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Santander Ballestín S, Giménez Campos MI, Ballestín Ballestín J, Luesma Bartolomé MJ. Is Supplementation with Micronutrients Still Necessary during Pregnancy? A Review. Nutrients 2021; 13:3134. [PMID: 34579011 PMCID: PMC8469293 DOI: 10.3390/nu13093134] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/26/2021] [Accepted: 09/06/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Proper nutrition during pregnancy is important to prevent nutritional imbalances that interfere with pregnancy. Micronutrients play critical roles in embryogenesis, fetal growth, and maternal health, as energy, protein, vitamin, and mineral needs can increase during pregnancy. Increased needs can be met by increasing the intake of dietary micronutrients. Severe micronutrient deficiency or excess during pregnancy can have negative effects on fetal growth (intrauterine growth retardation, low birth weight, or congenital malformations) and pregnancy development (pre-eclampsia or gestational diabetes). We investigate whether it is necessary to continue micronutrient supplementation during pregnancy to improve women's health in this stage and whether this supplementation could prevent and control pathologies associated with pregnancy. AIM The present review aims to summarize evidence on the effects of nutritional deficiencies on maternal and newborn morbidity. METHODS This aim is addressed by critically reviewing results from published studies on supplementation with different nutrients during pregnancy. For this, major scientific databases, scientific texts, and official webpages have been consulted. PubMed searches using the terms "pregnancy" OR "maternal-fetal health" AND "vitamins" OR "minerals" OR "supplementation" AND "requirement" OR "deficiency nutrients" were performed. RESULTS There are accepted interventions during pregnancy, such as folic acid supplementation to prevent congenital neural tube defects, potassium iodide supplementation to correct neurodevelopment, and oral iron supplementation during the second half of pregnancy to reduce the risk of maternal anemia and iron deficiency. A number of micronutrients have also been associated with pre-eclampsia, gestational diabetes mellitus, and nausea and vomiting in pregnancy. In general, experimental studies are necessary to demonstrate the benefits of supplementation with different micronutrients and to adjust the recommended daily doses and the recommended periconceptional nutrition for mothers. CONCLUSIONS Presently, there is evidence of the benefits of micronutrient supplementation in perinatal results, but indiscriminate use is discouraged due to the fact that the side effects of excessive doses are not known. Evidence supports the idea that micronutrient deficiencies negatively affect maternal health and the outcome of pregnancy. No single micronutrient is responsible for the adverse effects; thus, supplementing or correcting one deficiency will not be very effective while other deficiencies exist.
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Affiliation(s)
- Sonia Santander Ballestín
- Department of Pharmacology, Physiology and Legal and Forensic Medicine, Faculty of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | | | | | - María José Luesma Bartolomé
- Department of Human Anatomy and Histology, Faculty of Science, University of Zaragoza, 50009 Zaragoza, Spain;
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Horvat D, Afroze SH, Cromer WE, Pantho AF, Ashraf AHMZ, Kuehl TJ, Zawieja DC, Uddin MN. Cartiotonic steroids affect monolayer permeability in lymphatic endothelial cells. Mol Cell Biochem 2021; 476:3207-3213. [PMID: 33866492 DOI: 10.1007/s11010-021-04147-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/31/2021] [Indexed: 11/24/2022]
Abstract
Edema is common in preeclampsia (preE), a hypertensive disorder of pregnancy. Cardiotonic steroids (CTSs) such as marinobufagenin (MBG) are involved in the pathogenesis of preE. To assess whether CTSs are involved in the leakage of lymphatic endothelial cell (LEC), we evaluated their effect on monolayer permeability of LECs (MPLEC) in culture. A rat mesenteric LECs were treated with DMSO (vehicle), and CTSs (MBG, CINO, OUB) at concentrations of 1, 10, and 100 nM. Some LECs were pretreated with 1 μM L-NAME (N-Nitro-L-Arginine Methyl Ester) before adding 100 nM MBG or cinobufotalin (CINO). Expression of β-catenin and vascular endothelial (VE)-cadherin in CTS-treated LECs was measured by immunofluorescence and MPLEC was quantified using a fluorescence plate reader. Western blot was performed to measure β-catenin and VE-cadherin protein levels and myosin light chain 20 (MLC20) phosphorylation. MBG (≥ 1 nM) and CINO (≥ 10 nM) caused an increase (p < 0.05) in the MPLEC compared to DMSO while ouabain (OUB) had no effect. Pretreatment of LECs with 1 μM L-NAME attenuated (p < 0.05) the MPLEC. The β-catenin expression in LECs was downregulated (p < 0.05) by MBG and CINO. However, there was no effect on the LECs tight junctions for the CINO group. VE-cadherin expression was downregulated (p < 0.05) by CINO, and MLC20 phosphorylation was upregulated (p < 0.05) by MBG. We demonstrated that MBG and CINO caused an increase in the MPLEC, which were attenuated by L-NAME pretreatment. The data suggest that CTSs exert their effect via nitric-oxide-dependent signaling pathway and may be involved in vascular leak syndrome of LEC lining in preE.
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Affiliation(s)
- Darijana Horvat
- Orion Institute for Translational Medicine, Temple, TX, USA.,Emergent Biotechnologies LLC, Temple, TX, USA
| | - Syeda H Afroze
- Orion Institute for Translational Medicine, Temple, TX, USA.,Emergent Biotechnologies LLC, Temple, TX, USA
| | - Walter E Cromer
- Department of Medical Physiology, Texas A&M Health Science Center College of Medicine, Bryan, TX, USA
| | - Ahmed F Pantho
- Orion Institute for Translational Medicine, Temple, TX, USA.,Emergent Biotechnologies LLC, Temple, TX, USA
| | | | - Thomas J Kuehl
- Orion Institute for Translational Medicine, Temple, TX, USA.,Emergent Biotechnologies LLC, Temple, TX, USA
| | - David C Zawieja
- Department of Medical Physiology, Texas A&M Health Science Center College of Medicine, Bryan, TX, USA
| | - Mohammad Nasir Uddin
- Orion Institute for Translational Medicine, Temple, TX, USA. .,Emergent Biotechnologies LLC, Temple, TX, USA. .,Department of Medical Physiology, Texas A&M Health Science Center College of Medicine, Bryan, TX, USA.
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Guo R, Teng Z, Wang Y, Zhou X, Xu H, Liu D. Integrated Learning: Screening Optimal Biomarkers for Identifying Preeclampsia in Placental mRNA Samples. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:6691096. [PMID: 33680070 PMCID: PMC7925050 DOI: 10.1155/2021/6691096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/17/2021] [Accepted: 01/27/2021] [Indexed: 01/28/2023]
Abstract
Preeclampsia (PE) is a maternal disease that causes maternal and child death. Treatment and preventive measures are not sound enough. The problem of PE screening has attracted much attention. The purpose of this study is to screen placental mRNA to obtain the best PE biomarkers for identifying patients with PE. We use Limma in the R language to screen out the 48 differentially expressed genes with the largest differences and used correlation-based feature selection algorithms to reduce the dimensionality and avoid attribute redundancy arising from too many mRNA samples participating in the classification. After reducing the mRNA attributes, the mRNA samples are sorted from large to small according to information gain. In this study, a classifier model is designed to identify whether samples had PE through mRNA in the placenta. To improve the accuracy of classification and avoid overfitting, three classifiers, including C4.5, AdaBoost, and multilayer perceptron, are used. We use the majority voting strategy integrated with the differentially expressed genes and the genes filtered by the best subset method as comparison methods to train the classifier. The results show that the classification accuracy rate has increased from 79% to 82.2%, and the number of mRNA features has decreased from 48 to 13. This study provides clues for the main PE biomarkers of mRNA in the placenta and provides ideas for the treatment and screening of PE.
