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Razzak R, Shivkumar PV. Early Prediction of Hypertensive Diseases of Pregnancy by Using Combined Screening Methods in a Rural Population. Cureus 2023; 15:e50624. [PMID: 38226112 PMCID: PMC10789305 DOI: 10.7759/cureus.50624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2023] [Indexed: 01/17/2024] Open
Abstract
INTRODUCTION The most frequent medical issue during pregnancy is hypertension, which can complicate up to 10% to 15% of pregnancies worldwide. An estimated 14% of all maternal fatalities worldwide are thought to be caused by hypertensive disease of pregnancy, one of the main causes of maternal and fetal morbidity and mortality. Despite the fact that maternal mortality is substantially lower in high-income countries than in low- and middle-income countries, hypertension is still one of the leading causes of maternal death globally. Maternal mortality associated with hypertension fluctuated between 0.08 and 0.42 per 100,000 births between 2009 and 2015. In India, the estimated overall pooled prevalence of HDP was determined to be one out of 11 women, or 11% (95% CI, 5%-17%). Despite various government programs, there is still a high prevalence of hypertension, which calls for stakeholders and healthcare professionals to focus on providing both therapeutic and preventive care. The best solution is to concentrate more on the early detection of pregnancy-related hypertension and to guarantee its universal application so that proper care can be carried out to prevent maternal and fetal morbidity. AIM To estimate the predictive value of the combination of maternal characteristics, i.e., mean arterial pressure (MAP), biophysical evaluation (uterine artery Doppler), and biochemical markers (pregnancy-associated plasma protein A (PAPP-A)), in the first trimester of pregnancy for hypertensive diseases of pregnancy. METHODOLOGY It was a prospective observational study of longitudinal variety that took over 18 months in a tertiary care rural hospital. The number of women admitted to the hospital for labor care during 2019 was 5261. A total of 513 were diagnosed with hypertensive illnesses during pregnancy. At a prevalence rate of 10%, we calculated a sample size of 350 to achieve a sensitivity of 85% with an absolute error of 12.5% at a 95% CI. Maternal histories, such as age, education, socio-economic status, gravidity, and BMI, were taken along with three parameters, i.e., MAP, which was significant above 90 mmHg, uterine artery Doppler, which was taken significant above 1.69, and serum PAPP-A, which was significant at less than 0.69 ml/IU. OBSERVATION AND RESULTS We have found that the following are associated with the prediction of hypertension: among the maternal characteristics are advanced age >35 years, presence of body edema, and urine proteins along with MAP, uterine artery pulsatility index (UtA-PI), and PAPP-A are significant. The predictive accuracy of the combination of MAP, UtA-PI, and PAPP-A is also significant. We also found that there is a significant increase in cesarean sections and NICU admissions in hypertensive patients. CONCLUSION A combination of screening parameters, including MAP, UtA-PI, and PAPP-A, to predict early hypertensive disease of pregnancy is developed and tested.
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Affiliation(s)
- Ruhida Razzak
- Obstetrics and Gynecology, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
| | - Poonam V Shivkumar
- Obstetrics and Gynecology, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
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Chen Y, Liu M, Wang Y. Bioinformatic analysis reveals lysosome-related biomarkers and molecular subtypes in preeclampsia: novel insights into the pathogenesis of preeclampsia. Front Genet 2023; 14:1228110. [PMID: 37576559 PMCID: PMC10416227 DOI: 10.3389/fgene.2023.1228110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/14/2023] [Indexed: 08/15/2023] Open
Abstract
Background: The process of lysosomal biogenesis and exocytosis in preeclamptic placentae plays a role in causing maternal endothelial dysfunction. However, the specific lysosome-associated markers relevant to preeclampsia (PE) are not well-defined. Our objective is to discover new biomarkers and molecular subtypes associated with lysosomes that could improve the diagnosis and treatment of PE. Methods: We obtained four microarray datasets related to PE from the Gene Expression Omnibus (GEO) database. The limma package was utilized to identify genes that were differentially expressed between individuals with the disease and healthy controls. The logistic regression analysis was used to identify core diagnostic biomarkers, which were subsequently validated by independent datasets and clinical samples. Additionally, a consensus clustering method was utilized to distinguish between different subtypes of PE. Following this, functional enrichment analysis, GSEA, GSVA, and immune cell infiltration were conducted to compare the two subtypes and identify any differences in their functional characteristics and immune cell composition. Results: We identified 16 PE-specific lysosome-related genes. Through regression analysis, two genes, GNPTG and CTSC, were identified and subsequently validated in the external validation cohort GSE60438 and through qRT-PCR experiment. A nomogram model for the diagnosis of PE was developed and evaluated using these two genes. The model had a remarkably high predictive power (AUC values of the training set, validation set, and clinical samples were 0.897, 0.788, and 0.979, respectively). Additionally, two different molecular subtypes (C1 and C2) were identified, and we found notable variations in the levels of immune cells present in the two subtypes. Conclusion: Our results not only offered a classification system but also identified novel diagnostic biomarkers for PE patients. Our findings offered an additional understanding of how to categorize PE patients and also highlighted potential avenues for creating treatments for individuals with PE.
