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Buncha V, Cherezova A, Alexander S, Baranovskaya I, Coleman KA, Cherian-Shaw M, Brands MW, Sullivan JC, O'Connor PM, Mamenko M. Aldosterone Antagonism Is More Effective at Reducing Blood Pressure and Excessive Renal ENaC Activity in AngII-Infused Female Rats Than in Males. Hypertension 2023; 80:2196-2208. [PMID: 37593894 PMCID: PMC10528186 DOI: 10.1161/hypertensionaha.123.21287] [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] [Received: 03/27/2023] [Accepted: 08/03/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND AngII (angiotensin II)-dependent hypertension causes comparable elevations of blood pressure (BP), aldosterone levels, and renal ENaC (epithelial Na+ channel) activity in male and female rodents. Mineralocorticoid receptor (MR) antagonism has a limited antihypertensive effect associated with insufficient suppression of renal ENaC in male rodents with AngII-hypertension. While MR blockade effectively reduces BP in female mice with salt-sensitive and leptin-induced hypertension, MR antagonism has not been studied in female rodents with AngII-hypertension. We hypothesize that overstimulation of renal MR signaling drives redundant ENaC-mediated Na+ reabsorption and BP increase in female rats with AngII-hypertension. METHODS We employ a combination of physiological, pharmacological, biochemical, and biophysical approaches to compare the effect of MR inhibitors on BP and ENaC activity in AngII-infused male and female Sprague Dawley rats. RESULTS MR blockade markedly attenuates AngII-hypertension in female rats but has only a marginal effect in males. Spironolactone increases urinary sodium excretion and urinary sodium-to-potassium ratio in AngII-infused female, but not male, rats. The expression of renal MR and HSD11β2 (11β-hydroxysteroid dehydrogenase type 2) that determines the availability of MR to aldosterone is significantly higher in AngII-infused female rats than in males. ENaC activity is ≈2× lower in spironolactone-treated AngII-infused female rats than in males. Reduced ENaC activity in AngII-infused female rats on spironolactone correlates with increased interaction with ubiquitin ligase Nedd4-2 (neural precursor cell expressed developmentally down-regulated protein 4-2), targeting ENaC for degradation. CONCLUSIONS MR-ENaC axis is the primary determinant of excessive renal sodium reabsorption and an attractive antihypertensive target in female rats with AngII-hypertension, but not in males.
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Affiliation(s)
- Vadym Buncha
- Department of Physiology, Medical College of Georgia, Augusta University
| | - Alena Cherezova
- Department of Physiology, Medical College of Georgia, Augusta University
| | - Sati Alexander
- Department of Physiology, Medical College of Georgia, Augusta University
| | - Irina Baranovskaya
- Department of Physiology, Medical College of Georgia, Augusta University
| | - Kathleen A Coleman
- Department of Physiology, Medical College of Georgia, Augusta University
| | - Mary Cherian-Shaw
- Department of Physiology, Medical College of Georgia, Augusta University
| | - Michael W Brands
- Department of Physiology, Medical College of Georgia, Augusta University
| | | | - Paul M O'Connor
- Department of Physiology, Medical College of Georgia, Augusta University
| | - Mykola Mamenko
- Department of Physiology, Medical College of Georgia, Augusta University
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2
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Shoemaker R, Poglitsch M, Huang H, Vignes K, Srinivasan A, Cockerham C, Schadler A, Bauer JA, O’Brien JM. Activation of the Renin-Angiotensin-Aldosterone System Is Attenuated in Hypertensive Compared with Normotensive Pregnancy. Int J Mol Sci 2023; 24:12728. [PMID: 37628909 PMCID: PMC10454898 DOI: 10.3390/ijms241612728] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Hypertension during pregnancy increases the risk of adverse maternal and fetal outcomes, but the mechanisms of pregnancy hypertension are not precisely understood. Elevated plasma renin activity and aldosterone concentrations play an important role in the normal physiologic adaptation to pregnancy. These effectors are reduced in patients with pregnancy hypertension, creating an opportunity to define the features of the renin-angiotensin-aldosterone system (RAAS) that are characteristic of this disorder. In the current study, we used a novel LC-MS/MS-based methodology to develop comprehensive profiles of RAAS peptides and effectors over gestation in a cohort of 74 pregnant women followed prospectively for the development of gestational hypertension and pre-eclampsia (HYP, 27 patients) versus those remaining normotensive (NT, 47 patients). In NT pregnancy, the plasma renin activity surrogate, (PRA-S, calculated from the sum of Angiotensin I + Angiotensin II) and aldosterone concentrations significantly increased from the first to the third trimester, accompanied by a modest increase in the concentrations of angiotensin peptide metabolites. In contrast, in HYP pregnancies, PRA-S and angiotensin peptides were largely unchanged over gestation, and third-trimester aldosterone concentrations were significantly lower compared with those in NT pregnancies. The results indicated that the predominant features of pregnancies that develop HYP are stalled or waning activation of the RAAS in the second half of pregnancy (accompanied by unchanging levels of angiotensin peptides) and the attenuated secretion of aldosterone.
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Affiliation(s)
- Robin Shoemaker
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY 40506, USA
| | | | - Hong Huang
- Department of Pediatrics, University of Kentucky, Lexington, KY 40536, USA
| | - Katherine Vignes
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40506, USA
| | - Aarthi Srinivasan
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40506, USA
| | - Cynthia Cockerham
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40506, USA
| | - Aric Schadler
- Department of Pediatrics, University of Kentucky, Lexington, KY 40536, USA
| | - John A. Bauer
- Department of Pediatrics, University of Kentucky, Lexington, KY 40536, USA
| | - John M. O’Brien
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40506, USA
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3
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Menkhorst E, Zhou W, Santos L, Zhang JG, St-Pierre Y, Young MJ, Dimitriadis E. Galectin-7 dysregulates renin-angiotensin-aldosterone and NADPH oxide synthase pathways in preeclampsia. Pregnancy Hypertens 2022; 30:130-136. [PMID: 36183583 DOI: 10.1016/j.preghy.2022.09.008] [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: 05/06/2022] [Revised: 09/12/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Preeclampsia is a life-threatening disorder of pregnancy unique to humans. Poor placentation in the first trimester of pregnancy is widely accepted to be an underlying cause of preeclampsia. Galectin-7 is abnormally elevated in chorionic villous samples and serum from women that subsequently develop pre-term preeclampsia. Administration of exogenous galectin-7 to pregnant mice causes preeclampsia-like features (hypertension, proteinuria), associated with dysregulation of the renin-angiotensin system (RAS). In this study investigated the mechanism by which galectin-7 induces alterations to tissue RAS homeostasis and ROS production. We hypothesized that galectin-7 induces alterations in the production of either placental RAS or NADPH oxidases (or both) to drive the dysregulated RAS and ROS production seen in preeclampsia. STUDY DESIGN Mated female mice (n = 5-6/group) received single (embryonic day [E]12/13) or multiple (E8-12) subcutaneous injections of 400 μg/kg/day galectin-7 or vehicle control and killed on E13 or E18. Human first trimester placental villous and decidual tissue (n = 11) was cultured under 8 % oxygen with 1 µg/mL galectin-7 or vehicle control for 16 h. RESULTS Galectin-7 administration to pregnant mice impaired placental labyrinth formation, suppressed circulating aldosterone and altered placental RAS (Agt, Renin) and NADPH oxidase (Cyba, Cybb and Icam1) mRNA expression. In vitro, galectin-7 regulated human placental villous RAS (AGT) and NADPH oxidase (CYBA, ICAM1 and VCAM1) mRNA expression. CONCLUSIONS Overall, galectin-7 likely drives hypertension in preeclampsia via its direct regulation of multiple pathways associated with preeclampsia in the placenta. Galectin-7 may therefore be a therapeutic target to improve placental function and prevent preeclampsia.