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Affiliation(s)
- Rong Guo
- Information and Computer Engineering College, Northeast Forestry University, Harbin 150040, China
| | - Zhixia Teng
- Information and Computer Engineering College, Northeast Forestry University, Harbin 150040, China
| | - Yiding Wang
- Information and Computer Engineering College, Northeast Forestry University, Harbin 150040, China
| | - Xin Zhou
- Information and Computer Engineering College, Northeast Forestry University, Harbin 150040, China
| | - Heze Xu
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dan Liu
- Information and Computer Engineering College, Northeast Forestry University, Harbin 150040, China
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Yan JQ, Huang F, Hao F, Su XL, Meng Q, Xu MJ. Oxidative Stress in the Rostral Ventrolateral Medulla Contributes To Cardiovascular Regulation in Preeclampsia. Front Physiol 2017; 8:772. [PMID: 29085302 PMCID: PMC5649191 DOI: 10.3389/fphys.2017.00772] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 09/21/2017] [Indexed: 12/24/2022] Open
Abstract
Background: It has been demonstrated that preeclampsia, a pregnancy-specific hypertension disorder, is characterized by high blood pressure (BP) and sympathetic overactivity. Increased reactive oxygen species (ROS) in the rostral ventrolateral medulla (RVLM), a key region for controlling sympathetic tone, has been reported to contribute to high level of BP and sympathetic outflow. The aim of the present study was to determine the role of the RVLM ROS in mediating the preeclampsia-associated cardiovascular dysfunction. Methods: The animal model of preeclampsia was produced by administration of desoxycorticosterone acetate (DOCA) to pregnant rats. Results: Compared with normal pregnant rats without DOCA treatment (NP), the protein concentration and norepinephrine excretion in 24-h urine, as well as BP in pregnant rats with DOCA treatment (PDS) were significantly increased. The levels of superoxide anion and the protein expression of NADPH oxidase subtype (NOX4) in the RVLM were significantly increased in PDS than in NP groups. Furthermore, microinjection of the superoxide dismutase (SOD) mimic Tempol (5 nmol) into the RVLM significantly decreased BP, heart rate, and renal sympathetic never activity in PDS but not in NP group. Conclusion: The present data suggest that high BP and sympathetic overactivity in preeclampsia rats is associated with increased oxidative stress in the RVLM via upregulation of NOX4 expression.
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Affiliation(s)
- Jiu-Qiong Yan
- Department of Obstetrics and Gynecology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Fang Huang
- Department of Geriatics, Jinling Hospital, Nanjing, China
| | - Fan Hao
- Department of Obstetrics and Gynecology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xiao-Ling Su
- Department of Obstetrics and Gynecology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qi Meng
- Department of Obstetrics and Gynecology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ming-Juan Xu
- Department of Obstetrics and Gynecology, Changhai Hospital, Second Military Medical University, Shanghai, China
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Madar-Shapiro L, Karady I, Trahtenherts A, Syngelaki A, Akolekar R, Poon L, Cohen R, Sharabi-Nov A, Huppertz B, Sammar M, Juhasz K, Than NG, Papp Z, Romero R, Nicolaides KH, Meiri H. Predicting the Risk to Develop Preeclampsia in the First Trimester Combining Promoter Variant -98A/C of LGALS13 (Placental Protein 13), Black Ethnicity, Previous Preeclampsia, Obesity, and Maternal Age. Fetal Diagn Ther 2017; 43:250-265. [PMID: 28728156 PMCID: PMC5882584 DOI: 10.1159/000477933] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 05/30/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND LGALS13 (placental protein 13 [PP13]) promoter DNA polymorphisms was evaluated in predicting preeclampsia (PE), given PP13's effects on hypotension, angiogenesis, and immune tolerance. METHODS First-trimester plasma samples (49 term and 18 intermediate) of PE cases matched with 196 controls were collected from King's College Hospital, London, repository. Cell-free DNA was extracted and the LGALS13 exons were sequenced after PCR amplification. Expression of LGALS13 promoter reporter constructs was determined in BeWo trophoblast-like cells with luciferase assays. Adjusted odds ratio (OR) was calculated for the A/A genotype combined with maternal risk factors. RESULTS The A/A, A/C, and C/C genotypes in the -98 promoter position were in Hardy-Weinberg equilibrium in the control but not in the PE group (p < 0.036). The dominant A/A genotype had higher frequency in the PE group (p < 0.001). The A/C and C/C genotypes protected from PE (p < 0.032). The ORs to develop term and all PE, calculated for the A/A genotype, previous PE, body mass index (BMI) >35, black ethnicity, and maternal age >40 were 15.6 and 11.0, respectively (p < 0.001). In luciferase assays, the "-98A" promoter variant had lower expression than the "-98C" variant in non-differentiated (-13%, p = 0.04) and differentiated (-26%, p < 0.001) BeWo cells. Forskolin-induced differentiation led to a larger expression increase in the "-98C" variant than in the "-98A" variant (4.55-fold vs. 3.85-fold, p < 0.001). CONCLUSION Lower LGALS13 (PP13) expression with the "A" nucleotide in the -98 promoter region position (compared to "C") and high OR calculated for the A/A genotype in the -98A/C promoter region position, history of previous PE, BMI >35, advanced maternal age >40, and black ethnicity could serve to aid in PE prediction in the first trimester.
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Anderson CM, Lopez F, Zhang HY, Shirasawa Y, Pavlish K, Benoit JN. Mesenteric Vascular Responsiveness in a Rat Model of Pregnancy-Induced Hypertension. Exp Biol Med (Maywood) 2016; 231:1398-402. [PMID: 16946408 DOI: 10.1177/153537020623100813] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Reduced perfusion to the placenta in early pregnancy is believed to be the initiating factor in the development of preeclampsia, triggering local ischemia and systemic vascular hyperresponsiveness. This sequence of events creates a predisposition to the development of altered vascular function and hypertension. This study was designed to determine the influence of placental insufficiency on the responsiveness of mesenteric resistance arteries in an animal model of preeclampsia. Placental insufficiency was induced by reduction in uteroplacental perfusion pressure (RUPP) in experimental Sprague-Dawley rat dams. The uterine branches of the ovarian arteries and the abdominal aortae of pregnant rats were surgically constricted on gestational Day 14. Dams in the control group underwent a sham procedure. Rats were euthanized on gestational Day 20, followed by removal of the small intestine and adjacent mesentery. First-order mesenteric resistance arteries were mounted on a small vessel wire myograph and challenged with incremental concentrations of vasoconstrictors and vasorelaxants. Mesenteric arteries in dams with placental insufficiency demonstrated an increased maximal tension to phenylephrine (7.15 ± 0.15 vs. 5.4 ± 0.27 mN/mm, P < 0.001); potassium chloride at 60 mM (3.43 ± 0.11 vs. 2.77 ± 0.14 mN/mm, P < 0.01) and 120 mM (3.92 ± 0.18 vs. 2.97 ± 0.16 mN/mm, P < 0.01); and angiotensin II (2.59 ± 0.42 vs. 1.51 ± 0.22 mN/mm, P < 0.05). Maximal relaxation to endothelium-dependent relaxants acetylcholine and calcium lonophore (A23187) was not significantly reduced. Data suggest that placental insufficiency leads to hyperresponsiveness to vasoconstrictor stimuli in mesenteric arteries.
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Affiliation(s)
- Cindy M Anderson
- College of Nursing, University of North Dakota, Grand Forks, ND 58202, USA.
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Ehrig JC, Afroze SH, Reyes M, Allen SR, Drever NS, Pilkinton KA, Kuehl TJ, Uddin MN. A p38 mitogen-activated protein kinase inhibitor attenuates cardiotonic steroids-induced apoptotic and stress signaling in a Sw-71 cytotrophoblast cell line. Placenta 2015; 36:1276-82. [DOI: 10.1016/j.placenta.2015.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 08/27/2015] [Accepted: 08/28/2015] [Indexed: 12/14/2022]
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Cardiotonic steroids induce anti-angiogenic and anti-proliferative profiles in first trimester extravillous cytotrophoblast cells. Placenta 2014; 35:932-6. [DOI: 10.1016/j.placenta.2014.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/22/2014] [Accepted: 07/28/2014] [Indexed: 12/30/2022]
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Uddin MN, Horvat D, Jones RO, Beeram MR, Zawieja DC, Perger L, Sprague DCC, Kuehl TJ. Suppression of aldosterone and progesterone in preeclampsia. J Matern Fetal Neonatal Med 2014; 28:1296-1301. [PMID: 25164552 DOI: 10.3109/14767058.2014.951627] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Preeclampsia (preE) is a hypertensive disorder seen in 3-10% of human pregnancies and is diagnosed by de novo onset of hypertension and proteinuria. Several research groups provided evidence for reduced aldosterone (Aldo) and progesterone (Prog) availability in preE. The aim of this study was to determine the levels of Aldo and Prog in preE. METHODS Normal pregnant (NP; n = 39) and preE (n = 30) patients were recruited to have their blood drawn between 21 and 40 weeks of pregnancy. Two groups of rats were used in this study: NP rats (n = 10) and preE rats (n = 10), which were given weekly injections of desoxycorticosterone acetate and 0.9% saline to drink. Aldo and Prog levels were assayed in plasma and urine samples by ELISA kits. RESULTS In preE patients, the mean Aldo and Prog levels were suppressed (p < 0.05) compared to NP patients. NP patients exhibited a trend of increased levels of Aldo with an increase in gestational age; however, preE patients had the opposite trend. Both normal and preE patients exhibited a trend of increased levels of Prog with an increase in gestational age. The plasma and urinary Aldo and Prog levels were lower (p < 0.05) in preE rats compared to NP rats. CONCLUSIONS We have demonstrated using a rat model and patients that both Aldo and Prog are suppressed in preE and thus may be used as biomarkers for preE.