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Affiliation(s)
- Yao Chen
- Department of Obstetrics, The First People’s Hospital of Chenzhou, Chenzhou, China
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Hochberg A, Mills G, Volodarsky-Perel A, Nu TNT, Machado-Gedeon A, Cui Y, Shaul J, Dahan MH. The impact of polycystic ovary syndrome on placental histopathology patterns in in-vitro fertilization singleton live births. Placenta 2023; 139:12-18. [PMID: 37290292 DOI: 10.1016/j.placenta.2023.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Pregnant polycystic ovary syndrome (PCOS) patients are at increased risk for myriad obstetric complications, with the placenta thought to play a key role in their development. We aimed to evaluate placental histopathology patterns in placentas of women with PCOS who underwent in-vitro-fertilization (IVF). METHODS This retrospective study utilized full gross and histopathologic assessment of placentas of all women who had IVF treatment and delivered at the Royal Victoria Hospital from 2009 to 2017, regardless of complications or mode of delivery. Pathologic findings included anatomic, inflammation, villous maturation, and vascular mal-perfusion features. Placentas of PCOS women were compared to those of ovulatory controls. Multivariate logistic regression was used to adjust results for confounding factors potentially associated with significant placental and perinatal characteristics. RESULTS Women with PCOS (n = 47) were more likely to develop gestational diabetes mellitus compared to ovulatory controls (n = 1121) (38.3% vs. 9.8%, p < 0.001). Placentas from PCOS women were more likely circumvallate placentas (aOR 8.3, 95%CI 1.9-37.3) and more likely to have a hypercoiled umbilical cord (aOR 6.8 95%CI 1.3-36.8) and villitis of unknown etiology (aOR 6.1, 95%CI 1.5-25.6). There was an increased likelihood of chorangiosis (aOR 2.7, 95% CI 1.3-5.8), evidence of fetal vascular malperfusion based on one criteria (aOR 2.7, 95%CI 1.1-7.4), or more than one criteria (aOR 6.4, 95%CI 1.6-25.9), more nucleated fetal red blood cells (aOR 5.2, 95%CI 1.1-24.5), and a higher likelihood of chorangiomas (aOR 9.4, 95%CI 1.6-55.1) in placentas from PCOS women than in controls. DISCUSSION IVF pregnancies' placental histopathological characteristics are significantly impacted by an underlying diagnosis of PCOS, including important anatomic changes and vascular placental abnormalities.
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Affiliation(s)
- Alyssa Hochberg
- Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University, Montreal, QC, Canada; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ginevra Mills
- Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University, Montreal, QC, Canada
| | - Alexander Volodarsky-Perel
- Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University, Montreal, QC, Canada; Lady Davis Research Institute, Jewish General Hospital, Montreal, Canada
| | - Tuyet Nhung Ton Nu
- Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University, Montreal, QC, Canada; Department of Pathology, Royal Victoria Hospital, McGill University, Montreal, QC, Canada
| | - Alexandre Machado-Gedeon
- Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University, Montreal, QC, Canada
| | - Yiming Cui
- Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University, Montreal, QC, Canada
| | - Jonathan Shaul
- Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University, Montreal, QC, Canada
| | - Michael H Dahan
- Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University, Montreal, QC, Canada.