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Affiliation(s)
- Ellen Menkhorst
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC, Australia; Gynaecology Research Centre, Royal Women's Hospital, Parkville, VIC, Australia; Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, VIC, Australia.
| | - Wei Zhou
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC, Australia; Gynaecology Research Centre, Royal Women's Hospital, Parkville, VIC, Australia
| | - Leilani Santos
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC, Australia; Gynaecology Research Centre, Royal Women's Hospital, Parkville, VIC, Australia
| | - Jian-Guo Zhang
- Walter and Eliza Hall Institute, Parkville, VIC, Australia; Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia
| | | | - Morag J Young
- Baker Heart & Diabetes Institute, Prahran, VIC, Australia
| | - Evdokia Dimitriadis
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC, Australia; Gynaecology Research Centre, Royal Women's Hospital, Parkville, VIC, Australia; Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, VIC, Australia; Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, Australia.
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4
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Mistry HD, Klossner R, Kallol S, Lüthi MP, Moser R, Schneider H, Ontsouka EC, Kurlak LO, Mohaupt MG, Albrecht C. Effects of aldosterone on the human placenta: Insights from placental perfusion studies. Placenta 2022; 123:32-40. [DOI: 10.1016/j.placenta.2022.03.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 11/24/2022]
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5
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Tissue Sodium Accumulation: Pathophysiology and Clinical Implications. Antioxidants (Basel) 2022; 11:antiox11040750. [PMID: 35453435 PMCID: PMC9031161 DOI: 10.3390/antiox11040750] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/02/2022] [Accepted: 04/07/2022] [Indexed: 02/05/2023] Open
Abstract
Excessive sodium intake has been well established as a risk factor for the development and progression of cardiovascular and renal diseases. Its adverse effects are achieved by renal sodium retention and related volume expansion and by inducing low-grade inflammation and oxidative stress (OS) in the target tissues. This review presents the recent concept of nonosmotic sodium storage in the skin interstitium, the subsequent dissociation of sodium and volume homeostasis, and the cellular response to the increased tissue sodium concentration. Furthermore, data are shown on the sodium barrier and buffering potential of the endothelial glycocalyx that may protect the functional integrity of the endothelium when it is challenged by an increased sodium load. Finally, examples will be given of the involvement of oxygen free radicals (OFR) in sodium-induced tissue damage, and some clinical entities will be mentioned that are causally associated with sodium/volume retention and OS.
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6
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Bezerra KRV, Tanaka SCSV, Silva VRS, Paschoinni MC, Grecco RLDS, Soardi FC, Balarin MAS. Contribution of rs1799998 polymorphism in CYP11B2 gene in susceptibility to preeclampsia. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2020. [DOI: 10.1590/1806-93042020000200008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract Objectives: the present study aimed to evaluate the association between the rs1799998 polymorphism of the CYP11B2 gene and the susceptibility to preeclampsia (PE) in a Brazilian population. Methods: the study group comprised 61 women who were diagnosed with PE. The control group included 116 women who did not show changes in their blood pressure levels during their pregnancies. The rs1799998 polymorphism of the CYP11B2 gene was amplified by allele-specific polymerase chain reaction (PCR). A multiple logistic regression analysis was performed using the SNPStat program to evaluate the risk of the CYP11B2 gene rs1799998 polymorphism contributing to PE. Results: the PE group had the following genotypes: 1.64% CC, 91.80% CT, and 6.56% TT. In the control group, the observed genotypic frequencies were: 11% CC, 73% CT, and 16% TT. The genotypic frequency distribution did not fit the Hardy Weinberg Equilibrium (HWE) in either study group. The multiple logistic regression analysis showed a statistically significant difference for the rs1799998 polymorphism in the recessive model. Conclusion: the results suggest an association between the recessive model of C/C genotype of the rs1799998 polymorphism of the CYP11B2 gene and susceptibility to PE.
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Procopciuc LM, Nemeti G, Buzdugan E, Iancu M, Stamatian F, Caracostea G. Renin-angiotensin system gene variants and risk of early- and late-onset preeclampsia: A single center case-control study. Pregnancy Hypertens 2019; 18:1-8. [PMID: 31442828 DOI: 10.1016/j.preghy.2019.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/09/2019] [Accepted: 08/15/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Changes in the renin-angiotensin-aldosterone system's (RAAS) activity due to different genetic variations could represent risk factors for the onset of preeclampsia. OBJECTIVE To test and quantify the relationships of 8 RAAS gene polymorphisms (angiotensinogen (AGT)-M235T, AGT-T174M, angiotensin converting enzyme (ACE)-I/D, ACE8-A2350G, angiotensin II type 1 receptor (AGTR1)-A1166C, angiotensin II type 2 receptor (AGTR2)-C3123A, renin (REN)-G83A, aldosterone synthase (CYP11B2)-T344C) with susceptibility to early- (EOPE) and late-onset preeclampsia (LOPE). STUDY DESIGN We performed polymerase chain reaction- restriction fragment length polymorphism (PCR-RFLP) analysis in 217 pregnant women, of whom 87 pregnant women with EOPE/LOPE and 130 normal pregnant women. The relationship between the studied RASS gene polymorphisms and EOPE/LOPE was tested by multiple logistic regressions. RESULTS The multivariate logistic regression analysis showed that AGT-M235T (adjusted OR = 4.63), AGT-T174M (adjusted OR = 4.13), REN-G83A (adjusted OR = 3) and CYP11B2-C344T (adjusted OR = 3.13) gene polymorphisms remained independent risk factors for EOPE. Moreover, ACE-I/D (adjusted OR = 4.04), ACE-A2350G (adjusted OR = 3.5), AGTR1-A1166C (adjusted OR = 2.73), and REN-G83A (adjusted OR = 2.67) polymorphisms remained independent risk factors for LOPE. The frequency of overweight was significantly different (p = 0.001) in pregnant women with EOPE, LOPE and the control group (LOPE:16, 29.6% vs. EOPE:12, 36.4% vs. control group:16, 12.3%). Pregnant women with EOPE had babies with a significantly lower mean birth weight (2067.9 ± 887.9) in comparison to women with LOPE (mean ± SD: 2860.1 ± 771.1, p < 0.001) and women with normal pregnancies, respectively (mean ± SD: 3324.9 ± 484.9, p < 0.001). CONCLUSION We confirmed the influence of the renin-angiotensin-aldosterone system through these 8 genetic variations on the onset of preeclampsia.