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Affiliation(s)
- Mohammad N Uddin
- a Department of Obstetrics & Gynecology.,b Department of Pediatrics
| | | | | | | | | | - Lena Perger
- d Division of Pediatric Surgery , Baylor Scott & White Health and Texas A&M Health Science Center College of Medicine , Temple , TX , USA , and
| | | | - Thomas J Kuehl
- a Department of Obstetrics & Gynecology.,b Department of Pediatrics
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Li X, Li C, Dong X, Gou W. MicroRNA-155 inhibits migration of trophoblast cells and contributes to the pathogenesis of severe preeclampsia by regulating endothelial nitric oxide synthase. Mol Med Rep 2014; 10:550-4. [PMID: 24806148 DOI: 10.3892/mmr.2014.2214] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 03/21/2014] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to characterize the role of microRNA (miR)-155 in the pathogenesis of severe preeclampsia (PE). A total of 19 severe preeclampsic and 22 normal placentas were collected to measure miR-155 and endothelial nitric oxide synthase (eNOS) expression using quantitative (q)PCR and western blot analysis. The results demonstrated a significant increase in the levels of miR-155 and decreased eNOS expression in the severe preeclampsic placentas, as compared with the normal controls. In order to examine the function of miR-155 in the human placenta, the HTR8/Svneo cell line was transiently transfected with an miR-155 mimic or its inhibitor, anti-miR-155. It was confirmed that miR-155 may suppress the expression of eNOS in HTR-8/SVneo cells. Furthermore, a transwell insert invasion assay demonstrated that miR-155 inhibited cell invasion in trophoblast cells, and the effect was rescued by over expression of eNOS. The present study revealed that miR-155 has a negative regulatory role in the migratory behavior of HTR-8/SVneo cells via modulating eNOS.
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Affiliation(s)
- Xuelan Li
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital, Xi'an Jiao Tong University, Xi'an, Shaanxi 710061, P.R. China
| | - Chunfang Li
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital, Xi'an Jiao Tong University, Xi'an, Shaanxi 710061, P.R. China
| | - Xin Dong
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital, Xi'an Jiao Tong University, Xi'an, Shaanxi 710061, P.R. China
| | - Wenli Gou
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital, Xi'an Jiao Tong University, Xi'an, Shaanxi 710061, P.R. China
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Calicchio R, Buffat C, Vaiman D, Miralles F. [Endothelial dysfunction: role in the maternal syndrome of preeclampsia and long-term consequences for the cardiovascular system]. Ann Cardiol Angeiol (Paris) 2013; 62:215-220. [PMID: 23721989 DOI: 10.1016/j.ancard.2013.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 03/08/2013] [Indexed: 06/02/2023]
Abstract
Preeclampsia is a pregnancy disorder being a leading cause of maternal and fetal mortality and morbidity. It is a complex multisystem disease characterized by hypertension and proteinuria. In preeclampsia the placenta releases factors into the maternal circulation which cause a systemic endothelial dysfunction. Here, we review data demonstrating the central role played by the endothelium in the development of the maternal syndrome of preeclampsia. We present also original data showing how circulating factors present in the plasma of preeclamptic women can alter the transcriptome of endothelial cells. The expression of genes involved in essential functions such as vasoregulation, oxidative stress, apoptosis and cell proliferation show differential expression when endothelial cells are exposed to preeclamptic or normal pregnancy plasma. We conclude by discussing the growing evidences that the alterations of the endothelium during preeclampsia are linked to an increased risk of cardiovascular diseases latter on life. Therefore, a better understanding of the modifications undergone by the endothelial cells during preeclampsia is essential to develop new therapeutic approaches to both, manage preeclampsia and to prevent the long-term sequelae of the disease on women cardiovascular system.
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Affiliation(s)
- R Calicchio
- Inserm U1016-CNRS UMR8104, université Paris Descartes, institut Cochin, 24, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
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McCrae KR. Thrombocytopenia in Pregnancy. Platelets 2013. [DOI: 10.1016/b978-0-12-387837-3.00044-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mousa AA, Archer KJ, Cappello R, Estrada-Gutierrez G, Isaacs CR, Strauss JF, Walsh SW. DNA methylation is altered in maternal blood vessels of women with preeclampsia. Reprod Sci 2012; 19:1332-42. [PMID: 22902744 DOI: 10.1177/1933719112450336] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We analyzed 27,578 CpG sites that map to 14,495 genes in omental arteries of normal pregnant and preeclamptic women for DNA methylation status using the Illumina platform. We found 1685 genes with a significant difference in DNA methylation at a false discovery rate of <10% with many inflammatory genes having reduced methylation. Unsupervised hierarchical clustering revealed natural clustering by diagnosis and methylation status. Of the genes with significant methylation differences, 236 were significant at a false discovery rate of <5%. When data were analyzed more stringently to a false discovery rate of <5% and difference in methylation of >0.10, 65 genes were identified, all of which showed reduced methylation in preeclampsia. When these genes were mapped to gene ontology for molecular functions and biological processes, 75 molecular functions and 149 biological processes were overrepresented in the preeclamptic vessels. These included smooth muscle contraction, thrombosis, inflammation, redox homeostasis, sugar metabolism, and amino acid metabolism. We speculate that reduced methylation may contribute to the pathogenesis of preeclampsia and that alterations in DNA methylation resulting from preeclampsia may increase maternal risk of cardiovascular disease later in life.
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Affiliation(s)
- Ahmad A Mousa
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA 23298, USA
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Uddin MN, Allen SR, Jones RO, Zawieja DC, Kuehl TJ. Pathogenesis of pre-eclampsia: marinobufagenin and angiogenic imbalance as biomarkers of the syndrome. Transl Res 2012; 160:99-113. [PMID: 22683369 DOI: 10.1016/j.trsl.2012.01.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 01/03/2012] [Accepted: 01/05/2012] [Indexed: 11/17/2022]
Abstract
Pre-eclampsia (preE), a pregnancy disorder with the de novo onset of hypertension and proteinuria after 20 weeks of gestation, has multiple triggers that initiate pathophysiologic mechanisms. This review addresses translational aspects of preE by synthesizing information on preE pathogenesis, describing diagnostic biomarkers that predict disease, and suggesting strategies to lessen adverse outcomes. Key to this understanding is the role of cardiotonic bufodienolides, with marinobufagenin (MBG) as the prototype, and angiogenic factors in preE pathogenesis. Data from a rat model believed to mimic human preE show that urinary excretion of MBG increases before the onset of hypertension and proteinuria and that affected animals have an increased vascular leakage and blood brain barrier permeability. Angiogenic imbalance occurs with the onset of the syndrome in this model. Also, we report that MBG levels in preE patients exceed those in normal pregnancy and that angiogenic factors are altered in patients showing signs and symptoms of overt disease. In vitro administration of MBG inhibits cytotrophoblast function and triggers hyperpermeability in endothelial cell monolayers. We advance the hypotheses that MBG precedes preE; MBG causes disruption of tight junction proteins leading to vascular leak via activation of MAPK which triggers apoptotic mechanisms resulting in further endothelial dysfunction leading to edema with the release of angiogenic factors. This review provides new evidence about the role of MBG and vasoactive intermediates in preE pathogenesis including the neurologic sequela and may reveal new therapeutic targets for the prevention of preE complications.
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Affiliation(s)
- Mohammad N Uddin
- Department of Obstetrics and Gynecology, Scott & White Healthcare and Texas A&M Health Science Center College of Medicine, Temple, TX 76508, USA.
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Alasztics B, Kukor Z, Pánczél Z, Valent S. The pathophysiology of preeclampsia in view of the two-stage model. Orv Hetil 2012; 153:1167-76. [DOI: 10.1556/oh.2012.29415] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Preeclampsia is a common and severe disease in pregnancy, a major cause of maternal and fetal morbidity and mortality. The main features of the disease are de novo hypertension after the 20th gestational week and proteinuria, and it is frequently accompanied by edema and other subjective symptoms. The origin of the disease is the placenta, but its sequelae affect multiple organ systems. According to the two-stage model of preeclampsia, the abnormal and hypoperfused placenta (stage 1) releases factors to the bloodstream, which are responsible for the maternal symptoms (stage 2). Oxidative stress, impaired function of nitric-oxide synthase, cellular and humoral immunological factors play an important role in the pathophysiology of the placenta. Endothelial dysfunction is the common denominator of the clinical symptoms. The theory explains the origins of hypertension, proteinuria, edema and other symptoms as well. Orv. Hetil., 2012, 153, 1167–1176.
