of Obstetrics and Gynecology, Medical Center - University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Mirjam Kunze
- Department of Obstetrics and Gynecology, Medical Center - University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Stefan Zschiedrich
- Department of Medicine IV (Nephrology and Primary Care), Medical Center, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Ulrich Massing
- Andreas Hettich GmbH & Co KG, Engesser Straße 4a, 79108, Freiburg, Germany
| | - Irmgard Merfort
- Department of Pharmaceutical Biology and Biotechnology, Albert-Ludwigs-University of Freiburg, Stefan-Meier-Straße 19, 79104, Freiburg, Germany
| | - Heinrich Prömpeler
- Department of Obstetrics and Gynecology, Medical Center - University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Ulrich Pecks
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein Campus, Kiel, Germany
| | - Karl Winkler
- Institute of Clinical Chemistry and Laboratory Medicine, Medical Center - University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Gerhard Pütz
- Institute of Clinical Chemistry and Laboratory Medicine, Medical Center - University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
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Nawathe A, David AL. Prophylaxis and treatment of foetal growth restriction. Best Pract Res Clin Obstet Gynaecol 2018; 49:66-78. [PMID: 29656983 DOI: 10.1016/j.bpobgyn.2018.02.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/13/2018] [Accepted: 02/15/2018] [Indexed: 02/07/2023]
Abstract
Foetal growth restriction (FGR) and associated placental pathologies such as pre-eclampsia and stillbirth arise in early pregnancy when inadequate remodelling of maternal spiral arteries leads to persistent high-resistance low-flow uteroplacental circulation. Current interventions concentrate on targeting the placental ischaemia-reperfusion injury and oxidative stress associated with an imbalance in angiogenic/anti-angiogenic factors. Recent meta-analyses confirm that aspirin modestly reduces the risk for small-for-gestational-age pregnancy in high-risk women. A dose of ≥100 mg starting by 16 weeks of gestation is recommended. In vitro and in vivo studies suggest that low-molecular-weight heparin may prevent FGR; further research is needed to confirm efficacy. Once FGR is diagnosed, no treatment will improve foetal growth. Potential FGR therapies such as phosphodiesterase type-5 inhibitors or maternal VEGF gene therapy aim to improve poor placentation and/or uterine blood flow. Melatonin, creatine and N-acetyl cysteine have potential as novel neuroprotective and cardioprotective agents in FGR.
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Affiliation(s)
- Aamod Nawathe
- Fetal Medicine Unit, University College London NHS Foundation Trust, 235 Euston Road, NW1 2BU, UK.
| | - Anna L David
- Research Department of Maternal Fetal Medicine, Institute for Women's Health, University College London, 86-96 Chenies Mews, London, WC1E 6HX, UK; NIHR University College London Hospitals Biomedical Research Centre, Research & Development, Maple House 1st Floor, 149 Tottenham Court Road, London, W1T 7DN, UK.
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Ellis KL, Boffa MB, Sahebkar A, Koschinsky ML, Watts GF. The renaissance of lipoprotein(a): Brave new world for preventive cardiology? Prog Lipid Res 2017; 68:57-82. [DOI: 10.1016/j.plipres.2017.09.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/01/2017] [Accepted: 09/05/2017] [Indexed: 12/24/2022]
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Abstract
Patients with familial hypercholesterolemia (FH) have early development of atherosclerosis and cardiovascular disease (CVD). Lipid level-lowering medications are not always successful in reducing increased low-density lipoprotein C (LDL-C) levels. Lipoprotein apheresis (LA) therapy has proven its clinical benefit in reducing CVD events for patients with FH with hypercholesterolemia. LA reduces LDL-C levels by more than 60% in patients with FH and reduces CVD events. LA also reduces Lp(a) levels and CVD events. LA reduces inflammatory markers and blood viscosity.