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Najafova T, Dagdeviren G, Kasikci M, Sahin D, Yucel A, Ozyuncu O, Gurler M. Segmental hair metabolomics analysis in pregnant women with pregnancy complications. Metabolomics 2023; 19:45. [PMID: 37084096 DOI: 10.1007/s11306-023-02009-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
INTRODUCTION Pregnancy complications, as preeclampsia (PE) and HELLP syndrome, occurring with similar pathophysiological mechanisms, have adverse effects on the health of both mother and fetus during pregnancy and thereafter, they are leading causes of maternal and fetal morbidity and mortality. The hair metabolome has been recognized as a valuable source of information in pregnancy research, as it provides stable metabolite information to be able to assist with studying biomarkers or metabolic mechanisms of pregnancy and its complications. OBJECTIVE The aim of this study was to investigate the hair metabolome profile of pregnant women with PE, HELLP syndrome and healthy women. METHOD Hair samples of new-borns' mothers (patients and controls) were investigated segmentally relevant to each trimester using a proper sample preparation and gas chromatography-mass spectrometry (GC-MS) to identify robust biomarkers that can be useful for screening, early detection, follow-up and treatment of PE and HELLP syndrome, the etiology of which are still unknown. RESULTS The results showed a significant change in the metabolome profiles of the patient and control groups regarding the trimesters. A striking decrease was observed in all 100 metabolites investigated in the patient group (p < 0.000). The metabolic pathways associated with significant metabolites have also been investigated, and the most affected pathways were observed to be the urea cycle, glycine, serine, aspartate, methionine and purine metabolism, ammonia cycle, and phosphatidylethanolamine biosynthesis. CONCLUSION The found metabolites provide us with extensive data on the ability to establish biomarkers for predicting, early detection and monitoring of PE.
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Affiliation(s)
- Tahmina Najafova
- Department of Medical Biochemistry, Faculty of Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey.
| | - Gulsah Dagdeviren
- Department of Perinatology, University of Health Sciences Etlik Zubeyde Hanım Women's Health Care, Training and Research Hospital, Ankara, Turkey
| | - Merve Kasikci
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Dilek Sahin
- Department of Perinatology, University of Health Sciences Etlik Zubeyde Hanım Women's Health Care, Training and Research Hospital, Ankara, Turkey
| | - Aykan Yucel
- Department of Perinatology, University of Health Sciences Etlik Zubeyde Hanım Women's Health Care, Training and Research Hospital, Ankara, Turkey
| | - Ozgur Ozyuncu
- Department of Gynaecology and Obstetrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mukaddes Gurler
- Department of Medical Biochemistry, Faculty of Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey
- Department of Medical Biochemistry and Forensic Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Arleevskaya M, Takha E, Petrov S, Kazarian G, Renaudineau Y, Brooks W, Larionova R, Korovina M, Valeeva A, Shuralev E, Mukminov M, Kravtsova O, Novikov A. Interplay of Environmental, Individual and Genetic Factors in Rheumatoid Arthritis Provocation. Int J Mol Sci 2022; 23:ijms23158140. [PMID: 35897715 PMCID: PMC9329780 DOI: 10.3390/ijms23158140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 02/05/2023] Open
Abstract
In this review, we explore systemization of knowledge about the triggering effects of non-genetic factors in pathogenic mechanisms that contribute to the development of rheumatoid arthritis (RA). Possible mechanisms involving environmental and individual factors in RA pathogenesis were analyzed, namely, infections, mental stress, sleep deprivation ecology, age, perinatal and gender factors, eating habits, obesity and smoking. The non-genetic factors modulate basic processes in the body with the impact of these factors being non-specific, but these common challenges may be decisive for advancement of the disease in the predisposed body at risk for RA. The provocation of this particular disease is associated with the presence of congenital loci minoris resistentia. The more frequent non-genetic factors form tangles of interdependent relationships and, thereby, several interdependent external factors hit one vulnerable basic process at once, either provoking or reinforcing each other. Understanding the specific mechanisms by which environmental and individual factors impact an individual under RA risk in the preclinical stages can contribute to early disease diagnosis and, if the factor is modifiable, might be useful for the prevention or delay of its development.
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Affiliation(s)
- Marina Arleevskaya
- Central Research Laboratory, Kazan State Medical Academy, 420012 Kazan, Russia; (E.T.); (S.P.); (G.K.); (R.L.); (M.K.); (A.V.); (E.S.); (M.M.)
- Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia;
- Correspondence: ; Tel.: +7-89172-886-679; Fax: +7-843-238-5413
| | - Elena Takha
- Central Research Laboratory, Kazan State Medical Academy, 420012 Kazan, Russia; (E.T.); (S.P.); (G.K.); (R.L.); (M.K.); (A.V.); (E.S.); (M.M.)
| | - Sergey Petrov
- Central Research Laboratory, Kazan State Medical Academy, 420012 Kazan, Russia; (E.T.); (S.P.); (G.K.); (R.L.); (M.K.); (A.V.); (E.S.); (M.M.)