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Affiliation(s)
- Bálint Alasztics
- Semmelweis Egyetem Általános Orvostudományi Kar Budapest Fecske u. 41. 1084
| | - Zoltán Kukor
- Orvosi Vegytani, Molekuláris Biológiai és Patobiokémiai Intézet Budapest
| | - Zita Pánczél
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Szülészeti és Nőgyógyászati Klinika Budapest
| | - Sándor Valent
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Szülészeti és Nőgyógyászati Klinika Budapest
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Abstract
Preeclampsia (PE) is a multisystem disorder of human pregnancy, affecting about 6% of all pregnancies worldwide, and is one of the leading causes of maternal and infant morbidity and mortality. Despite decades of research into the pathogenesis of this complex disease, the underlying mechanisms remain unclear. As a result, the options for prevention and management of PE are limited. In recent years, there has been a growing body of evidence suggesting that folate deficiency is associated with PE, and folic acid supplementation may reduce the risk of developing PE in certain populations. Folate contributes to cell division and growth, and folate metabolism is involved in a large number of physiological and pathophysiological processes in human development. Sufficient supply of folate is therefore particularly important during pregnancy. Nevertheless, the exact mechanisms of folic acid deficiency increasing the risk of developing PE are still unclear. This article reviews what is understood about the aetiology of PE and the relationship between folate metabolism and PE so as to enhance further discussions on the subject.
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Effect of intravenous hydralazine infusion on maternal plasma nitric oxide levels in gestations complicated with severe preeclampsia: a pilot study. Arch Gynecol Obstet 2012; 285:1183-7. [PMID: 22258304 DOI: 10.1007/s00404-012-2217-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 01/05/2012] [Indexed: 10/14/2022]
Abstract
AIM To investigate the effect of intravenous hydralazine infusion on maternal nitric oxide (NO) levels. METHODS This pilot study comprised 40 (n = 40) gestations complicated with severe preeclampsia to whom maternal plasma NO levels were determined by chemiluminescence before and after hydralazine administration. Blood pressure values were concomitantly assessed. RESULTS After 20 min of intravenous hydralazine infusion blood pressure values decrease significantly in term and preterm gestations. This was accompanied by an overall significant decrease in mean plasma NO values (38.7 ± 12.9 to 35.4 ± 13.9 μmol/L, p < 0.05). Despite this, NO values decreased in 67.5% of cases (a 17.6% from baseline) and increased in 32.5% (a 14.8% from baseline) (p < 0.05 for both). Blood pressure decrease (%) was lower (systolic and diastolic) among those displaying a NO decrement than in the increment group. Interestingly, gestational age was higher in the group displaying decreased NO; however, this did not reach statistical significance (37.5 ± 2.7 vs. 35.9 ± 2.8 weeks, p = 0.08). CONCLUSION The results of this study fail to demonstrate a similar NO secretion after hydralazine infusion in women with severe preeclampsia.
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Musha Y, Itoh S, Miyakawa M, Ohtsuji M, Hanson MA, Kinoshita K, Takeda S. Vascular, renal and placental effects on pregnant offspring of protein-restricted rat dams. J Obstet Gynaecol Res 2011; 37:343-51. [PMID: 21272146 DOI: 10.1111/j.1447-0756.2010.01351.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIM Our previous study showed that a maternal low-protein diet induced hypertension and vascular dysfunction in rat offspring after day 175. In the present study, we hypothesized that these female offspring would develop hypertension in their own pregnancies even at ages less than 175 days because potential vascular dysfunction is exacerbated by the circulatory demands of pregnancy. MATERIAL AND METHODS Wistar rats were fed an isocaloric diet containing either 18% (control group) or 9% (low-protein group) casein throughout pregnancy. The female offspring were fed standard chow and mated between days 70 and 125. At the end of pregnancy, blood pressure was measured, and the uterine arteries were dissected and investigated with a wire myograph. RESULTS Placental weights were significantly lower in offspring of the low-protein group versus control. There were no significant differences in blood pressure. Renal expression of AT1 receptor mRNA was greater, and of AT2 receptor was less, in the low-protein group versus control. Vasoconstriction of uterine arteries to phenylephrine and U46619 was increased in the low-protein group, and vasodilatation to sodium nitroprusside was also increased. CONCLUSION Low-protein diet induces vascular effects on female offspring in their pregnancy, in terms of increased uterine artery vasoconstriction. This may be compensated for by increased sensitivity to nitric oxide (NO), maintaining blood pressure normal in the face of the demands of pregnancy. Such renal and vascular effects, combined with placental size, may transmit risk of vascular dysfunction to subsequent generations.
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Affiliation(s)
- Yuka Musha
- Department of Obstetrics and Gynecology, School of Medicine, Juntendo University, Tokyo, Japan.
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Uddin MN, Agunanne EE, Horvat D, Puschett JB. Resibufogenin Administration Prevents Oxidative Stress in a Rat Model of Human Preeclampsia. Hypertens Pregnancy 2010; 31:70-8. [DOI: 10.3109/10641955.2010.525275] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Uddin MN, Horvat D, Demorrow S, Agunanne E, Puschett JB. Marinobufagenin is an upstream modulator of Gadd45a stress signaling in preeclampsia. Biochim Biophys Acta Mol Basis Dis 2010; 1812:49-58. [PMID: 20851181 DOI: 10.1016/j.bbadis.2010.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 09/09/2010] [Accepted: 09/13/2010] [Indexed: 11/18/2022]
Abstract
Preeclampsia (PE) is a hypertensive disorder of pregnancy, in which marinobufagenin (MBG), a circulating cardiotonic steroid, is increased. The Gadd45a stress sensor protein is an upstream modulator of the pathophysiological changes observed in PE. However, the effects of MBG on Gadd45a stress signaling remain unknown. We examined the expression of Gadd45a, the sFlt-1 receptor, and p38, as well as caspase 3 and 8 activities in placental samples from four groups of rats. These were: normal pregnant (NP, n=8); pregnant rats which received weekly injections of desoxycorticosterone acetate and 0.9% saline as their drinking water (PDS, n=9); normal pregnant rats injected with MBG (NPM, n=8); and PDS rats injected with resibufogenin (RBG), an in vivo antagonist of MBG (PDSR, n=8). Utilizing human cytotrophoblast (CTB) cells, we examined the effect of MBG on these stress signaling proteins in vitro. Placental Gadd45a expression, caspase 3 and 8 activities, sFlt-1 concentrations, and sFlt-1 receptor expression were significantly higher in PDS and NPM compared to NP and PDSR rats. Gadd45a protein was significantly upregulated in the CTB cells when MBG was present in concentrations ≥1nM. Treatment with MBG (≥1nM) also significantly arrested cell cycle progression and activated the expression of the Gadd45a-mediated stress signaling proteins. Inhibition of Gadd45a through RNAi-mediation attenuated MBG-induced CTB cell stress signaling. In conclusion, MBG is involved in the alteration in Gadd45a stress signaling both in vivo and in vitro and RBG prevents these changes when administered in vivo.
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Affiliation(s)
- Mohammad N Uddin
- Division of Nephrology and Hypertension, Department of Medicine, Texas A&M Health Science Center College of Medicine and Scott & White Memorial Hospital, Temple, TX 76508, USA
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22
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Puschett JB, Agunanne E, Uddin MN. Emerging Role of the Bufadienolides in Cardiovascular and Kidney Diseases. Am J Kidney Dis 2010; 56:359-70. [DOI: 10.1053/j.ajkd.2010.01.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Accepted: 01/05/2010] [Indexed: 01/11/2023]
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Horvat D, Severson J, Uddin MN, Mitchell B, Puschett JB. Resibufogenin prevents the manifestations of preeclampsia in an animal model of the syndrome. Hypertens Pregnancy 2010; 29:1-9. [PMID: 19277924 DOI: 10.3109/10641950802629709] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND OBJECTIVES We have developed a rat model of preeclampsia which is based upon excessive volume expansion and includes hypertension, proteinuria and intrauterine growth restriction. In this model, the urinary excretion of the circulating steroid inhibitor of Na +/ K+ ATPase, marinobufagenin, is increased prior to the development of hypertension and proteinuria. An analogue of marinobufagenin, resibufogenin, successfully treats the hypertension and proteinuria. METHODS We administered resibufogenin early in pregnancy in this model, prior to the development of the syndrome. RESULTS We found that resibufogenin not only prevented the advent of hypertension and proteinuria, but also the development of intrauterine growth restriction. DISCUSSION These results may have relevance to the human condition.