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Affiliation(s)
- Patrick M Moriarty
- Division of Clinical Pharmacology and Atherosclerosis/Lipoprotein-Apheresis Center, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3008, Kansas City, KS 66160, USA.
| | - Linda Hemphill
- Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
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Enkhmaa B, Anuurad E, Berglund L. Lipoprotein (a): impact by ethnicity and environmental and medical conditions. J Lipid Res 2015; 57:1111-25. [PMID: 26637279 DOI: 10.1194/jlr.r051904] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Indexed: 12/11/2022] Open
Abstract
Levels of lipoprotein (a) [Lp(a)], a complex between an LDL-like lipid moiety containing one copy of apoB, and apo(a), a plasminogen-derived carbohydrate-rich hydrophilic protein, are primarily genetically regulated. Although stable intra-individually, Lp(a) levels have a skewed distribution inter-individually and are strongly impacted by a size polymorphism of the LPA gene, resulting in a variable number of kringle IV (KIV) units, a key motif of apo(a). The variation in KIV units is a strong predictor of plasma Lp(a) levels resulting in stable plasma levels across the lifespan. Studies have demonstrated pronounced differences across ethnicities with regard to Lp(a) levels and some of this difference, but not all of it, can be explained by genetic variations across ethnic groups. Increasing evidence suggests that age, sex, and hormonal impact may have a modest modulatory influence on Lp(a) levels. Among clinical conditions, Lp(a) levels are reported to be affected by kidney and liver diseases.
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Affiliation(s)
- Byambaa Enkhmaa
- Department of Internal Medicine, University of California, Davis, CA
| | | | - Lars Berglund
- Department of Internal Medicine, University of California, Davis, CA Veterans Affairs Northern California Health Care System, Sacramento, CA
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Marson P, Gervasi MT, Tison T, Colpo A, De Silvestro G. Therapeutic apheresis in pregnancy: General considerations and current practice. Transfus Apher Sci 2015; 53:256-61. [PMID: 26621537 DOI: 10.1016/j.transci.2015.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
It is widely known that pregnancy does not represent a contraindication to therapeutic apheresis (TA) techniques. In fact, since the first experiences of TA in pregnancy for the prevention of hemolytic disease of the newborn, several diseases are at present treated with TA, mainly within 6 clinical categories: (a) TA is a priority and has no alternative equally effective treatment (e.g., thrombotic thrombocytopenic purpura); (b) TA is a priority but there are alternative therapies not contraindicated in pregnancy (e.g., myasthenia gravis); (c) TA is an effective tool of saving/avoiding drugs contraindicated in pregnancy (e.g., systemic lupus erythematosus); (d) TA is a treatment of specific conditions/complications of pregnancy with maternal and/or fetal risk (e.g., antiphospholipid syndrome); (e) TA is a treatment of specific conditions of pregnancy with exclusive fetal risk (e.g., hemolytic disease of the newborn); (f) TA is a treatment of disease which is strongly indicated and can exceptionally occur during pregnancy (e.g., Goodpasture's syndrome). When dealing with TA pregnant patients, some technical aspects due to the physiological changes of gestation have to be carefully considered, in particular the increase of the circulating blood volume. Moreover a multidisciplinary medical team, including an obstetrician, a clinical consultant, specialist in TA and in transfusion medicine, and a neonatologist stand as a basic requirement for the proper management of some clinical conditions that may be characterized by high maternal and fetal risk.
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Affiliation(s)
- Piero Marson
- Apheresis Unit, Blood Transfusion Service, University Hospital of Padua, Padua, Italy.