- Institute of Environmental Sciences, Kazan (Volga Region) Federal University, 420008 Kazan, Russia
| | - Gevorg Kazarian
- Central Research Laboratory, Kazan State Medical Academy, 420012 Kazan, Russia; (E.T.); (S.P.); (G.K.); (R.L.); (M.K.); (A.V.); (E.S.); (M.M.)
| | - Yves Renaudineau
- Department of Immunology, CHU Toulouse, INSERM U1291, CNRS U5051, University Toulouse IIII, 31000 Toulouse, France;
| | - Wesley Brooks
- Department of Chemistry, University of South Florida, Tampa, FL 33620, USA;
| | - Regina Larionova
- Central Research Laboratory, Kazan State Medical Academy, 420012 Kazan, Russia; (E.T.); (S.P.); (G.K.); (R.L.); (M.K.); (A.V.); (E.S.); (M.M.)
| | - Marina Korovina
- Central Research Laboratory, Kazan State Medical Academy, 420012 Kazan, Russia; (E.T.); (S.P.); (G.K.); (R.L.); (M.K.); (A.V.); (E.S.); (M.M.)
- Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia;
| | - Anna Valeeva
- Central Research Laboratory, Kazan State Medical Academy, 420012 Kazan, Russia; (E.T.); (S.P.); (G.K.); (R.L.); (M.K.); (A.V.); (E.S.); (M.M.)
| | - Eduard Shuralev
- Central Research Laboratory, Kazan State Medical Academy, 420012 Kazan, Russia; (E.T.); (S.P.); (G.K.); (R.L.); (M.K.); (A.V.); (E.S.); (M.M.)
- Institute of Environmental Sciences, Kazan (Volga Region) Federal University, 420008 Kazan, Russia
| | - Malik Mukminov
- Central Research Laboratory, Kazan State Medical Academy, 420012 Kazan, Russia; (E.T.); (S.P.); (G.K.); (R.L.); (M.K.); (A.V.); (E.S.); (M.M.)
- Institute of Environmental Sciences, Kazan (Volga Region) Federal University, 420008 Kazan, Russia
| | - Olga Kravtsova
- Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia;
| | - Andrey Novikov
- Mathematical Center, Sobolev Instiute of Mathematics, Siberian Branch of Russian Academy of Sciences, 630090 Novosibirsk, Russia;
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Gonzalez-Brown VM, Ma'ayeh M, Kniss DA, Cackovic M, Landon MB, Rood KM. Low-dose aspirin increases 15-epi-lipoxins A 4 in pregnancies at high-risk for developing preeclampsia. Pregnancy Hypertens 2021; 26:75-78. [PMID: 34563982 DOI: 10.1016/j.preghy.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 06/21/2021] [Accepted: 09/09/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND LDA triggers biosynthesis of endogenous anti-inflammatory molecules, aspirin-triggered 15-epi-lipoxin A4 (15-epi-LXA4), which may counteract inflammatory process of preeclampsia (PE), and play role in LDA's mechanism of action in PE prevention in high-risk patients. OBJECTIVE Investigate the effects of daily LDA on levels of 15-epi-LXA4 in pregnancies at high-risk for developing PE. MATERIALS AND METHODS Secondary analysis of multi-centered randomized controlled trial investigating effects of daily LDA (60 mg) in high-risk pregnancies. Maternal samples were drawn at three points: before LDA initiation (13-26 weeks' gestation), 24-28 weeks' gestation (at least two weeks after LDA) and 34-36 weeks' gestation. 15-epi-LXA4 levels were measured by ELISA. RESULTS Analysis included 82 patients: 63 receiving daily LDA and 29 receiving daily placebo starting between 13 and 25 weeks gestation. Prior to randomization, baseline 15-epi-LXA4 levels were similar between both groups (75.9 pg/mL [IQR; 63.8-114.0] vs 136.2 pg/mL [52.4-476.2]; p = 0.10). Patients receiving daily LDA were noted to have significantly increased levels of 15-epi-LXA4 after LDA administration (136.2 pg/mL [IQR; 52.4-476.2] vs 1758.2 pg/mL [905.4-6638.5]; p < 0.001). They also had higher 15-epi-LXA4 levels compared to those receiving placebo at 24-28 weeks' (50.3 [38.1-94.2] vs 1758.2 [905.4-6638.5]; p < 0.001 and 34-38 weeks' gestation (57.9 [41.9-76.7] vs 2310.3 pg/mL [656.9-10609.4]; p < 0.001). After LDA administration in the second trimester, patients who developed PE had decrease in 15-epi-LXA4 levels compared to those without PE (942 pg/mL [348.3-1810.3] vs 1758.2 pg/mL [905.4-6638.5]; p = 0.129). CONCLUSION Daily LDA administration increases 15-epi-LXA4 levels in high-risk pregnancies for PE. In LDA group, pregnancies complicated by PE have lower levels of 15-epi-LXA4 compared to pregnancies without PE.