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Affiliation(s)
- Darijana Horvat
- Department of Medicine, Texas A & M College of Medicine/Scott & White, Temple, USA
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24
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Puschett JB, Agunanne E, Uddin MN. Marinobufagenin, resibufogenin and preeclampsia. Biochim Biophys Acta Mol Basis Dis 2010; 1802:1246-53. [PMID: 20167272 DOI: 10.1016/j.bbadis.2010.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 01/15/2010] [Accepted: 02/06/2010] [Indexed: 11/18/2022]
Abstract
The bufodienolides are cardiac glycosides which have the ability to inhibit the enzyme, Na(+)/K(+) ATPase (sodium potassium adenosine triphosphatase). They are cardiac inotropes, cause vasoconstriction (and, potentially, hypertension) and are natriuretic. Evidence has accrued over time which supports the view that they are mechanistically involved in volume expansion-mediated hypertension. In this communication, the authors summarize data which support the view that the bufodienolides and, in particular, marinobufagenin (MBG) are involved in the pathogenesis of preeclampsia. In a rat model of the syndrome, MBG causes hypertension, proteinuria, intrauterine growth restriction and increased weight gain. All of these phenotypic characteristics are prevented by an antagonist to MBG, resibufogenin (RBG). The "preeclamptic" animals also develop a vascular leak syndrome, resulting in hemoconcentration. Abnormalities in the MAPK (mitogen-activated protein kinase) system play a role in the mechanism by which MBG produces the abnormalities in the pregnant rat. Studies to discover the relevance of these findings to human preeclampsia are currently underway in several laboratories and clinics.
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Affiliation(s)
- J B Puschett
- Department of Medicine, Texas A&M Health Science Center, Temple, TX 76508, USA.
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25
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Hultin H, Hellman P, Lundgren E, Olovsson M, Ekbom A, Rastad J, Montgomery SM. Association of parathyroid adenoma and pregnancy with preeclampsia. J Clin Endocrinol Metab 2009; 94:3394-9. [PMID: 19531594 DOI: 10.1210/jc.2009-0012] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Case reports have described associations between calcium metabolism disturbances and primary hyperparathyroidism with preeclampsia, suggesting parathyroid involvement in preeclampsia etiology. This study examines whether parathyroid adenoma, the main cause of hyperparathyroidism, diagnosed and treated before pregnancy is associated with preeclampsia. DESIGN We conducted a register-based study to assess the association between parathyroid adenoma and subsequent preeclampsia. SETTING Births among Sweden's general population were studied. POPULATION The study population included 52 women with a diagnosis of parathyroid adenoma and 519 without, all of whom had a subsequent singleton pregnancy between 1973 and 1997. METHODS We performed a conditional logistic regression investigating the association of parathyroid adenoma with subsequent preeclampsia in the first singleton pregnancy with adjustment for potential confounding factors. MAIN OUTCOME MEASURE The main outcome was a diagnosis of preeclampsia that does not include women with prior chronic hypertension. To ensure that treatment of parathyroid adenoma was completed before pregnancy, those with a diagnosis of parathyroid adenoma made less than 2 yr before delivery (and the matched comparison women) were excluded. RESULTS Statistically, parathyroid adenoma prior to delivery is significantly (P < 0.001) associated with preeclampsia, producing an adjusted odds ratio of 6.89 (95% confidence interval, 2.30, 20.58). CONCLUSION A history of parathyroid adenoma should be viewed as a risk for preeclampsia.
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Affiliation(s)
- Hella Hultin
- Department of Surgical Sciences, University Hospital, SE-751 85 Uppsala, Sweden
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26
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Bánhidy F, Puhó E, Acs N, Czeizel AE. Possible association between maternal recurrent orofacial herpes in pregnancy and a lower rate of preterm birth. J Matern Fetal Neonatal Med 2009; 19:537-42. [PMID: 16966121 DOI: 10.1080/14767050600901044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To study the possible association between orofacial herpes during pregnancy and pregnancy complications including preterm birth and low birth weight, since the results of previous studies are inconsistent. METHOD The population-based large data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities was used; pregnancies in mothers with and without recurrent orofacial herpes were compared. RESULTS. Of 38,151 newborn infants, 572 (1.5%) had mothers with recurrent orofacial herpes during pregnancy, while 37 577 had mothers with no orofacial herpes. Pregnant women with recurrent orofacial herpes had a higher prevalence of severe nausea and vomiting, threatened preterm delivery, and placental disorders but a lower prevalence of preeclampsia. Mothers with recurrent orofacial herpes during pregnancy also had a somewhat longer (0.4 weeks) gestation (adjusted t = 2.7; p = 0.006) and an obviously lower proportion of preterm births (3.5% vs. 9.3%; adjusted POR with 95% CI = 0.42, 0.27-0.65). However, there was no significant difference in the mean birth weight and rate of low birth weight infants between the two study groups. CONCLUSION Recurrent orofacial herpes during pregnancy is associated with a smaller proportion of preterm births.
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Affiliation(s)
- Ferenc Bánhidy
- Second Department of Obstetrics and Gynecology, Semmelweis University, School of Medicine, Budapest, Hungary
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27
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Ianosi-Irimie M, Vu HV, Whitbred JM, Pridjian CA, Nadig JD, Williams MY, Wrenn DC, Pridjian G, Puschett JB. A Rat Model of Preeclampsia. Clin Exp Hypertens 2009; 27:605-17. [PMID: 16303637 DOI: 10.1080/10641960500298608] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Preeclampsia/eclampsia is a disorder of human pregnancy that continues to exact significant maternal morbidity and mortality and fetal wastage. Therapy of these disorders has not changed in over 50 years and there are no proven preventive measures. We describe a model of the development of a syndrome in the pregnant rat that resembles preeclampsia, which results from the imposition of excessive volume expansion early in gestation. We administered desoxycorticosterone acetate (DOCA) to pregnant animals whose drinking water had been replaced with saline. We compared the results obtained in these animals with those resulting from the study of control, virgin animals, virgin animals receiving DOCA and saline, and normal pregnant (NP) animals. The virgin animals given DOCA and saline did not become hypertensive. The experimental paradigm in the DOCA plus saline pregnant (PDS) animals provides many of the phenotypic characteristics of the human disorder including the development of hypertension, proteinuria, and intrauterine growth restriction. In addition, the mean blood nitrite/nitrate concentration was reduced in the PDS rats compared with their NP counterparts. We propose that this model may prove to be useful in the study of the human condition.
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Affiliation(s)
- Monica Ianosi-Irimie
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Uddin MN, Horvat D, Childs EW, Puschett JB. Marinobufagenin causes endothelial cell monolayer hyperpermeability by altering apoptotic signaling. Am J Physiol Regul Integr Comp Physiol 2009; 296:R1726-34. [PMID: 19386984 DOI: 10.1152/ajpregu.90963.2008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Marinobufagenin (MBG) is an endogenous mammalian cardiotonic steroid that is involved in the inhibition of the sodium pump Na(+)/K(+)-ATPase. Increased plasma levels of MBG have been reported in patients with preeclampsia. MBG increases microvascular barrier permeability in an animal model of preeclampsia. However, the mechanism by which MBG impairs endothelial permeability is unknown. We utilized rat lung microvascular endothelial cells (RLMEC) to examine alterations in MBG-induced monolayer permeability and the effect of MBG on the phosphorylation status of ERK1/2, Jnk, and p38. Apoptosis was evaluated by examining alterations in caspases 3/7, 8, and 9 and annexin-V staining. We also examined the effect of MBG on the endothelial adherens junctions of the RLMEC monolayer. MBG inhibited the proliferation, and increased the monolayer permeability, of RLMEC. These actions of MBG were attenuated by ERK, p38, and pan caspase inhibition. MBG significantly decreased the phosphorylation of ERK1/2 and activated the phosphorylation of Jnk and p38. MBG also significantly increased the expression of caspases 3/7, 8, and 9, indicating the activation of apoptosis. MBG-induced apoptosis signaling was not observed in cells pretreated with a p38 inhibitor. MBG treatment induced the disruption of endothelial cell junctions. This effect was prevented by a pan caspase inhibitor. In conclusion, 1) MBG induced an impairment of RLMEC proliferation; 2) the bufadienolide also caused endothelial hyperpermeability; and 3) these effects of MBG were mediated by the downregulation of ERK1/2, the upregulation of Jnk and p38, by the activation of apoptosis, and by the disruption of endothelial cell junctions.