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Affiliation(s)
- Lucia Maria Procopciuc
- Department of Medical Biochemistry, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Georgiana Nemeti
- Gynecological Clinic 1, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Elena Buzdugan
- Medical Clinic V, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihaela Iancu
- Department of Medical Informatics and Biostatistics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Florin Stamatian
- Gynecological Clinic 1, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Gabriela Caracostea
- Gynecological Clinic 1, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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8
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Birukov A, Andersen LB, Herse F, Rakova N, Kitlen G, Kyhl HB, Golic M, Haase N, Kräker K, Müller DN, Jørgensen JS, Andersen MS, Dechend R, Jensen BL. Aldosterone, Salt, and Potassium Intakes as Predictors of Pregnancy Outcome, Including Preeclampsia. Hypertension 2019; 74:391-398. [PMID: 31177907 DOI: 10.1161/hypertensionaha.119.12924] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The mineralocorticoid aldosterone increases in plasma in healthy pregnancy along with renin and angiotensin II and plays a key role in the physiological plasma volume expansion. In mice, aldosterone contributes to an optimal fetal development by enhancing PlGF (placental growth factor) expression and trophoblast cell proliferation. In preeclampsia, there is coincident suppression of aldosterone and impaired placental development. We hypothesized that aldosterone independently contributes to placental and birth weight in humans, and high dietary sodium and low potassium intakes affect this relationship adversely. We analyzed 24-hour urine collections and plasma samples from gestational week 29 in a subsample of 569 pregnant women from the Odense Child Cohort-a Danish population-based longitudinal cohort study. Plasma and urinary aldosterone were measured by ELISA, sodium and potassium excretions by flame photometer. Predictive values of aldosterone levels and sodium and potassium intakes were assessed by multiple and Cox regression analyses. Primary outcomes were placental weight and birth weight. Secondary outcome was preeclampsia. Urinary aldosterone excretion at gestational week 29 independently contributed to placental and birth weights (adjusted β-coefficients [95% CI], 24.50 [9.66-39.35] and 9.59 [4.57-14.61], respectively). Aldosterone levels were not associated to preeclampsia incidence. Salt intake >6 g/d was associated with development of preeclampsia (hazard ratio [95% CI], 5.68 [1.51-21.36]). At gestational week 29, urinary aldosterone excretion is an independent predictor of placental and birth weights. High salt intake is a risk factor for preeclampsia. In perspective, suppression of aldosterone in pregnancy has adverse trophic effects.
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Affiliation(s)
- Anna Birukov
- From the Experimental and Clinical Research Center, a joint cooperation between Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité-Universitätsmedizin Berlin (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.).,Charité-Universitätsmedizin Berlin (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.), corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.).,German Centre for Cardiovascular Research, Partner Site Berlin, Germany (A.B., M.G., N.H., K.K., D.N.M., R.D.).,Department of Obstetrics and Gynecology (A.B., L.B.A., J.S.J., R.D.), Odense University Hospital, Denmark
| | - Louise Bjørkholt Andersen
- Institute of Clinical Research (L.B.A., J.S.J.), University of Southern Denmark, Odense.,Department of Obstetrics and Gynecology, Herlev Hospital, Denmark (L.B.A.).,Department of Obstetrics and Gynecology (A.B., L.B.A., J.S.J., R.D.), Odense University Hospital, Denmark
| | - Florian Herse
- From the Experimental and Clinical Research Center, a joint cooperation between Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité-Universitätsmedizin Berlin (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.).,Charité-Universitätsmedizin Berlin (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.), corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.)
| | - Natalia Rakova
- From the Experimental and Clinical Research Center, a joint cooperation between Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité-Universitätsmedizin Berlin (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.).,Charité-Universitätsmedizin Berlin (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.), corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.)
| | - Gitte Kitlen
- Institute for Molecular Medicine (G.K., B.L.J.), University of Southern Denmark, Odense
| | - Henriette Boye Kyhl
- Odense Child Cohort, Hans Christian Andersen Hospital for Children and Adolescents (H.B.K., J.S.J.), Odense University Hospital, Denmark.,Odense Patient Data Explorative Network (H.B.K., J.S.J.), Odense University Hospital, Denmark
| | - Michaela Golic
- From the Experimental and Clinical Research Center, a joint cooperation between Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité-Universitätsmedizin Berlin (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.).,Charité-Universitätsmedizin Berlin (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.), corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.).,German Centre for Cardiovascular Research, Partner Site Berlin, Germany (A.B., M.G., N.H., K.K., D.N.M., R.D.)
| | - Nadine Haase
- From the Experimental and Clinical Research Center, a joint cooperation between Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité-Universitätsmedizin Berlin (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.).,Charité-Universitätsmedizin Berlin (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.), corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.).,German Centre for Cardiovascular Research, Partner Site Berlin, Germany (A.B., M.G., N.H., K.K., D.N.M., R.D.)
| | - Kristin Kräker
- From the Experimental and Clinical Research Center, a joint cooperation between Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité-Universitätsmedizin Berlin (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.).,Charité-Universitätsmedizin Berlin (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.), corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.).,German Centre for Cardiovascular Research, Partner Site Berlin, Germany (A.B., M.G., N.H., K.K., D.N.M., R.D.)
| | - Dominik N Müller
- From the Experimental and Clinical Research Center, a joint cooperation between Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité-Universitätsmedizin Berlin (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.).,Charité-Universitätsmedizin Berlin (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.), corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.).,German Centre for Cardiovascular Research, Partner Site Berlin, Germany (A.B., M.G., N.H., K.K., D.N.M., R.D.)
| | - Jan Stener Jørgensen
- Institute of Clinical Research (L.B.A., J.S.J.), University of Southern Denmark, Odense.,Odense Child Cohort, Hans Christian Andersen Hospital for Children and Adolescents (H.B.K., J.S.J.), Odense University Hospital, Denmark.,Odense Patient Data Explorative Network (H.B.K., J.S.J.), Odense University Hospital, Denmark.,Department of Obstetrics and Gynecology (A.B., L.B.A., J.S.J., R.D.), Odense University Hospital, Denmark
| | | | - Ralf Dechend
- From the Experimental and Clinical Research Center, a joint cooperation between Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité-Universitätsmedizin Berlin (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.).,Charité-Universitätsmedizin Berlin (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.), corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany (A.B., F.H., N.R., M.G., N.H., K.K., D.N.M., R.D.).,German Centre for Cardiovascular Research, Partner Site Berlin, Germany (A.B., M.G., N.H., K.K., D.N.M., R.D.).,Department of Obstetrics and Gynecology (A.B., L.B.A., J.S.J., R.D.), Odense University Hospital, Denmark.,Department of Cardiology and Nephrology, HELIOS-Klinikum, Berlin, Germany (R.D.)