| | - Maria Teresa Gervasi
- Obstetrics and Gynecology Unit, Department for Health of Woman and Child, University Hospital of Padua, Padua, Italy
| | - Tiziana Tison
- Apheresis Unit, Blood Transfusion Service, University Hospital of Padua, Padua, Italy
| | - Anna Colpo
- Apheresis Unit, Blood Transfusion Service, University Hospital of Padua, Padua, Italy
| | - Giustina De Silvestro
- Apheresis Unit, Blood Transfusion Service, University Hospital of Padua, Padua, Italy
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Response to Plasmapheresis Measured by Angiogenic Factors in a Woman with Antiphospholipid Syndrome in Pregnancy. Case Rep Obstet Gynecol 2015; 2015:123408. [PMID: 26413360 PMCID: PMC4564609 DOI: 10.1155/2015/123408] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 07/08/2015] [Indexed: 12/19/2022] Open
Abstract
An imbalance of angiogenic and antiangiogenic placental factors such as endoglin and soluble fms-like tyrosine kinase 1 has been implicated in the pathophysiology of preeclampsia. Extraction of these substances by plasmapheresis might be a therapeutical approach in cases of severe early-onset preeclampsia. Case Report. A 21-year-old primigravida with antiphospholipid syndrome developed early-onset preeclampsia at 18 weeks' gestation. She was treated successfully with plasmapheresis in order to prolong pregnancy. Endoglin and sflt-1-levels were measured by ELISA before and after treatment. Endoglin levels decreased significantly after treatment (p < 0.05) and showed a significant decrease throughout pregnancy. A rerise of endoglin and sflt-1 preceded placental abruption 4 weeks before onset of incident. Conclusion. Due to the limited long-term therapeutical possibilities for pregnancies complicated by PE, plasmapheresis seems to be a therapeutical option. This consideration refers especially to pregnancies with early-onset preeclampsia, in which, after first conventional treatment of PE, prolongation of pregnancy should be above all.
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Grahammer F, Benzing T, Huber TB. New insights into mechanisms of glomerular injury and repair from the 10th International Podocyte Conference 2014. Kidney Int 2015; 87:885-93. [DOI: 10.1038/ki.2015.5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 11/11/2014] [Accepted: 11/20/2014] [Indexed: 01/17/2023]
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Müller-Deile J, Schiffer M. Preeclampsia from a renal point of view: Insides into disease models, biomarkers and therapy. World J Nephrol 2014; 3:169-81. [PMID: 25374810 PMCID: PMC4220349 DOI: 10.5527/wjn.v3.i4.169] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 08/06/2014] [Accepted: 09/04/2014] [Indexed: 02/06/2023] Open
Abstract
Proteinuria is a frequently detected symptom, found in 20% of pregnancies. A common reason for proteinuria in pregnancy is preeclampsia. To diagnose preeclampsia clinically and to get new insights into the pathophysiology of the disease it is at first essential to be familiar with conditions in normal pregnancy. Animal models and biomarkers can help to learn more about disease conditions and to find new treatment strategies. In this article we review the changes in kidney function during normal pregnancy and the differential diagnosis of proteinuria in pregnancy. We summarize different pathophysiological theories of preeclampsia with a special focus on the renal facets of the disease. We describe the current animal models and give a broad overview of different biomarkers that were reported to predict preeclampsia or have a prognostic value in preeclampsia cases. We end with a summary of treatment options for preeclampsia related symptoms including the use of plasmapheresis as a rescue therapy for so far refractory preeclampsia. Most of these novel biomarkers for preeclampsia are not yet implemented in clinical use. Therefore, we recommend using proteinuria (measured by UPC ratio) as a screening parameter for preeclampsia. Delivery is the only curative treatment for preeclampsia. In early preeclampsia the primary therapy goal is to prolong pregnancy until a state were the child has an acceptable chance of survival after delivery.
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Wang W, Lan P. Surface glycosylation of poly(3-hydroxybutyrate-co-4-hydroxybutyrate) membrane for selective adsorption of low-density lipoprotein. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2014; 25:2094-112. [DOI: 10.1080/09205063.2014.970605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Barrett HL, Dekker Nitert M, McIntyre HD, Callaway LK. Maternal lipids in pre-eclampsia: innocent bystander or culprit? Hypertens Pregnancy 2014; 33:508-23. [PMID: 25121342 DOI: 10.3109/10641955.2014.946614] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pre-eclampsia continues to be a challenge--to understand the underlying pathogenesis and to prevent or treat in the clinical setting. One area of potential therapies opening up is treatment of maternal lipids and clinical trials are underway using statins in early pre-eclampsia. At present, most potential therapies to treat lipids cannot be recommended for general use in pregnancy and if we were to target maternal lipids to reduce rates of pre-eclampsia, very large numbers of women may need to be treated. Prior to reaching that point, we first need to understand whether maternal lipids are pathogenic in the processes underlying pre-eclampsia. The aim of this review is to examine the role of lipids in the pathogenesis and outcomes of pre-eclampsia, how abnormal lipid genes may be implicated and consider whether treatment of hyperlipidemia has a more general place in the prevention or treatment of pre-eclampsia.