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Affiliation(s)
- Mohammad N Uddin
- Division of Nephrology and Hypertension, Department of Medicine, Texas A&M University Health Science Center College of Medicine and Scott & White Memorial Hospital, Temple, Texas, USA
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Uddin MN, McLean LB, Hunter FA, Horvat D, Severson J, Tharakan B, Childs EW, Puschett JB. Vascular leak in a rat model of preeclampsia. Am J Nephrol 2009; 30:26-33. [PMID: 19194101 DOI: 10.1159/000193220] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Accepted: 12/08/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Preeclampsia is a hypertensive disorder which develops de novo in women during pregnancy. The urinary excretion of the cardiotonic steroid, marinobufagenin (MBG), is increased prior to the development of hypertension. Preeclamptic patients are volume expanded but much of the excess salt and water appears to be located primarily in the interstitial space. Therefore, 'capillary leak' syndrome has been postulated in this disorder. METHODS We evaluated the vascular leakage in normal rats following MBG injection and in a rat model of human preeclampsia. We measured the changes in light intensity comparing that in the intravascular to the extravascular space by assessing 'leak' of fluorescein-labeled albumin (FITC-albumin) from mesenteric postcapillary venules. RESULTS FITC-albumin extravasation continued to increase in a time-dependent fashion after MBG infusion and was significant (p < 0.05) at 60 min of observation when compared to sham rats. We also observed a significant difference in 'vascular leakage' in preeclamptic rats compared to control non-pregnant and normal pregnant groups starting at 20 min after the FITC-albumin infusion. CONCLUSION We propose that MBG is involved in the production of a 'vascular leak' in our rat model of preeclampsia.
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Affiliation(s)
- Mohammad N Uddin
- Division of Nephrology and Hypertension, Department of Medicine, Texas A&M Health Science Center/Scott & White, Temple, Tex., USA
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The angiotensinogen gene M235T polymorphism and development of preeclampsia/eclampsia: a meta-analysis and meta-regression of observational studies. J Hypertens 2008; 26:1726-34. [DOI: 10.1097/hjh.0b013e3283009ca5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Abstract
Preeclampsia is specific to pregnancy and is still a leading cause of maternal and perinatal mortality and morbidity, affecting about 3% of women, but the underlying pathogenetic mechanisms still remain unclear. Immune maladaptation, placental ischemia and increased oxidative stress represent the main components discussed to be of etiologic importance, and they all may have genetic implications. Since the familial nature of preeclampsia is known for many years, extensive research on the genetic contribution to the pathogenesis of this severe pregnancy disorder has been performed. In this review, we will overview the linkage and candidate gene studies carried out so far as well as summarize important historical notes on the genetic hypotheses generated in preeclampsia research. Moreover, the influence of maternal and fetal genes and their interaction as well as the role of genomic imprinting in preeclampsia will be discussed.
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Affiliation(s)
- Sabine Mütze
- Department of Obstetrics and Gynecology, Aachen University (RWTH), Aachen, Germany.
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32
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Azenabor AA, Kennedy P, Balistreri S. Chlamydia trachomatis infection of human trophoblast alters estrogen and progesterone biosynthesis: an insight into role of infection in pregnancy sequelae. Int J Med Sci 2007; 4:223-31. [PMID: 17848980 PMCID: PMC1975777 DOI: 10.7150/ijms.4.223] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Accepted: 09/05/2007] [Indexed: 01/02/2023] Open
Abstract
The trophoblast cells are in direct contact with endometrial tissues throughout gestation, playing important early roles in implantation and placentation. The physiologic significance and the operating mechanisms involved in probable altered trophoblast functions following Chlamydia trachomatis infection were investigated to determine if C. trachomatis initiates productive infection in trophoblast, effects of such event on the biosynthesis of cholesterol and its derivatives estrogen and progesterone; and the regulator of the biosynthesis of these hormones, human chorionic gonadotropin. Chlamydia trachomatis exhibited productive infection in trophoblast typified by inclusion formation observed when chlamydia elementary bodies were harvested from trophoblast and titrated onto HEp-2 cells. Assessment of the status of C. trachomatis in trophoblast showed a relative increase in protein of HSP-60 compared with MOMP, features suggestive of chlamydial chronicity. There was a decrease in cellular cholesterol of chlamydia infected trophoblast and a down regulation of HMG-CoA reductase. The levels of estrogen and progesterone were decreased, while the expression of aromatase and adrenodoxin reductase was up regulated. Also, there was a decrease in human chorionic gonadotropin expression. The implications of these findings are that C. trachomatis infection of trophoblast may compromise cellular cholesterol biosynthesis, thus depleting the substrate pool for estrogen and progesterone synthesis. This defect may impair trophoblast functions of implantation and placentation, and consequently affect pregnancy sequelae.
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Affiliation(s)
- Anthony A Azenabor
- Department of Health Sciences, University of Wisconsin, Milwaukee, WI 53211, USA.
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Anderson CM. Preeclampsia: exposing future cardiovascular risk in mothers and their children. J Obstet Gynecol Neonatal Nurs 2007; 36:3-8. [PMID: 17238941 DOI: 10.1111/j.1552-6909.2006.00115.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
There is an increased risk for future cardiovascular disease in women who have had preeclampsia. In infants born to mothers with preeclampsia, there is growing evidence of increased risk for both cardiovascular disease and preeclampsia. Epidemiologic and experimental data provide a strong link between intrauterine exposure to preeclampsia and subsequent risk for the development of cardiovascular disease in women.
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Pridjian G, Pridjian C, Danchuk S, Ianosi-Irimie M, Vu HV, Puschett JB. Beneficial Effects of Metolazone in a Rat Model of Preeclampsia. J Pharmacol Exp Ther 2006; 318:1027-32. [PMID: 16717105 DOI: 10.1124/jpet.106.104901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Preeclampsia is a disorder that continues to exact a significant toll with respect to maternal morbidity and mortality as well as fetal wastage. Furthermore, the treatment of this disorder has not changed significantly in 50 years and is unsatisfactory. The use of diuretics in this syndrome is controversial because there is a concern related to potential baleful effects of volume contraction leading to a possible further decrement in the perfusion of the maternal-fetal unit. Metolazone is a diuretic/antihypertensive agent, which has a therapeutic effect on blood pressure (BP) in human essential hypertension without causing a natriuresis. We administered the drug in nondiuretic doses in a rat model of preeclampsia previously developed in this laboratory. The drug reduced BP without an accompanying natriuresis. Although there was a trend toward an improvement in intrauterine growth restriction, as determined by litter size and the number of pups demonstrating malformations, the values did not reach statistical significance. We conclude that metolazone, in low dosage, is an effective antihypertensive in this rat model. These studies have implications for the treatment of the human disorder.
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Affiliation(s)
- Gabriella Pridjian
- Department of Obstetrics and Gynecology, Tulane University School of Medicine, New Orleans, LA 70112-2699, USA.
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36
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Yu CKH, Casas JP, Savvidou MD, Sahemey MK, Nicolaides KH, Hingorani AD. Endothelial nitric oxide synthase gene polymorphism (Glu298Asp) and development of pre-eclampsia: a case-control study and a meta-analysis. BMC Pregnancy Childbirth 2006; 6:7. [PMID: 16542455 PMCID: PMC1431561 DOI: 10.1186/1471-2393-6-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2005] [Accepted: 03/16/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pre-eclampsia is thought to have an important genetic component. Recently, pre-eclampsia has been associated in some studies with carriage of a common eNOS gene Glu298Asp polymorphism, a variant that leads to the replacement of glutamic acid by aspartic acid at codon 298. METHOD Healthy women with singleton pregnancies were recruited from 7 district general hospitals in London, UK. Women at high risk of pre-eclampsia were screened by uterine artery Doppler velocimetry at 22-24 weeks of gestation and maternal blood was obtained to genotype the eNOS Glu298Asp polymorphism. Odds ratios (OR) and 95%CI, using logistic regression methods, were obtained to evaluate the association between the Glu298Asp polymorphism and pre-eclampsia. A meta-analysis was then undertaken of all published studies up to November 2005 examining the association of eNOS Glu298Asp genotype and pre-eclampsia. RESULTS 89 women with pre-eclampsia and 349 controls were included in the new study. The Glu298Asp polymorphism in a recessive model was not significantly associated with pre-eclampsia (adjusted-OR: 0.83 [95%CI: 0.30-2.25]; p = 0.7). In the meta-analysis, under a recessive genetic model (1129 cases & 2384 controls) women homozygous for the Asp298 allele were not at significantly increased risk of pre-eclampsia (OR: 1.28 [95%CI: 0.76-2.16]; p = 0.34). A dominant model (1334 cases & 2894 controls) was associated with no increase of risk of pre-eclampsia for women carriers of the Asp298 allele (OR: 1.12 [95%CI: 0.84-1.49]; p = 0.42). CONCLUSION From the data currently available, the eNOS Glu298Asp polymorphism is not associated with a significant increased risk of pre-eclampsia. However, published studies have been underpowered, much larger studies are needed to confirm or refute a realistic genotypic risk of disease, but which might contribute to many cases of pre-eclampsia in the population.