| | - Boye L Jensen
- Institute for Molecular Medicine (G.K., B.L.J.), University of Southern Denmark, Odense
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9
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Eisele N, Klossner R, Escher G, Rudloff S, Larionov A, Theilig F, Mohaupt MG, Mistry HD, Gennari‐Moser C. Physiological and Molecular Responses to Altered Sodium Intake in Rat Pregnancy. J Am Heart Assoc 2018; 7:e008363. [PMID: 30371243 PMCID: PMC6201473 DOI: 10.1161/jaha.117.008363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/07/2018] [Indexed: 11/21/2022]
Abstract
Background In pregnancy, a high plasma volume maintains uteroplacental perfusion and prevents placental ischemia, a condition linked to elevated maternal blood pressure ( BP ). Reducing BP by increasing Na+ intake via plasma volume expansion appears contra-intuitive. We hypothesize that an appropriate Na+ intake in pregnancy reduces maternal BP and adapts the renin-angiotensin system in a pregnancy-specific manner. Methods and Results BP was measured by implanted telemetry in Sprague-Dawley rats before and throughout pregnancy. Pregnant and nonpregnant animals received either a normal-salt (0.4%; NS ), high-salt (8%; HS ), or low-salt (0.01%; LS ) diet, or HS (days 1-14) followed by LS (days 14-20) diet ( HS / LS ). Before delivery (day 20), animals were euthanized and organs collected. Food, water, and Na+ intake were monitored in metabolic cages, and urinary creatinine and Na+ were analyzed. Na+ intake and retention increased in pregnancy ( NS , LS ), leading to a positive Na+ balance ( NS , LS ). BP was stable during LS , but reduced in HS conditions in pregnancy. The renin-angiotensin system was adapted as expected. Activating cleavage of α- and γ-subunits of the renal epithelial Na+ channel and expression of-full length medullary β-subunits, accentuated further in all LS conditions, were upregulated in pregnancy. Conclusions Pregnancy led to Na+ retention adapted to dietary changes. HS exposure paradoxically reduced BP . Na+ uptake while only modestly linked to the renin-angiotensin system is enhanced in the presence of posttranslational renal epithelial Na+ channel modifications. This suggests (1) storage of Na+ in pregnancy upon HS exposure, bridging periods of LS availability; and (2) that potentially non-renin-angiotensin-related mechanisms participate in EN aC activation and consecutive Na+ retention.
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Affiliation(s)
- Nicole Eisele
- Department of Nephrology and HypertensionUniversity of BernSwitzerland
- Department of BioMedical ResearchUniversity of BernSwitzerland
| | - Rahel Klossner
- Department of BioMedical ResearchUniversity of BernSwitzerland
- Teaching Hospital Internal Medicine LindenhofgruppeBerneSwitzerland
| | - Geneviève Escher
- Department of Nephrology and HypertensionUniversity of BernSwitzerland
- Department of BioMedical ResearchUniversity of BernSwitzerland
| | - Stefan Rudloff
- Department of Nephrology and HypertensionUniversity of BernSwitzerland
- Department of BioMedical ResearchUniversity of BernSwitzerland
| | - Alexey Larionov
- Division of Internal MedicineUniversity of FribourgSwitzerland
| | | | - Markus G. Mohaupt
- Department of BioMedical ResearchUniversity of BernSwitzerland
- Teaching Hospital Internal Medicine LindenhofgruppeBerneSwitzerland
| | - Hiten D. Mistry
- Department of BioMedical ResearchUniversity of BernSwitzerland
- Division of Child Health, Obstetrics and GynaecologySchool of MedicineCity Hospital NottinghamNottinghamUnited Kingdom
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Association of gene polymorphisms of aldosterone synthase and angiotensin converting enzyme in pre-eclamptic South African Black women. Pregnancy Hypertens 2017. [PMID: 29523271 DOI: 10.1016/j.preghy.2017.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The exact cause of preeclampsia (PE) remains elusive. Recently, many researchers have focused on the role of genetic variations in pathogenesis of PE. The renin-angiotensin-aldosterone system is affected in the pathogenesis of PE. OBJECTIVES To determine association of gene polymorphisms of aldosterone synthase (CYP11B2) and angiotensin converting enzyme (ACE) in PE and normotensive South African Black women. METHODS A group of 603 South African Black pregnant women, 246 normotensive and 357 with PE, was recruited. Purified DNA was extracted from venous blood. The distribution and frequencies of gene polymorphisms of CYP11B2 (C-344T) and ACE deletion/insertion (D/I) were determined by real time polymerase chain reaction. RESULTS As the main outcome measure, the risk of C allele for PE was 1.28 (95%CI: 0.94-1.74; p = .1) for all allele comparisons. Thus no significant association with development of PE was observed for the CYP11B2 variants. However, post analysis of the distribution of TT genotypes of CYP11B2 were higher in the HIV uninfected normotensive than in the HIV uninfected PE group (OR: 0.47, 95%CI: 0.27-0.79, p = .0027). The C alleles of late-onset PE and HIV uninfected PE were higher than all normotensive and HIV uninfected normotensive (OR: 1.47, 95%CI: 1.02-2.10, p = .03 and OR: 1.77, 95%CI: 1.13-2.81, p = .0094 respectively). The CT genotype of CYP11B2 was statistically significant between normotensive and PE in HIV uninfected groups (OR: 2.24, 95%CI: 1.28-3.98, p = .0026). There was no significant difference in frequencies of D/I for ACE gene in PE.
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11
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Salt, aldosterone and extrarenal Na + - sensitive responses in pregnancy. Placenta 2017; 56:53-58. [PMID: 28094006 PMCID: PMC5526786 DOI: 10.1016/j.placenta.2017.01.100] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/30/2016] [Accepted: 01/09/2017] [Indexed: 12/23/2022]
Abstract
Outside of pregnancy excessive salt consumption is known to be harmful being linked to increased blood pressure and cardiovascular disease. However, pregnancy represents a major change to a woman's physiology resulting in an intimate adaptation to environmental conditions. It is now becoming apparent that salt is essential for a number of these changes during pregnancy including haematological, cardiac adaptations as well as directly influencing placental development and the uteroplacental immune environment. The present review discusses the important role that salt has during normal pregnancy and evidence will also be presented to show how the placenta may act as a salt sensing organ temporarily, yet substantially regulating maternal blood pressure. The placenta may function as an extrarenal regulator of maternal blood pressure. Na+handling in pregnancy is completely different to the non-pregnant situation. Na+may actually lower blood pressure in pregnancy affected with pre-eclampsia. Aldosterone is an important regulator of placental and fetal development. Na+ may compensate for aldosterone deficiency in pregnancy.