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Affiliation(s)
- Veronica M Gonzalez-Brown
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, San Antonio Uniformed Services Health Science Consortium, Brooke Army Medical Center, Ft Sam Houston, TX, United States.
| | - Marwan Ma'ayeh
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Douglas A Kniss
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Michael Cackovic
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Mark B Landon
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Kara M Rood
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, United States
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Schoorlemmer J, Macías-Redondo S, Strunk M, Ramos-Ruíz R, Calvo P, Benito R, Paules C, Oros D. Altered DNA methylation in human placenta after (suspected) preterm labor. Epigenomics 2020; 12:1769-1782. [PMID: 33107765 DOI: 10.2217/epi-2019-0346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The aim of this study was to determine if alterations in DNA methylation in the human placenta would support suspected preterm labor as a pathologic insult associated with diminished placental health. Methods: We evaluated placental DNA methylation at seven loci differentially methylated in placental pathologies using targeted bisulfite sequencing, in placentas associated with preterm labor (term birth after suspected preterm labor [n = 15] and preterm birth [n = 15]), and controls (n = 15). Results: DNA methylation levels at the NCAM1 and PLAGL1 loci in placentas associated with preterm labor did differ significantly (p < 0.05) from controls. Discussion: Specific alterations in methylation patterns indicative of an unfavourable placental environment are associated with preterm labor per se and not restricted to preterm birth.
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Affiliation(s)
- Jon Schoorlemmer
- Instituto Aragonés de Ciencias de la Salud (IACS) & Aragon Institute for Health Research (IIS Aragón), Zaragoza, Spain.,Placental pathophysiology & fetal programming research group, B05 DGA & GIIS-028 del IISA.,ARAID Foundation, Zaragoza, Spain
| | - Sofía Macías-Redondo
- Instituto Aragonés de Ciencias de la Salud (IACS) & Aragon Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | - Mark Strunk
- Instituto Aragonés de Ciencias de la Salud (IACS), Sequencing & Functional Genomics, Aragon Biomedical Research Center (CIBA), Zaragoza, Spain
| | - Ricardo Ramos-Ruíz
- Unidad de Genómica, Fundación Parque Científico de Madrid, Madrid, Spain
| | - Pilar Calvo
- Placental pathophysiology & fetal programming research group, B05 DGA & GIIS-028 del IISA.,Aragon Institute for Health Research (IIS Aragón), Obstetrics Department, Hospital Clínico Universitario Zaragoza, Spain
| | - Rafael Benito
- Aragon Institute for Health Research (IIS Aragón), Microbiology Department, Hospital Clínico Universitario Zaragoza, Spain
| | - Cristina Paules
- Placental pathophysiology & fetal programming research group, B05 DGA & GIIS-028 del IISA.,Aragon Institute for Health Research (IIS Aragón), Obstetrics Department, Hospital Clínico Universitario Zaragoza, Spain
| | - Daniel Oros
- Placental pathophysiology & fetal programming research group, B05 DGA & GIIS-028 del IISA.,Aragon Institute for Health Research (IIS Aragón), Obstetrics Department, Hospital Clínico Universitario Zaragoza, Spain.,Red de Salud Materno Infantil y del Desarrollo (SAMID), RETICS, Instituto de Salud Carlos III (ISCIII), Subdirección General de Evaluación y Fomento de la Investigación, Fondo Europeo de Desarrollo Regional (FEDER), Spain
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Hu H, Jiang J, Chen Q, Wei S, Liu M, Chen X, Fan C, Ma J, Chen W, Wang X, Zhong M. Cyclophilin A inhibits trophoblast migration and invasion in vitro and vivo through p38/ERK/JNK pathways and causes features of preeclampsia in mice. Life Sci 2020; 261:118351. [PMID: 32858039 DOI: 10.1016/j.lfs.2020.118351] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/15/2020] [Accepted: 08/20/2020] [Indexed: 11/15/2022]
Abstract
AIMS Numerous studies suggest that excessive maternal inflammation and defective extravillous trophoblast (EVT) invasion could contribute to the development of preeclampsia (PE), but the underlying mechanism remains unclear. Some evidence suggests that CyPA is elevated in PE. This research aims to investigate the effect of recombinant human CyPA on trophoblast migration and invasion both in vitro and in vivo. MATERIALS AND METHODS We detected the expression and localization of CyPA in human placenta and explored the effects of CyPA on cell migration and invasion on HTR8/SVneo cell. Additionally, the expression levels of matrix metalloproteinase (MMP)-2/9 and molecules in the p38/ERK/JNK signaling pathway were detected. We established a mouse model by injecting pregnant mice with recombinant human CyPA and measured blood pressure, albumin/creatinine ratio, fetal and placenta weight of mice. Moreover, we examined the placental histology and MMP-2/9 and p38/ERK/JNK expression. KEY FINDINGS Our results showed that CyPA inhibited the migration and invasion of HTR8/SVneo cells in a dose-dependent manner, decreasing the expression of matrix metalloproteinase (MMP)-2/9 and molecules in the p38/ERK/JNK signaling pathway. Silencing CyPA could reverse the above effects. Moreover, CyPA could induce PE-like features in pregnant mice and disrupt the structure of the mouse placenta by reducing the junctional zone area. CyPA attenuated the trophoblast invasiveness in mice placenta by downregulating MMP-2/9 expression and p38/ERK/JNK pathway activity. SIGNIFICANCE We proposed that CyPA could inhibit trophoblast migration and invasion both in vitro and in vivo, which was involved in PE development.