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Affiliation(s)
- Helen L Barrett
- School of Medicine, The University of Queensland, St Lucia , Queensland , Australia
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Ornaghi S, Paidas MJ. Upcoming drugs for the treatment of preeclampsia in pregnant women. Expert Rev Clin Pharmacol 2014; 7:599-603. [DOI: 10.1586/17512433.2014.944501] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Spencer RN, Carr DJ, David AL. Treatment of poor placentation and the prevention of associated adverse outcomes--what does the future hold? Prenat Diagn 2014; 34:677-84. [PMID: 24799349 PMCID: PMC4265258 DOI: 10.1002/pd.4401] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 12/14/2022]
Abstract
Poor placentation, which manifests as pre-eclampsia and fetal growth restriction, is a major pregnancy complication. The underlying cause is a deficiency in normal trophoblast invasion of the spiral arteries, associated with placental inflammation, oxidative stress, and an antiangiogenic state. Peripartum therapies, such as prenatal maternal corticosteroids and magnesium sulphate, can prevent some of the adverse neonatal outcomes, but there is currently no treatment for poor placentation itself. Instead, management relies on identifying the consequences of poor placentation in the mother and fetus, with iatrogenic preterm delivery to minimise mortality and morbidity. Several promising therapies are currently under development to treat poor placentation, to improve fetal growth, and to prevent adverse neonatal outcomes. Interventions such as maternal nitric oxide donors, sildenafil citrate, vascular endothelial growth factor gene therapy, hydrogen sulphide donors, and statins address the underlying pathology, while maternal melatonin administration may provide fetal neuroprotection. In the future, these may provide a range of synergistic therapies for pre-eclampsia and fetal growth restriction, depending on the severity and gestation of onset.
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Affiliation(s)
- RN Spencer
- Institute for Women's Health, University College LondonLondon, UK
| | - DJ Carr
- Institute for Women's Health, University College LondonLondon, UK
| | - AL David
- Institute for Women's Health, University College LondonLondon, UK
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Wang W, Huang XJ, Cao JD, Lan P, Wu W. Immobilization of sodium alginate sulfates on polysulfone ultrafiltration membranes for selective adsorption of low-density lipoprotein. Acta Biomater 2014; 10:234-43. [PMID: 24008179 DOI: 10.1016/j.actbio.2013.08.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 08/15/2013] [Accepted: 08/26/2013] [Indexed: 12/17/2022]
Abstract
A novel method for the immobilization of sodium alginate sulfates (SAS) on polysulfone (PSu) ultrafiltration membranes to achieve selective adsorption of low-density lipoprotein (LDL) was developed, which involved the photoinduced graft polymerization of acrylamide on the membrane and the Hofmann rearrangement reaction of grafted acrylamide followed by chemical binding of SAS with glutaraldehyde. The surface modification processes were confirmed by attenuated total reflectance Fourier transform infrared spectroscopy and X-ray photoelectron spectroscopy characterization. Zeta potential and water contact angle measurements were performed to investigate the surface charge and wettability of the membranes. An enzyme-linked immunosorbent assay was used to measure the binding of LDL on plain and modified PSu membranes. It was found that the PSu membrane immobilized with sodium alginate sulfates (PSu-SAS) greatly enhanced the selective adsorption of LDL from protein solutions and the absorbed LDL could be easily eluted with sodium chloride solution, indicating a specific and reversible binding of LDL to SAS, mainly driven by electrostatic forces. Furthermore, the PSu-SAS membrane showed good blood compatibility as examined by platelet adhesion. The results suggest that the PSu-SAS membranes are promising for application in simultaneous hemodialysis and LDL apheresis therapy.
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Affiliation(s)
- Wei Wang
- College of Materials and Textile Engineering, Jiaxing University, Jiaxing 314001, China.