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Eisele N, Albrecht C, Mistry HD, Dick B, Baumann M, Surbek D, Currie G, Delles C, Mohaupt MG, Escher G, Gennari-Moser C. Placental expression of the angiogenic placental growth factor is stimulated by both aldosterone and simulated starvation. Placenta 2016; 40:18-24. [PMID: 27016778 DOI: 10.1016/j.placenta.2016.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/05/2016] [Accepted: 02/08/2016] [Indexed: 12/28/2022]
Abstract
Aldosterone is an important factor supporting placental growth and fetal development. Recently, expression of placental growth factor (PlGF) has been observed in response to aldosterone exposure in different models of atherosclerosis. Thus, we hypothesized that aldosterone up-regulates growth-adaptive angiogenesis in pregnancy, via increased placental PlGF expression. We followed normotensive pregnant women (n = 24) throughout pregnancy and confirmed these results in a second independent first trimester cohort (n = 36). Urinary tetrahydroaldosterone was measured by gas chromatography-mass spectrometry and corrected for creatinine. Circulating PlGF concentrations were determined by ELISA. Additionally, cultured cell lines, adrenocortical H295R and choriocarcinoma BeWo cells, as well as primary human third trimester trophoblasts were tested in vitro. PlGF serum concentrations positively correlated with urinary tetrahydroaldosterone corrected for creatinine in these two independent cohorts. This observation was not due to PlGF, which did not induce aldosterone production in cultured H295R cells. On the other hand, PlGF expression was specifically enhanced by aldosterone in the presence of forskolin (p < 0.01) in trophoblasts. A pronounced stimulation of PlGF expression was observed with reduced glucose concentrations simulating starvation (p < 0.001). In conclusion, aldosterone stimulates placental PlGF production, enhancing its availability during human pregnancy, a response amplified by reduced glucose supply. Given the crucial role of PlGF in maintaining a healthy pregnancy, these data support a key role of aldosterone for a healthy pregnancy outcome.
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Affiliation(s)
- Nicole Eisele
- Department of Nephrology, Hypertension and Clinical Pharmacology, University of Bern, 3010 Berne, Switzerland; Department of Clinical Research, University of Bern, 3010 Berne, Switzerland
| | - Christiane Albrecht
- Institute for Biochemistry and Molecular Medicine, University of Bern, 3010 Berne, Switzerland; Swiss National Center of Competence in Research, NCCR TransCure, University of Bern, 3010 Berne, Switzerland
| | - Hiten D Mistry
- Department of Nephrology, Hypertension and Clinical Pharmacology, University of Bern, 3010 Berne, Switzerland; Department of Clinical Research, University of Bern, 3010 Berne, Switzerland
| | - Bernhard Dick
- Department of Nephrology, Hypertension and Clinical Pharmacology, University of Bern, 3010 Berne, Switzerland; Department of Clinical Research, University of Bern, 3010 Berne, Switzerland
| | - Marc Baumann
- Department of Obstetrics and Gynecology, University Hospital Bern, University of Bern, 3010 Berne, Switzerland; Swiss National Center of Competence in Research, NCCR TransCure, University of Bern, 3010 Berne, Switzerland
| | - Daniel Surbek
- Department of Obstetrics and Gynecology, University Hospital Bern, University of Bern, 3010 Berne, Switzerland; Swiss National Center of Competence in Research, NCCR TransCure, University of Bern, 3010 Berne, Switzerland
| | - Gemma Currie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Markus G Mohaupt
- Department of Nephrology, Hypertension and Clinical Pharmacology, University of Bern, 3010 Berne, Switzerland; Department of Clinical Research, University of Bern, 3010 Berne, Switzerland.
| | - Geneviève Escher
- Department of Nephrology, Hypertension and Clinical Pharmacology, University of Bern, 3010 Berne, Switzerland; Department of Clinical Research, University of Bern, 3010 Berne, Switzerland
| | - Carine Gennari-Moser
- Department of Nephrology, Hypertension and Clinical Pharmacology, University of Bern, 3010 Berne, Switzerland; Department of Clinical Research, University of Bern, 3010 Berne, Switzerland
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Okada Y, Best SA, Jarvis SS, Shibata S, Parker RS, Casey BM, Levine BD, Fu Q. Asian women have attenuated sympathetic activation but enhanced renal-adrenal responses during pregnancy compared to Caucasian women. J Physiol 2015; 593:1159-68. [PMID: 25545472 DOI: 10.1113/jphysiol.2014.282277] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 12/24/2014] [Indexed: 12/15/2022] Open
Abstract
Asians have a lower prevalence of hypertensive disorders of pregnancy than Caucasians. Since sympathetic overactivity and dysregulation of the renal-adrenal system (e.g. low aldosterone levels) have been found in preeclamptic women, we hypothesized that Asians have lower muscle sympathetic nerve activity (MSNA) and greater aldosterone concentrations during normal pregnancy than Caucasians. In a prospective study, blood pressure (BP), heart rate (HR), and MSNA were measured during supine and upright tilt (30 deg and 60 deg for 5 min each) in 9 Asians (32 ± 1 years (mean ± SEM)) and 12 Caucasians (29 ± 1 years) during pre-, early (≤8 weeks of gestation) and late (32-36 weeks) pregnancy, and post-partum (6-10 weeks after delivery). Supine MSNA increased with pregnancy in both groups (P < 0.001); it was significantly lower in Asians than Caucasians (14 ± 3 vs. 23 ± 3 bursts min(-1) and 16 ± 5 vs. 30 ± 3 bursts min(-1) in early and late pregnancy, respectively; P = 0.023). BP decreased during early pregnancy (P < 0.001), but was restored during late pregnancy. HR increased during pregnancy (P < 0.001) with no racial difference (P = 0.758). MSNA increased during tilting and it was markedly lower in Asians than Caucasians in late pregnancy (31 ± 6 vs. 49 ± 3 bursts min(-1) at 60 deg tilt; P = 0.003). Upright BP was lower in Asians, even in pre-pregnancy (P = 0.006), and this racial difference persisted during pregnancy. Direct renin and aldosterone increased during pregnancy (both P < 0.001); these hormones were greater in Asians (P = 0.086 and P = 0.014). Thus, Asians have less sympathetic activation but more upregulated renal-adrenal responses than Caucasians during pregnancy. These results may explain, at least in part, why Asian women are at low risk of hypertensive disorders in pregnancy.