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Affiliation(s)
- Haoyue Hu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jiayi Jiang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qian Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Songren Wei
- Department of Neuropharmacology and Drug Discovery, School of Pharmaceutical Sciences, Southern Medical University, China
| | - Mian Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xia Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Cuixia Fan
- Institute of Neuroscience and Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jing Ma
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wenqian Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xuefei Wang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Mei Zhong
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Mauro AK, Berdahl DM, Khurshid N, Clemente L, Ampey AC, Shah DM, Bird IM, Boeldt DS. Conjugated linoleic acid improves endothelial Ca2+ signaling by blocking growth factor and cytokine-mediated Cx43 phosphorylation. Mol Cell Endocrinol 2020; 510:110814. [PMID: 32259635 PMCID: PMC7253345 DOI: 10.1016/j.mce.2020.110814] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/13/2020] [Accepted: 03/31/2020] [Indexed: 12/21/2022]
Abstract
Sustained Ca2+ burst signaling is crucial for endothelial vasodilator production and is disrupted by growth factors and cytokines. Conjugated linoleic acid (CLA), a Src inhibitor in certain preparations, is generally regarded as safe during pregnancy by the FDA. Multiple CLA preparations; t10, c12 or c9, t11 CLA, or a 1:1 mixture of the two were administered before growth factor or cytokine treatment. Growth factors and cytokines caused a significant decrease in Ca2+ burst numbers in response to ATP stimulation. Both t10, c12 CLA and the 1:1 mixture rescued VEGF165 or TNFα inhibited Ca2+ bursts and correlated with Src-specific phosphorylation of connexin 43. VEGF165, TNFα, and IL-6 in combination at physiologic concentrations revealed IL-6 amplified the inhibitory effects of lower dose of VEGF165 and TNFα. Again, the 1:1 CLA mixture was most effective at rescue of function. Therefore, CLA formulations may be a promising treatment for endothelial dysfunction in diseases such as preeclampsia.
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Affiliation(s)
- Amanda K Mauro
- Perinatal Research Laboratories, Department of Obstetrics & Gynecology, University of Wisconsin - Madison, School Medicine and Public Health, Madison, WI, 53715, USA
| | - Danielle M Berdahl
- Perinatal Research Laboratories, Department of Obstetrics & Gynecology, University of Wisconsin - Madison, School Medicine and Public Health, Madison, WI, 53715, USA; Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of Wisconsin - Madison, School Medicine and Public Health, Madison, WI, 53715, USA
| | - Nauman Khurshid
- Perinatal Research Laboratories, Department of Obstetrics & Gynecology, University of Wisconsin - Madison, School Medicine and Public Health, Madison, WI, 53715, USA; Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of Wisconsin - Madison, School Medicine and Public Health, Madison, WI, 53715, USA
| | - Luca Clemente
- Perinatal Research Laboratories, Department of Obstetrics & Gynecology, University of Wisconsin - Madison, School Medicine and Public Health, Madison, WI, 53715, USA
| | - Amanda C Ampey
- Perinatal Research Laboratories, Department of Obstetrics & Gynecology, University of Wisconsin - Madison, School Medicine and Public Health, Madison, WI, 53715, USA
| | - Dinesh M Shah
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of Wisconsin - Madison, School Medicine and Public Health, Madison, WI, 53715, USA
| | - Ian M Bird
- Perinatal Research Laboratories, Department of Obstetrics & Gynecology, University of Wisconsin - Madison, School Medicine and Public Health, Madison, WI, 53715, USA; Department of Pediatrics, University of Wisconsin - Madison, School Medicine and Public Health, Madison, WI, 53715, USA
| | - Derek S Boeldt
- Perinatal Research Laboratories, Department of Obstetrics & Gynecology, University of Wisconsin - Madison, School Medicine and Public Health, Madison, WI, 53715, USA.