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Affiliation(s)
- Christina KH Yu
- Harris Birthright Research Centre for Fetal Medicine, King's College, Hospital, Medical School, Denmark Hill, London, SE5 9RS, UK
| | - Juan P Casas
- Centre for Clinical Pharmacology, Department of Medicine, BHF Laboratories at UCL, Rayne Building, 5 University Street, London WC1E 6JJ, UK
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Makrina D Savvidou
- Harris Birthright Research Centre for Fetal Medicine, King's College, Hospital, Medical School, Denmark Hill, London, SE5 9RS, UK
| | - Manpreet K Sahemey
- Centre for Clinical Pharmacology, Department of Medicine, BHF Laboratories at UCL, Rayne Building, 5 University Street, London WC1E 6JJ, UK
| | - Kypros H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College, Hospital, Medical School, Denmark Hill, London, SE5 9RS, UK
| | - Aroon D Hingorani
- Centre for Clinical Pharmacology, Department of Medicine, BHF Laboratories at UCL, Rayne Building, 5 University Street, London WC1E 6JJ, UK
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37
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Vu H, Ianosi-Irimie M, Danchuk S, Rabon E, Nogawa T, Kamano Y, Pettit GR, Wiese T, Puschett JB. Resibufogenin corrects hypertension in a rat model of human preeclampsia. Exp Biol Med (Maywood) 2006; 231:215-20. [PMID: 16446498 DOI: 10.1177/153537020623100212] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The study of the pathogenesis of preeclampsia has been hampered by a relative dearth of animal models. We developed a rat model of preeclampsia in which the excretion of a circulating inhibitor of Na/K ATPase, marinobufagenin (MBG), is elevated. These animals develop hypertension, proteinuria, and intrauterine growth restriction. The administration of a congener of MBG, resibufogenin (RBG), reduces blood pressure to normal in these animals, as is the case when given to pregnant animals rendered hypertensive by the administration of MBG. Studies of Na/K ATPase inhibition by MBG and RBG reveal that these agents are equally effective as inhibitors of the enzyme.
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Affiliation(s)
- Hop Vu
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA
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38
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Liévano S, Alarcón L, Chávez-Munguía B, González-Mariscal L. Endothelia of term human placentae display diminished expression of tight junction proteins during preeclampsia. Cell Tissue Res 2006; 324:433-48. [PMID: 16508790 DOI: 10.1007/s00441-005-0135-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2005] [Accepted: 11/22/2005] [Indexed: 01/20/2023]
Abstract
This study explores the molecular composition of the tight junction (TJ) in human term placenta from normal women and from patients with preeclampsia, a hypertensive disorder of pregnancy. Maternal endothelial dysfunction is a critical characteristic of preeclampsia; hence, we have analyzed its impact on placental vessels. The study concentrates on the TJ because this structure regulates the sealing of the paracellular route. We have found that, in placental endothelial vessels, TJ components include the peripheral protein ZO-1 and the integral proteins occludin and claudins 1, 3, and 5. During preeclampsia, the amounts of occludin and ZO-1 exhibit no significant variation, whereas those of claudins 1, 3, and 5 diminish, suggesting the presence of leakier TJs in the endothelia of the preeclamptic placenta, possibly in response to the decreased perfusion of this organ during preeclampsia. We have unexpectedly found that, in normal placentae, the multinucleated syncytiotrophoblast layer displays claudin 4 at the basal surface of the plasma membrane, and claudin 16 along the apical and basolateral surfaces. The presence of membrane-lined channels that cross the syncytiotrophoblast constituting a paracellular pathway has been determined by transmission electron microscopy and by the co-immunolocalization of claudin 16 with the plasma membrane proteins Na+K+-ATPase and GP135. Since claudin 16 functions as a paracellular channel for Mg2+, its diffuse pattern in preeclamptic placentae suggests the altered paracellular transport of Mg2+ between the maternal blood and the placental tissue.
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Affiliation(s)
- Samuel Liévano
- Gynecology and Obstetrics Hospital, La Raza Medical Center, Mexican Institute of Social Security (IMSS), México D.F., Mexico
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39
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Mignini LE, Villar J, Khan KS. Mapping the theories of preeclampsia: the need for systematic reviews of mechanisms of the disease. Am J Obstet Gynecol 2006; 194:317-21. [PMID: 16458623 DOI: 10.1016/j.ajog.2005.08.065] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2005] [Revised: 08/12/2005] [Accepted: 08/24/2005] [Indexed: 10/25/2022]
Abstract
Preeclampsia, a major cause of morbidity in pregnancy, is still a disease of unknown cause, despite considerable research in recent times. We believe that progress in understanding the disorder would be enhanced if the systematic review methodology, similar to that used to assess data from clinical trials, is applied to studies that investigate the many theories advanced to explain its cause. This article discusses the need for and a frame work of such an endeavor. The systematic review approach helps to determine where research should be focused, to prioritize the use of resources, to understand, and then hopefully to conquer a disease that still kills mothers and infants each year, worldwide.
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Affiliation(s)
- Luciano E Mignini
- UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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40
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Vu HV, Ianosi-Irimie MR, Pridjian CA, Whitbred JM, Durst JM, Bagrov AY, Fedorova OV, Pridjian G, Puschett JB. Involvement of marinobufagenin in a rat model of human preeclampsia. Am J Nephrol 2005; 25:520-8. [PMID: 16179779 DOI: 10.1159/000088461] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2005] [Accepted: 07/25/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Preeclampsia is a potentially devastating disorder of hypertension in pregnancy for which there is currently no definitive treatment short of delivery. The bufadienolide, marinobufagenin (MBG), an inhibitor of Na(+)/K(+) ATPase, has been found to be elevated in extracellular fluid volume-expanded hypertensive patients, a condition similar to preeclampsia. Thus, these studies sought to examine the role of MBG in our rat model of preeclampsia. METHODS AND RESULTS Pregnant female rats were injected intraperitoneally with deoxycorticosterone acetate (DOCA) and given 0.9% saline as drinking water for the duration of their pregnancy. Urinary MBG was measured using a DELFIA immunoassay. Blood pressure was measured via the tail-cuff method. Injections of anti-MBG antibody were given intraperitoneally or intravenously to hypertensive pregnant rats. MBG was given intraperitoneally to pregnant rats. Uterine arterioles were dissected free and their diameters were measured before and after perfusion of MBG, ouabain, or digoxin. MBG was found to be elevated in the pregnant + DOCA + saline (PDS) rats compared to normal pregnant animals. In addition, when PDS rats were injected with anti-MBG antibody, there was a subsequent reduction in blood pressure. Administration of MBG in normal pregnant rats caused an elevation in blood pressure equivalent to the PDS model. Also, uterine vessel measurements showed an increased vasoconstrictive reactivity to MBG in the PDS animals vs. the normal pregnant controls; while no changes were observed with perfusion of digoxin or ouabain at the same concentration. CONCLUSION These results suggest a relationship between MBG and a syndrome in rats resembling preeclampsia. Armed with these promising results, it would seem logical to further examine the role of MBG in human preeclampsia.
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Affiliation(s)
- Hop V Vu
- Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112-2699, USA
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41
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Anderson CM, Lopez F, Zhang HY, Pavlish K, Benoit JN. Characterization of changes in leptin and leptin receptors in a rat model of preeclampsia. Am J Obstet Gynecol 2005; 193:267-72. [PMID: 16021089 DOI: 10.1016/j.ajog.2004.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the influence of reduced uteroplacental perfusion pressure on plasma leptin and placental leptin receptor expression in rats that develop hypertension in the third trimester of pregnancy. STUDY DESIGN The ovarian arteries and abdominal aortae of pregnant Sprague-Dawley rats (n=9) were constricted surgically on day 14 of gestation and were matched with sham controls. Systolic blood pressure and weight were measured biweekly. Maternal plasma leptin levels, placental leptin receptor abundance, fetal number, fetal weight, and placental weight were determined. RESULTS Reductions in perfusion pressure induced a significant decrease in maternal plasma leptin. Maternal systolic blood pressure and leptin receptor protein abundance was increased in the experimental group. Litter size and fetal and placental weight were significantly decreased in response to reduced perfusion pressure. CONCLUSION Reduced uteroplacental perfusion pressure reduces litter size, fetal and placental weights, and maternal plasma leptin levels and increases placental expression of leptin receptors.
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Affiliation(s)
- Cindy M Anderson
- College of Nursing and Department of Pharmacology, Physiology, and Therapeutics, University of North Dakota, Grand Forks 58202, USA.