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Kanasaki K, Kanasaki M. Angiogenic defects in preeclampsia: What is known, and how are such defects relevant to preeclampsia pathogenesis? HYPERTENSION RESEARCH IN PREGNANCY 2013. [DOI: 10.14390/jsshp.1.57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Keizo Kanasaki
- Department of Diabetology and Endocrinology, Kanazawa Medical University
| | - Megumi Kanasaki
- Department of Diabetology and Endocrinology, Kanazawa Medical University
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Fanshawe AE, Ibrahim M. The current status of lipoprotein (a) in pregnancy: a literature review. J Cardiol 2012; 61:99-106. [PMID: 23165148 DOI: 10.1016/j.jjcc.2012.09.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 09/06/2012] [Accepted: 09/13/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND PURPOSE Lipoprotein (Lp) (a) is a neglected element of the blood lipid profile. It is now recognized as a determinant of coronary heart disease progression and its role in atherosclerosis and its ability to induce thrombosis make it potentially important in the course of normal and complicated pregnancies. Pregnancy involves a major transformation of metabolism to sustain fetal growth. Multiple studies have been conducted on Lp(a) in pregnancy, and it is timely to synthesize and evaluate this evidence. METHODS AND SUBJECTS We reviewed the MEDLINE database for all articles published concerning "lipoprotein a" and "pregnancy" from May 2003 to May 2012. A previous comprehensive review assessed the literature up to May 2003. RESULTS We critically analyzed 14 studies detailing the effect of complications in pregnancy on Lp(a) profile, and subsequent pregnancy outcomes where available. Studies evaluating the normal metabolic response to pregnancy, pregnancies complicated by pre-eclampsia and intra-uterine growth restriction were reviewed. CONCLUSIONS A substantial mass of data has accumulated describing Lp(a) changes in pregnancy. The diversity of study design limits the ability to draw broad-ranging conclusions, but brings into focus the important questions remaining, which we discuss.
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Lumlertgul D, Suteeka Y, Tumpong S, Bunnachak D, Boonkaew S. Double filtration plasmapheresis in different diseases in Thailand. Ther Apher Dial 2012; 17:99-116. [PMID: 23379501 DOI: 10.1111/j.1744-9987.2012.01105.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Double filtration plasmapheresis (DFPP) was applied to the treatment of two different categories from 100 cases that had been collected over a 5 year period (2007-2011). These categories were allocated into groups by size of toxic substances, which were classified as two different kinds of diseases. Group I comprised diseases that were caused by alloimmunity in transplantation, autoimmune diseases, complicated nephrotic syndrome, pure red cell aplasia, and toxemia of pregnancy. This group was treated with a plasma separator (plasmaflow-05, Asahi Kasei) and plasma fractionators, EC-20W. The second group, which included hyperviscosity syndrome, was treated by the same plasma separator, but with different plasma fractionators using EC-40W. This group included diabetes nephropathy, hyperlipidemia, peripheral arterial diseases, and neurosensory hearing loss. Both groups used 1.5 plasma volumes in each treatment for three sessions in two consecutive weeks. The result of treatment in group I showed that plasma immunoglobulin G (IgG) was decreased substantially by 66% in either transplant or lupus nephritis patients after the third session. In the second group, IgM, fibrinogen, and lipid markedly responded to the treatment. Two diabetes nephropathy patients showed stable renal function for more than 12 months. Peripheral arterial disease was shown to benefit from significantly decreasing fibrinogen and IgM, which resulted in clinical tissue oxygenation. Neither bleeding diathesis nor membrane anaphylaxis were reported from the treatment. In summary, apheresis patients were shown to benefit in hypersensitized and hyperviscosity syndrome.