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Alterations of Several Serum Parameters Are Associated with Preeclampsia and May Be Potential Markers for the Assessment of PE Severity. DISEASE MARKERS 2020; 2020:7815214. [PMID: 32025276 PMCID: PMC6983284 DOI: 10.1155/2020/7815214] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/21/2019] [Accepted: 12/31/2019] [Indexed: 12/29/2022]
Abstract
The precise pathophysiological mechanisms of preeclampsia (PE) and preventative strategies remain unknown. Laboratory markers which can help in identifying PE patients from pregnant women and assessing the severity of PE during pregnancy are worthy to be explored. In this study, a retrospective case-control study was designed to assess whether the serum levels of albumin (ALB), total protein (TP), prealbumin (PA), alkaline phosphatase (ALP), lactic dehydrogenase (LDH), D-dimer, fibrinogen (Fbg), platelet (PLT) count, mean platelet volume (MPV), and platelet distribution width (PDW) can help in assessing PE and evaluate its severity. 256 pregnant women were enrolled and classified into 3 groups: mild preeclampsia (mPE, n = 85), severe preeclampsia (sPE, n = 78), and healthy normotensive controls (control, n = 93). Our result showed that the serum levels of ALP, LDH, and D-dimer were significantly higher in mild or severe PE patients compared with the healthy controls (66 (52.5-76.5) vs. 168 (141.5-201.25) vs. 182.5 (120-191.5), 152 (139.75-166.25) vs. 183.5 (163.25-307) vs. 282 (215.25-306), 1.05 (0.65-1.57) vs. 3.05 (2.25-4.08) vs. 5.65 (2.29-7.71)), while ALB, TP, and PA are lower (38 (37-42) vs. 31.5 (25.5-34.5) vs. 28.5 (24-33), 65 (63-68.25) vs. 56.5 (52-61) vs. 51.5 (49-58), 219.14 ± 68.25 vs. 167.88 ± 52.21 vs. 143.22 ± 50.46). On the other hand, compared with the mPE group, the sPE group showed significantly lower PLT count but higher level of LDH, D-dimer, and Fbg. No significant differences in MPV or PDW were found between any of the two groups. In conclusion, the above markers except for the MPV and PDW may be correlated with PE severity in this patient cohort, indicating possible values of these potential biomarkers in auxiliary diagnosis and severity assessment of PE.
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11
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Wang J, Zhu QW, Cheng XY, Liu JY, Zhang LL, Tao YM, Cui YB, Wei Y. Assessment efficacy of neutrophil-lymphocyte ratio and monocyte-lymphocyte ratio in preeclampsia. J Reprod Immunol 2019; 132:29-34. [PMID: 30861482 DOI: 10.1016/j.jri.2019.02.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 01/29/2019] [Accepted: 02/04/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Abnormal changes in immune-mediated inflammation contribute to the pathogenesis of preeclampsia (PE). We aim to investigate the value of systemic immune inflammation indices-neutrophil-lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR)-to identify and evaluate the prognosis of patients with PE. METHODS This study reviewed clinical records of 367 PE patients (162 with mild PE and 205 with severe PE), in addition to a control group of 172 normal pregnancies. Blood cell counts were performed at the first diagnosis of PE, and NLR and MLR were calculated by absolute cell count. RESULTS Absolute neutrophil, lymphocyte, and monocyte counts and NLR and MLR values in PE were significantly different from controls, although monocyte counts did not significantly differ between mild and severe PE. Receiver operating characteristics curve (ROC) analysis showed NLR and MLR had better diagnostic accuracy in distinguishing PE from controls [NLR area under the curve (AUC) = 0.70; MLR AUC = 0.78]. Further, NLR was the best predictor of disease severity (AUC = 0.71). Cutoff values of NLR > 4.198 or MLR > 0.325 for control and PE groups or a cutoff value of NLR > 4.182 for PE groups indicated that patients were more likely to encounter preterm delivery, have shorter admission-to-delivery interval, and develop maternal and neonatal complications. CONCLUSION Secondary analyses of white blood cell differential count parameters effectively evaluate the systemic inflammatory/immune state. Compared with absolute cell counts, NLR and MLR offer more effective indicators of clinical assessment, disease severity evaluation, and prognosis evaluation of PE.