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42
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Meher S, Duley L. Interventions for preventing pre-eclampsia and its consequences: generic protocol. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2005. [DOI: 10.1002/14651858.cd005301] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shireen Meher
- The University of Liverpool; C/o Cochrane Pregnancy and Childbirth Group, School of Reproductive and Developmental Medicine, Division of Perinatal and Reproductive Medicine; First Floor, Liverpool Women's NHS Foundation Trust Crown Street Liverpool UK L8 7SS
| | - Lelia Duley
- University of Leeds; Centre for Epidemiology and Biostatistics; Bradford Royal Infirmary, Bradford Institute of Health Research Temple Bank House, Duckworth Lane Bradford West Yorkshire UK BD9 6RJ
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43
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44
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Thway TM, Shlykov SG, Day MC, Sanborn BM, Gilstrap LC, Xia Y, Kellems RE. Antibodies From Preeclamptic Patients Stimulate Increased Intracellular Ca
2+
Mobilization Through Angiotensin Receptor Activation. Circulation 2004; 110:1612-9. [PMID: 15381659 DOI: 10.1161/01.cir.0000142855.68398.3a] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Preeclampsia is a serious disorder of pregnancy characterized by hypertension, proteinuria, edema, and coagulation and vascular abnormalities. At the cellular level, abnormalities include increased calcium concentration in platelets, lymphocytes, and erythrocytes. Recent studies have shown that antibodies directed against angiotensin II type I (AT
1
) receptors are also highly associated with preeclampsia.
Methods and Results—
We tested the hypothesis that AT
1
receptor–agonistic antibodies (AT
1
-AAs) could activate AT
1
receptors, leading to an increased intracellular concentration of free calcium and to downstream activation of Ca
2+
signaling pathways. Sera of 30 pregnant patients, 16 diagnosed with severe preeclampsia and 14 normotensive, were examined for the presence of IgG capable of stimulating intracellular Ca
2+
mobilization. IgG from all preeclamptic patients activated AT
1
receptors and increased intracellular free calcium. In contrast, none of the normotensive individuals had IgG capable of activating AT
1
receptors. The specific mobilization of intracellular Ca
2+
by AT
1
-AAs was blocked by losartan, an AT
1
receptor antagonist, and by a 7-amino-acid peptide that corresponds to a portion of the second extracellular loop of the AT
1
receptor. In addition, we have shown that AT
1
-AA–stimulated mobilization of intracellular Ca
2+
results in the activation of the transcription factor, nuclear factor of activated T cells.
Conclusions—
These results suggest that maternal antibodies capable of activating AT
1
receptors are likely to account for increased intracellular free Ca
2+
concentrations and changes in gene expression associated with preeclampsia.
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MESH Headings
- Adult
- Animals
- Autoantibodies/immunology
- Autoantibodies/isolation & purification
- Autoantibodies/pharmacology
- Autoantigens/immunology
- CHO Cells/drug effects
- Calcium Signaling/drug effects
- Cricetinae
- DNA-Binding Proteins/genetics
- Dose-Response Relationship, Immunologic
- Epitopes/immunology
- Female
- Gene Expression Regulation/drug effects
- Genes, Reporter
- Humans
- Immunoglobulin G/immunology
- Immunoglobulin G/isolation & purification
- Immunoglobulin G/pharmacology
- Luciferases, Renilla/biosynthesis
- Luciferases, Renilla/genetics
- NFATC Transcription Factors
- Nuclear Proteins/genetics
- Peptide Fragments/immunology
- Pre-Eclampsia/immunology
- Pregnancy
- Rats
- Receptor, Angiotensin, Type 1/agonists
- Receptor, Angiotensin, Type 1/genetics
- Receptor, Angiotensin, Type 1/immunology
- Transcription Factors/genetics
- Transcription, Genetic/drug effects
- Transfection
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Affiliation(s)
- Theingi M Thway
- Department of Biochemistry and Molecular Biology, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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45
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Frank KA, Buchmann EJ, Schackis RC. Does human immunodeficiency virus infection protect against preeclampsia-eclampsia? Obstet Gynecol 2004; 104:238-42. [PMID: 15291993 DOI: 10.1097/01.aog.0000130066.75671.b2] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE In view of recent suggestions that human immunodeficiency virus (HIV) infection may protect against preeclampsia, this study was done to evaluate whether untreated HIV-positive pregnant women have a lower rate of preeclampsia-eclampsia than HIV-negative women. METHODS Subjects for this study were pregnant women from Soweto, South Africa, who gave birth from March to December 2002 at midwife-run clinics or at the Chris Hani Baragwanath Hospital and in whom the HIV status was known. A sample size calculation indicated that 2,588 subjects would be required to show statistical significance at P <.05 with a power of 80% for a reduction in the rate of preeclampsia from 8% to 5% with HIV seropositivity, assuming an HIV seroprevalence rate of 30%. Data collection was by record review from randomly selected patient files and birth registers. RESULTS In the total sample of 2,600 women, 1,797 gave birth at the hospital and 803 at the midwife-run clinics. The HIV seroprevalence rate was 27.1%. Hypertension was found in 17.3% of women, with 5.3% having preeclampsia-eclampsia. The rates of preeclampsia-eclampsia were 5.2% in HIV-negative and 5.7% in HIV-positive women (P =.61). CD4 count results were available for only 13 women (0.5%). CONCLUSION Human immunodeficiency virus seropositivity was not associated with any reduction in the risk of developing preeclampsia-eclampsia.
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Affiliation(s)
- K A Frank
- Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa
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46
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Paltiel O, Friedlander Y, Tiram E, Barchana M, Xue X, Harlap S. Cancer after pre-eclampsia: follow up of the Jerusalem perinatal study cohort. BMJ 2004; 328:919. [PMID: 15003975 PMCID: PMC390203 DOI: 10.1136/bmj.38032.820451.7c] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2004] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare the incidence of cancer among women with and without a history of pre-eclampsia. DESIGN Cohort study. SETTING Jerusalem perinatal study of women who delivered in three large hospitals in West Jerusalem during 1964-76. PARTICIPANTS 37 033 women. MAIN OUTCOME MEASURES Age adjusted and multivariable adjusted hazard ratios for cancer incidence for the entire cohort and for women who were primiparous at study entry. RESULTS Cancer developed in 91 women who had pre-eclampsia and 2204 who did not (hazard ratio 1.27, 95% confidence interval 1.03 to 1.57). The risk of site specific cancers was increased, particularly of the stomach, ovary epithelium, breast, and lung or larynx. The incidence of cancer of the stomach, breast, ovary, kidney, and lung or larynx was increased in primiparous women at study entry who had a history pre-eclampsia. CONCLUSIONS A history of pre-eclampsia is associated with increases in overall risk of cancer and incidence at several sites. This may be explained by environmental and genetic factors common to the development of pre-eclampsia and cancer in this population.
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Affiliation(s)
- Ora Paltiel
- Braun School of Public Health and Community Medicine, Hadassah-Hebrew University, Jerusalem 91120, Israel.
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47
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Abstract
Hypertensive disorders during pregnancy, which account for approximately 15% of pregnancy-related deaths, represent the second-leading cause of morbidity and mortality in the United States. New classifications recommended by the National Institutes of Health's Working Group on High Blood Pressure in Pregnancy have decreased the confusion often associated with these disorders. The cause of preeclampsia-eclampsia still remains elusive, but continued research has provided hope with regard to screening, improved diagnosis, and management. Risk factors that have recently gained attention include inherited thrombophilias, inherited metabolic disorders, and lipid disorders. Treatment and management of the hypertensive disorders of pregnancy have not changed substantially in the past 50 years. Prevention of preeclampsia-eclampsia has been unsuccessful, and recurrence risks remain high. Careful diagnosis, classification, and further investigation of the causes of hypertensive disorders in pregnancy are needed to achieve optimal management of affected women and their fetuses.
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Affiliation(s)
- Sherri A Longo
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tulane University School of Medicine, New Orleans, LA 70112, USA
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48
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Lyell DJ, Lambert-Messerlian GM, Giudice LC. Prenatal screening, epidemiology, diagnosis, and management of preeclampsia. Clin Lab Med 2003; 23:413-42. [PMID: 12848452 DOI: 10.1016/s0272-2712(03)00027-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The cause of preeclampsia remains unknown. The disease manifests itself across a broad clinical spectrum from mild to severe, conferring vastly different morbidities and suggesting possibly different disease processes. Oxidative stress, endothelial dysfunction, maternal-fetal immune incompatibility, and abnormal placental implantation are among the suggested causes. The need for a marker or set of markers that allow for definitive diagnosis and assessment of future risk of preeclampsia is tremendous. Ultrasound techniques and several markers have been identified that are increased among patients with preeclampsia, but no test is highly sensitive. In the future, a combination of markers likely will be used to assess risk and, establish the diagnosis, and test treatment strategies. Such an approach would allow for more refined treatment studies of patients who are at highest risk for preeclampsia.
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Affiliation(s)
- Deirdre J Lyell
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
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