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Affiliation(s)
- Dusit Lumlertgul
- Renal Division, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Winkler K, Hoffmann MM, Pütz G. Letter by Winkler et al regarding article, "Pilot study of extracorporeal removal of soluble fms-like tyrosine kinase 1 in preeclampsia". Circulation 2012; 125:e522; author reply e523-4. [PMID: 22451615 DOI: 10.1161/circulationaha.111.060954] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Thadhani R, Kisner T, Hagmann H, Bossung V, Noack S, Schaarschmidt W, Jank A, Kribs A, Cornely OA, Kreyssig C, Hemphill L, Rigby AC, Khedkar S, Lindner TH, Mallmann P, Stepan H, Karumanchi SA, Benzing T. Pilot study of extracorporeal removal of soluble fms-like tyrosine kinase 1 in preeclampsia. Circulation 2011; 124:940-50. [PMID: 21810665 DOI: 10.1161/circulationaha.111.034793] [Citation(s) in RCA: 235] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Targeted therapies to stabilize the clinical manifestations and prolong pregnancy in preeclampsia do not exist. Soluble fms-like tyrosine kinase 1 (sFlt-1), an alternatively spliced variant of the vascular endothelial growth factor receptor 1, induces a preeclampsia-like phenotype in experimental models and circulates at elevated levels in human preeclampsia. Removing sFlt-1 may benefit women with very preterm (<32 weeks) preeclampsia. METHODS AND RESULTS We first show that negatively charged dextran sulfate cellulose columns adsorb sFlt-1 in vitro. In 5 women with very preterm preeclampsia and elevated circulating sFlt-1 levels, we next demonstrate that a single dextran sulfate cellulose apheresis treatment reduces circulating sFlt-1 levels in a dose-dependent fashion. Finally, we performed multiple apheresis treatments in 3 additional women with very preterm (gestational age at admission 28, 30, and 27+4 weeks) preeclampsia and elevated circulating sFlt-1 levels. Dextran sulfate apheresis lowered circulating sFlt-1, reduced proteinuria, and stabilized blood pressure without apparent adverse events to mother and fetus. Pregnancy lasted for 15 and 19 days in women treated twice and 23 days in a woman treated 4 times. In each, there was evidence of fetal growth. CONCLUSIONS This pilot study supports the hypothesis that extracorporeal apheresis can lower circulating sFlt-1 in very preterm preeclampsia. Further studies are warranted to determine whether this intervention safely and effectively prolongs pregnancy and improves maternal and fetal outcomes in this setting.
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Affiliation(s)
- Ravi Thadhani
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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SURFACE HEPARINIZATION OF POLYPROPYLENE MICROPOROUS MEMBRANES FOR SELECTIVE ADSORPTION OF LOW-DENSITY LIPOPROTEIN. ACTA POLYM SIN 2011. [DOI: 10.3724/sp.j.1105.2011.10271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Liu G, Wang W, Xie H, Che Y, Xue J, Wu Y, Zhou Q, Kong D. Improved neuronal survival of focal ischemia after delipid extracorporeal lipoprotein treatment in hyperlipidemic rabbits. Artif Organs 2011; 35:E145-54. [PMID: 21749409 DOI: 10.1111/j.1525-1594.2011.01249.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A delipid extracorporeal lipoprotein filter (DELP) system has been used to treat patients with stroke and has shown favorable prognosis. However, the mechanism for the neuronal functional recovery remains unclear. This study aimed to investigate the neuronal histological assessment, and the levels of C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), and oxidized low-density lipoprotein (oxLDL) after ischemic stroke following DELP treatment. Hyperlipidemic rabbits underwent middle cerebral artery occlusion. After 30 min, the animals received an extracorporeal apheresis treatment with a DELP filter. Total cholesterol (TC), triglyceride, and low-density lipoprotein (LDL) of the plasma were measured. The levels of CRP, TNF-α, and oxLDL in brain tissue were also measured by enzyme-linked immunosorbent assay. Hematoxylin and eosin staining, cresyl violet staining, neuron-specific enolase (NSE) and glial fibrillary acidic protein immunohistochemistry, and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay were performed. DELP apheresis reduced TC and LDL by >30%. The number of neurons at day 7 (P < 0.01) and the integrated optical density of NSE at day 1 (P < 0.05) and day 7 (P < 0.01) were significantly increased in the DELP group. TUNEL-positive cells were significantly decreased (P < 0.05). Astrocytes were moderately activated, and this activation persisted up to 7 days. Gliosis was not found in the DELP group. After treatment, the level of CRP declined at day 1 (P < 0.05); TNF-α and oxLDL declined at day 7 (P < 0.05). DELP apheresis decreased neuronal apoptosis, reduced inflammatory markers and oxidative stress in cerebral ischemia, and improved neuronal survival.