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Affiliation(s)
- Yoshiyuki Okada
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
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Jupe ER, Dalessandri KM, Mulvihill JJ, Miike R, Knowlton NS, Pugh TW, Zhao LP, DeFreese DC, Manjeshwar S, Gramling BA, Wiencke JK, Benz CC. A steroid metabolizing gene variant in a polyfactorial model improves risk prediction in a high incidence breast cancer population. BBA CLINICAL 2014; 2:94-102. [PMID: 26673457 PMCID: PMC4633888 DOI: 10.1016/j.bbacli.2014.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 10/29/2014] [Accepted: 11/02/2014] [Indexed: 01/08/2023]
Abstract
Background We have combined functional gene polymorphisms with clinical factors to improve prediction and understanding of sporadic breast cancer risk, particularly within a high incidence Caucasian population. Methods A polyfactorial risk model (PFRM) was built from both clinical data and functional single nucleotide polymorphism (SNP) gene candidates using multivariate logistic regression analysis on data from 5022 US Caucasian females (1671 breast cancer cases, 3351 controls), validated in an independent set of 1193 women (400 cases, 793 controls), and reassessed in a unique high incidence breast cancer population (165 cases, 173 controls) from Marin County, CA. Results The optimized PFRM consisted of 22 SNPs (19 genes, 6 regulating steroid metabolism) and 5 clinical risk factors, and its 5-year and lifetime risk prediction performance proved significantly superior (~ 2-fold) over the Gail model (Breast Cancer Risk Assessment Tool, BCRAT), whether assessed by odds (OR) or positive likelihood (PLR) ratios over increasing model risk levels. Improved performance of the PFRM in high risk Marin women was due in part to genotype enrichment by a CYP11B2 (-344T/C) variant. Conclusions and general significance Since the optimized PFRM consistently outperformed BCRAT in all Caucasian study populations, it represents an improved personalized risk assessment tool. The finding of higher Marin County risk linked to a CYP11B2 aldosterone synthase SNP associated with essential hypertension offers a new genetic clue to sporadic breast cancer predisposition. A polyfactorial breast cancer risk assessment model (PFRM) was built and validated. The optimized PFRM incorporates both genetic (22 SNPs/19 genes) and clinical risk factors. The PFRM was further validated in a high risk USA/Marin breast cancer population. This PFRM consistently performed significantly better than the BCRAT (Gail model). A functional aldosterone synthase SNP in PFRM improved predictive performance in Marin.
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Affiliation(s)
- Eldon R. Jupe
- Research and Development, InterGenetics Incorporated, Oklahoma City, OK, USA
| | | | - John J. Mulvihill
- Department of Pediatrics, Section of Genetics, University of Oklahoma, Oklahoma City, OK, USA
| | - Rei Miike
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | | | - Thomas W. Pugh
- Research and Development, InterGenetics Incorporated, Oklahoma City, OK, USA
| | - Lue Ping Zhao
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Daniele C. DeFreese
- Research and Development, InterGenetics Incorporated, Oklahoma City, OK, USA
| | - Sharmila Manjeshwar
- Research and Development, InterGenetics Incorporated, Oklahoma City, OK, USA
| | - Bobby A. Gramling
- Research and Development, InterGenetics Incorporated, Oklahoma City, OK, USA
| | - John K. Wiencke
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Christopher C. Benz
- Division of Hematology-Oncology, University of California, San Francisco, CA, USA
- Buck Institute for Research on Aging, Novato, CA, USA
- Corresponding author at: Buck Institute for Research on Aging, 8001 Redwood Blvd., Novato, CA 94945, USA. Tel.: + 1 415 209 2092.
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Washburn LK, Brosnihan KB, Chappell MC, Diz DI, Gwathmey TM, Nixon PA, Russell GB, Snively BM, O'Shea TM. The renin-angiotensin-aldosterone system in adolescent offspring born prematurely to mothers with preeclampsia. J Renin Angiotensin Aldosterone Syst 2014; 16:529-38. [PMID: 24737639 DOI: 10.1177/1470320314526940] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 01/28/2014] [Indexed: 11/16/2022] Open
Abstract
HYPOTHESIS/INTRODUCTION Preeclampsia is associated with alterations in the maternal renin-angiotensin-aldosterone system (RAAS), increased blood pressure (BP), and cardiovascular risk in the offspring. We hypothesized that preeclampsia is associated with alterations in the RAAS in the offspring that persist into adolescence. MATERIALS AND METHODS We compared components of the circulating (n = 111) and renal (n = 160) RAAS in adolescents born prematurely with very low birth weight (VLBW) of preeclamptic (PreE) and normotensive (NoHTN) pregnancies. Multivariable linear regression was used to evaluate potential confounding and intermediate variables. Analyses were stratified by sex. RESULTS Adjusting for race and antenatal steroid exposure, male offspring of PreE mothers had higher circulating aldosterone than those of NoHTN mothers (adjusted mean difference = 109; 95% confidence limits: -9, 227 pmol/L). Further adjustment for current BMI attenuated this difference (adjusted mean difference: 93; 95% confidence limits: -30, 215 pmol/L). CONCLUSION Among male preterm VLBW infants, maternal preeclampsia is associated with increased circulating aldosterone level in adolescence, which appears to be mediated in part by higher BMI.
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Affiliation(s)
- Lisa K Washburn
- Department of Pediatrics, Wake Forest School of Medicine, USA Hypertension and Vascular Research Center, Wake Forest School of Medicine, USA
| | - K Bridget Brosnihan
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, USA
| | - Mark C Chappell
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, USA
| | - Debra I Diz
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, USA
| | - TanYa M Gwathmey
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, USA
| | - Patricia A Nixon
- Department of Pediatrics, Wake Forest School of Medicine, USA Health and Exercise Science, Wake Forest School of Medicine, USA
| | - Gregory B Russell
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, USA
| | - Beverly M Snively
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, USA
| | - T Michael O'Shea
- Department of Pediatrics, Wake Forest School of Medicine, USA Hypertension and Vascular Research Center, Wake Forest School of Medicine, USA
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The renin-angiotensin-aldosterone system in pre-eclampsia: the delicate balance between good and bad. Clin Sci (Lond) 2014; 126:537-44. [PMID: 24400721 DOI: 10.1042/cs20130455] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pregnancy demands major changes of the cardiovascular system, and this involves, among others, activation of the RAAS (renin-angiotensin-aldosterone system), allowing an aldosterone-dependent increase in volume. Remarkably, a relative resistance to the pressor response of AngII (angiotensin II) develops simultaneously to prevent the increase in blood pressure that would normally accompany RAAS activation. The increase in volume, the degree of RAAS activation and the diminished pressor response to AngII are less pronounced in pre-eclampsia. However, animal models displaying excessive RAAS activation also result in a pre-eclampsia-like syndrome, and the aldosterone/renin ratio is elevated in pre-eclampsia compared with a normal pregnancy. New insights into the pathogenesis of pre-eclampsia have revealed a major role for VEGF (vascular endothelial growth factor), VEGF-inactivating sFlt-1 (soluble fms-like tyrosine kinase-1) and AT1 (angiotensin II type 1) receptor autoantibodies. The last mentioned activate AT(1) receptors, thereby potentially suppressing circulating renin and aldosterone. VEGF, both directly and indirectly (by increasing capillary density), affects adrenal aldosterone synthesis. The present review summarizes all of the recent findings regarding RAAS regulation in pre-eclampsia compared with normal pregnancy, concluding that factors such as sFlt-1 and AT(1) receptor autoantibodies disturb the delicate balance that normally results in a volume increase and a diminished vasoconstrictor response to AngII in pregnant women. It is possible that there are non-parallel changes in the circulating and renal RAAS in pre-eclampsia, which are potentially reflected by the urinary levels of renin.