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Affiliation(s)
- Guojing Liu
- Medical School of Nankai University, Tianjin, China
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Huang XJ, Guduru D, Xu ZK, Vienken J, Groth T. Blood compatibility and permeability of heparin-modified polysulfone as potential membrane for simultaneous hemodialysis and LDL removal. Macromol Biosci 2010; 11:131-40. [PMID: 20878965 DOI: 10.1002/mabi.201000278] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Indexed: 11/12/2022]
Abstract
Heparin was covalently immobilized on PSf membranes to obtain a dialysis membrane with high affinity for LDL. WCA and streaming potential measurements were performed to investigate wettability and surface charge of the membranes. The morphology of the membranes was investigated by SEM. An ELISA was used to measure the adsorption and desorption of LDL on plain and modified PSf. Blood compatibility was studied by measurement of thrombin time, partial thromboplastin time, kallikrein activity and platelet adhesion. It was found that the blood compatibility of the membrane was improved by covalent immobilization of heparin at its surface. However, PSf-Hep membrane showed higher flux recovery after BSA solution filtration, which revealed antifouling property of PSf-Hep membranes.
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Affiliation(s)
- Xiao-Jun Huang
- Biomedical Materials Group, Department Pharmaceutics and Biopharmaceutics, Institute of Pharmacy, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
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Auer J, Camoin L, Guillonneau F, Rigourd V, Chelbi ST, Leduc M, Laparre J, Mignot TM, Vaiman D. Serum profile in preeclampsia and intra-uterine growth restriction revealed by iTRAQ technology. J Proteomics 2010; 73:1004-17. [DOI: 10.1016/j.jprot.2009.12.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 12/14/2009] [Accepted: 12/30/2009] [Indexed: 12/24/2022]
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Huang XJ, Guduru D, Xu ZK, Vienken J, Groth T. Immobilization of heparin on polysulfone surface for selective adsorption of low-density lipoprotein (LDL). Acta Biomater 2010; 6:1099-106. [PMID: 19733266 DOI: 10.1016/j.actbio.2009.08.039] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 08/11/2009] [Accepted: 08/31/2009] [Indexed: 11/19/2022]
Abstract
A versatile method was developed to immobilize heparin covalently on polysulfone sheets (PSu) to achieve selective adsorption of low-density lipoprotein (LDL). This was achieved by activation of PSu with successive treatments of chlorodimethyl ether and ethylenediamine, and subsequent chemical binding of heparin with bifunctional linker molecules. A heparin density up to 0.86 microg cm(-2) on a dense PSu film was achieved. The modified PSu films were characterized by attenuated total reflectance Fourier transform infrared spectroscopy and X-ray photoelectron spectroscopy. The hydrophilicity of the PSu film was improved greatly by covalent immobilization of heparin. The water contact angle of PSu film was decreased from 86.6 + or - 3.7 degrees to 50.5 + or - 3.2 degrees after binding of 0.36 microg cm(-2) heparin. An enzyme-linked immunosorbent assay was used to measure the binding of LDL on plain and modified PSu films. It was found that the heparin-modified PSu film could selectively recognize LDL from binary protein solutions. Furthermore, it was possible to desorb LDL from heparinized PSu, but not from plain PSu, with heparin, sodium chloride or urea solution, which indicates a selective but reversible binding of LDL to heparin. The results suggest that heparin-modified PSu membranes are promising for application in simultaneous hemodialysis and LDL apheresis therapy.
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Affiliation(s)
- Xiao-Jun Huang
- Biomedical Materials Group, Department of Pharmaceutics and Biopharmaceutics, Institute of Pharmacy, Martin Luther University Halle-Wittenberg, Halle (Saale) 06120, Germany
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Moriarty PM. Association of ApoE and HDL-C with cardiovascular and cerebrovascular disease: potential benefits of LDL-apheresis therapy. ACTA ACUST UNITED AC 2009. [DOI: 10.2217/clp.09.21] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Onofrillo D, Accorsi P. What’s going on in LDL apheresis. Transfus Apher Sci 2007; 37:213-21. [DOI: 10.1016/j.transci.2007.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Accepted: 08/29/2007] [Indexed: 01/02/2023]
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