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Gennari-Moser C, Escher G, Kramer S, Dick B, Eisele N, Baumann M, Raio L, Frey FJ, Surbek D, Mohaupt MG. Normotensive Blood Pressure in Pregnancy. Hypertension 2014; 63:362-8. [DOI: 10.1161/hypertensionaha.113.02320] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Carine Gennari-Moser
- From the Division of Hypertension, Department of Nephrology, Hypertension, and Clinical Pharmacology (C.G.-M., G.E., S.K., B.D., N.E., F.J.F., M.G.M.) and Department of Obstetrics and Gynecology (M.B., L.R., D.S.), University Hospital Bern, University of Bern, Berne, Switzerland
| | - Geneviève Escher
- From the Division of Hypertension, Department of Nephrology, Hypertension, and Clinical Pharmacology (C.G.-M., G.E., S.K., B.D., N.E., F.J.F., M.G.M.) and Department of Obstetrics and Gynecology (M.B., L.R., D.S.), University Hospital Bern, University of Bern, Berne, Switzerland
| | - Simea Kramer
- From the Division of Hypertension, Department of Nephrology, Hypertension, and Clinical Pharmacology (C.G.-M., G.E., S.K., B.D., N.E., F.J.F., M.G.M.) and Department of Obstetrics and Gynecology (M.B., L.R., D.S.), University Hospital Bern, University of Bern, Berne, Switzerland
| | - Bernhard Dick
- From the Division of Hypertension, Department of Nephrology, Hypertension, and Clinical Pharmacology (C.G.-M., G.E., S.K., B.D., N.E., F.J.F., M.G.M.) and Department of Obstetrics and Gynecology (M.B., L.R., D.S.), University Hospital Bern, University of Bern, Berne, Switzerland
| | - Nicole Eisele
- From the Division of Hypertension, Department of Nephrology, Hypertension, and Clinical Pharmacology (C.G.-M., G.E., S.K., B.D., N.E., F.J.F., M.G.M.) and Department of Obstetrics and Gynecology (M.B., L.R., D.S.), University Hospital Bern, University of Bern, Berne, Switzerland
| | - Marc Baumann
- From the Division of Hypertension, Department of Nephrology, Hypertension, and Clinical Pharmacology (C.G.-M., G.E., S.K., B.D., N.E., F.J.F., M.G.M.) and Department of Obstetrics and Gynecology (M.B., L.R., D.S.), University Hospital Bern, University of Bern, Berne, Switzerland
| | - Luigi Raio
- From the Division of Hypertension, Department of Nephrology, Hypertension, and Clinical Pharmacology (C.G.-M., G.E., S.K., B.D., N.E., F.J.F., M.G.M.) and Department of Obstetrics and Gynecology (M.B., L.R., D.S.), University Hospital Bern, University of Bern, Berne, Switzerland
| | - Felix J. Frey
- From the Division of Hypertension, Department of Nephrology, Hypertension, and Clinical Pharmacology (C.G.-M., G.E., S.K., B.D., N.E., F.J.F., M.G.M.) and Department of Obstetrics and Gynecology (M.B., L.R., D.S.), University Hospital Bern, University of Bern, Berne, Switzerland
| | - Daniel Surbek
- From the Division of Hypertension, Department of Nephrology, Hypertension, and Clinical Pharmacology (C.G.-M., G.E., S.K., B.D., N.E., F.J.F., M.G.M.) and Department of Obstetrics and Gynecology (M.B., L.R., D.S.), University Hospital Bern, University of Bern, Berne, Switzerland
| | - Markus G. Mohaupt
- From the Division of Hypertension, Department of Nephrology, Hypertension, and Clinical Pharmacology (C.G.-M., G.E., S.K., B.D., N.E., F.J.F., M.G.M.) and Department of Obstetrics and Gynecology (M.B., L.R., D.S.), University Hospital Bern, University of Bern, Berne, Switzerland
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Yang J, Shang J, Zhang S, Li H, Liu H. The role of the renin-angiotensin-aldosterone system in preeclampsia: genetic polymorphisms and microRNA. J Mol Endocrinol 2013; 50:R53-66. [PMID: 23369849 DOI: 10.1530/jme-12-0216] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The compensatory alterations in the rennin-angiotensin-aldosterone system (RAAS) contribute to the salt-water balance and sufficient placental perfusion for the subsequent well-being of the mother and fetus during normal pregnancy and is characterized by an increase in almost all the components of RAAS. Preeclampsia, however, breaks homeostasis and leads to a disturbance of this delicate equilibrium in RAAS both for circulation and the uteroplacental unit. Despite being a major cause for maternal and neonatal morbidity and mortality, the pathogenesis of preeclampsia remains elusive, where RAAS has been long considered to be involved. Epidemiological studies have indicated that preeclampsia is a multifactorial disease with a strong familial predisposition regardless of variations in ethnic, socioeconomic, and geographic features. The heritable allelic variations, especially the genetic polymorphisms in RAAS, could be the foundation for the genetics of preeclampsia and hence are related to the development of preeclampsia. Furthermore, at a posttranscriptional level, miRNA can interact with the targeted site within the 3'-UTR of the RAAS gene and thereby might participate in the regulation of RAAS and the pathology of preeclampsia. In this review, we discuss the recent achievements of genetic polymorphisms, as well as the interactions between maternal and fetal genotypes, and miRNA posttranscriptional regulation associated with RAAS in preeclampsia. The results are controversial but utterly inspiring and attractive in terms of potential prognostic significance. Although many studies suggest positive associations with genetic mutations and increased risk for preeclampsia, more meticulously designed large-scale investigations are needed to avoid the interference from different variations.
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Affiliation(s)
- Jie Yang
- Department of Pathophysiology, School of Basic Medical Sciences, Capital Medical University, Beijing 100069, People's Republic of China
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Marino G, Kotsias B. Expression of the epithelial sodium channel sensitive to amiloride (ENaC) in normal and preeclamptic human placenta. Placenta 2013; 34:197-200. [DOI: 10.1016/j.placenta.2012.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 10/22/2012] [Accepted: 11/11/2012] [Indexed: 10/27/2022]
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Abstract
Chronic hypertension in pregnancy is one of the most common medical diseases affecting pregnancy. It is associated with serious maternal and fetal complications, including superimposed pre-eclampsia, fetal growth restriction, premature delivery, placental abruption, and stillbirth. Baseline evaluation as early as possible is important to differentiate women with essential hypertension from those with severe hypertension, coexisting end-organ damage, and secondary causes of hypertension, as their risks of poor outcomes are increased. An optimal plan for maternal treatment and fetal surveillance can then be formulated. Coordination of care after delivery is important for long-term maternal health and future pregnancies.
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Aldosterone deficiency adversely affects pregnancy outcome in mice. Pflugers Arch 2012; 464:331-43. [DOI: 10.1007/s00424-012-1145-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 08/18/2012] [Accepted: 08/19/2012] [Indexed: 11/30/2022]
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Koyama T, Yamada T, Furuta I, Morikawa M, Yamada T, Minakami H. Plasma Aldosterone Concentration and Plasma Renin Activity Decrease during the Third Trimester in Women with Twin Pregnancies. Hypertens Pregnancy 2012; 31:419-26. [DOI: 10.3109/10641955.2012.690057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pathogenesis of preeclampsia: the genetic component. J Pregnancy 2011; 2012:632732. [PMID: 22175024 PMCID: PMC3235819 DOI: 10.1155/2012/632732] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 10/11/2011] [Accepted: 10/12/2011] [Indexed: 12/13/2022] Open
Abstract
Preeclampsia (PE) is
one of the main causes of maternal and fetal
morbidity and mortality in the world, causing
nearly 40% of births delivered before 35
weeks of gestation. PE begins with inadequate
trophoblast invasion early in pregnancy, which
produces an increase in oxidative stress
contributing to the development of systemic
endothelial dysfunction in the later phases of
the disease, leading to the characteristic
clinical manifestation of PE. Numerous methods
have been used to predict the onset of PE with
different degrees of efficiency. These methods
have used fetal/placental and maternal markers
in different stages of pregnancy. From an
epidemiological point of view, many studies have
shown that PE is a disease with a strong
familiar predisposition, which also varies
according to geographical, socioeconomic, and
racial features, and this information can be
used in the prediction process. Large amounts of
research have shown a genetic association with a
multifactorial polygenic inheritance in the
development of this disease. Many biological
candidate genes and polymorphisms have been
examined in their relation with PE. We will
discuss the most important of them, grouped
by the different pathogenic mechanisms involved
in PE.
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Zaina S, Pérez-Luque EL, Lund G. Genetics talks to epigenetics? The interplay between sequence variants and chromatin structure. Curr Genomics 2011; 11:359-67. [PMID: 21286314 PMCID: PMC2945002 DOI: 10.2174/138920210791616662] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2010] [Revised: 06/12/2010] [Accepted: 06/15/2010] [Indexed: 12/29/2022] Open
Abstract
Transcription is regulated by two major mechanisms. On the one hand, changes in DNA sequence are responsible for genetic gene regulation. On the other hand, chromatin structure regulates gene activity at the epigenetic level. Given the fundamental participation of these mechanisms in transcriptional regulation of virtually any gene, they are likely to co-regulate a significant proportion of the genome. The simple concept behind this idea is that a mutation may have a significant impact on local chromatin structure by modifying DNA methylation patterns or histone type recruitment. Yet, the relevance of these interactions is poorly understood. Elucidating how genetic and epigenetic mechanisms co-participate in regulating transcription may assist in some of the unresolved cases of genetic variant-phenotype association. One example is loci that have biologically predictable functions but genotypes that fail to correlate with phenotype, particularly disease outcome. Conversely, a crosstalk between genetics and epigenetics may provide a mechanistic explanation for cases in which a convincing association between phenotype and a genetic variant has been established, but the latter does not lie in a promoter or protein coding sequence. Here, we review recently published data in the field and discuss their implications for genetic variant-phenotype association studies.
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Affiliation(s)
- Silvio Zaina
- Department of Medical Research, Division of Health Sciences, Leon Campus, University of Guanajuato, Leon, Mexico
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26
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Gennari-Moser C, Khankin EV, Schüller S, Escher G, Frey BM, Portmann CB, Baumann MU, Lehmann AD, Surbek D, Karumanchi SA, Frey FJ, Mohaupt MG. Regulation of placental growth by aldosterone and cortisol. Endocrinology 2011; 152:263-71. [PMID: 21068161 DOI: 10.1210/en.2010-0525] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
During pregnancy, trophoblasts grow to adapt the feto-maternal unit to fetal requirements. Aldosterone and cortisol levels increase, the latter being inactivated by a healthy placenta. By contrast, preeclamptic placental growth is reduced while aldosterone levels are low and placental cortisol tissue levels are high due to improper deactivation. Aldosterone acts as a growth factor in many tissues, whereas cortisol inhibits growth. We hypothesized that in preeclampsia low aldosterone and enhanced cortisol availability might mutually affect placental growth and function. Proliferation of cultured human trophoblasts was time- and dose-dependently increased with aldosterone (P < 0.04 to P < 0.0001) and inhibited by spironolactone and glucocorticoids (P < 0.01). Mineralo- and glucocorticoid receptor expression and activation upon agonist stimulation was verified by visualization of nuclear translocation of the receptors. Functional aldosterone deficiency simulated in pregnant mice by spironolactone treatment (15 μg/g body weight/day) led to a reduced fetal umbilical blood flow (P < 0.05). In rat (P < 0.05; R(2) = 0.2055) and human (X(2) = 3.85; P = 0.0249) pregnancy, placental size was positively related to plasma aldosterone. Autocrine production of these steroid hormones was excluded functionally and via the absence of specific enzymatic transcripts for CYP11B2 and CYP11B1. In conclusion, activation of mineralocorticoid receptors by maternal aldosterone appears to be required for trophoblast growth and a normal feto-placental function. Thus, low aldosterone levels and enhanced cortisol availability may be one explanation for the reduced placental size in preeclampsia and related disorders.
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Affiliation(s)
- Carine Gennari-Moser
- Department of Nephrology/Hypertension, University Hospital Bern, 3010 Berne, Switzerland
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Ramírez-Salazar M, Romero-Gutiérrez G, Zaina S, Malacara JM, Kornhauser C, Pérez-Luque E. Relationship of aldosterone synthase gene (C-344T) and mineralocorticoid receptor (S810L) polymorphisms with gestational hypertension. J Hum Hypertens 2010; 25:320-6. [PMID: 20535141 DOI: 10.1038/jhh.2010.58] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The extent of genetic influence in the aetiology of gestational hypertension has not been completely determined. The aim of this study was to analyse the relationship between aldosterone levels and the -344T/C polymorphism of the aldosterone synthase gene (CYP11B2) and to investigate the frequency of the S810L mutation of mineralocorticoid receptor (MR) in gestational hypertension. One hundred women with pregnancy-induced hypertension and 100 with normal pregnancy were studied to measure serum aldosterone and progesterone levels and for the genotypification of the -344T/C polymorphism of CYP11B2 gene and the S810L mutation of MR by RFLP-PCR and SSP, respectively. Serum aldosterone levels were reduced (<0.000001) and serum progesterone levels increased (<0.000001) in gestational hypertensive women as compared with normal pregnant women. The -344T/C of CYP11B2 genotypic frequencies were similar in the hypertensive and normotensive pregnant women. The 810L-mutated allele of MR was found in 12% of the hypertensive and 9.4% of the normotensive pregnant women. In contrast to the observations made in preeclampsia, the genotype of -344T/C of CYP11B2 was neither related with gestational hypertension nor with aldosterone levels at delivery. The frequency of the S810L mutation was similar in the hypertensive and normotensive women but higher than observed in other reports.
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Affiliation(s)
- M Ramírez-Salazar
- Department of Medical Sciences, University of Guanajuato, León, Guanajuato, México
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Lindheimer MD, August P. Aldosterone, maternal volume status and healthy pregnancies: a cycle of differing views. Nephrol Dial Transplant 2009; 24:1712-4. [DOI: 10.1093/ndt/gfp093] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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