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Affiliation(s)
- Jing Wang
- Department of Clinical Laboratory, Nantong Women and Children Health Care Hospital, Nantong, Jiangsu, China
| | - Qing-Wen Zhu
- Department of Clinical Laboratory, Nantong Women and Children Health Care Hospital, Nantong, Jiangsu, China
| | - Xiao-Yan Cheng
- Department of Obstetrics, Nantong Women and Children Health Care Hospital, Nantong, Jiangsu, China
| | - Jiang-Yue Liu
- Department of Clinical Laboratory, Nantong Women and Children Health Care Hospital, Nantong, Jiangsu, China
| | - Lin-Li Zhang
- Department of Clinical Laboratory, Nantong Women and Children Health Care Hospital, Nantong, Jiangsu, China
| | - Yu-Mei Tao
- Department of Pathology, Nantong Women and Children Health Care Hospital, Nantong, Jiangsu, China
| | - Yu-Bao Cui
- Department of Clinical Laboratory, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China.
| | - Ye Wei
- Department of Clinical Laboratory, Nantong Women and Children Health Care Hospital, Nantong, Jiangsu, China.
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12
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Second trimester inflammatory and metabolic markers in women delivering preterm with and without preeclampsia. J Perinatol 2019; 39:314-320. [PMID: 30518800 PMCID: PMC6760589 DOI: 10.1038/s41372-018-0275-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/28/2018] [Accepted: 10/18/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Inflammatory and metabolic pathways are implicated in preterm birth and preeclampsia. However, studies rarely compare second trimester inflammatory and metabolic markers between women who deliver preterm with and without preeclampsia. STUDY DESIGN A sample of 129 women (43 with preeclampsia) with preterm delivery was obtained from an existing population-based birth cohort. Banked second trimester serum samples were assayed for 267 inflammatory and metabolic markers. Backwards-stepwise logistic regression models were used to calculate odds ratios. RESULTS Higher 5-α-pregnan-3β,20α-diol disulfate, and lower 1-linoleoylglycerophosphoethanolamine and octadecanedioate, predicted increased odds of preeclampsia. CONCLUSIONS Among women with preterm births, those who developed preeclampsia differed with respect metabolic markers. These findings point to potential etiologic underpinnings for preeclampsia as a precursor to preterm birth.
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13
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Wang Z, Wang P, Wang Z, Qin Z, Xiu X, Xu D, Zhang X, Wang Y. MiRNA-548c-5p downregulates inflammatory response in preeclampsia via targeting PTPRO. J Cell Physiol 2018; 234:11149-11155. [PMID: 30443949 DOI: 10.1002/jcp.27758] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 10/30/2018] [Indexed: 12/12/2022]
Abstract
Preeclampsia is a serious complication of pregnancy and leads to maternal hypertension and proteinuria. It remains a major health problem for mothers and babies across the world due to high maternal and fetal morbidity and mortality. Accumulated data have implicated the critical role of microRNA in preeclampsia. However, to date, the role of miR-548c-5p in preeclampsia remains vaguely understood. In this study, we first elucidate the role of miR-548c-5p and its underlying molecular mechanism in preeclampsia. Compared with healthy controls, miR-548c-5p was obviously downregulated in serum exosomes and placental mononuclear cells in patients with preeclampsia. Nonetheless, PTPRO was significantly upregulated and negatively associated with miR-548c-5p in placental mononuclear cells in patients with preeclampsia. PTPRO was a target of miR-548c-5p. PTPRO was downregulated in the miR-548c-5p-overexpressed macrophages. In addition, miR-548c-5p could inhibit the proliferation and activation of LPS-stimulated macrophages, as evidenced by decreased levels of inflammatory cytokines (IL-12 and TNF-α) and less nuclear translocation of pNF-κB in pTHP1 cells. MiR-548c-5p acts as an anti-inflammatory factor in preeclampsia. The axis of miR-548c-5p/PTPRO/NF-κB may provide novel targets for the diagnosis and treatment of preeclampsia.
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Affiliation(s)
- Zengfang Wang
- Department of Gynecology and Obstetrics, Weifang Hospital of Maternal and Child Health, Weifang, China
| | - Pingping Wang
- Department of Gynecology and Obstetrics, Weifang Hospital of Maternal and Child Health, Weifang, China
| | - Zengyan Wang
- Department of Surgery, Zhucheng People's Hospital, Zhucheng, China
| | - Zhihao Qin
- Clinical laboratory, Zhucheng Chinese Medicine Hospital, Zhucheng, China
| | - Xia Xiu
- Department of Gynecology and Obstetrics, Weifang Hospital of Maternal and Child Health, Weifang, China
| | - Donghua Xu
- Department of Rheumatology and Immunology, the Affiliated Hospital of Weifang Medical University, Weifang, China
| | | | - Yingliang Wang
- Department of Rheumatology and Immunology, the Affiliated Hospital of Weifang Medical University, Weifang, China
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14
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Afkham A, Eghbal-Fard S, Heydarlou H, Azizi R, Aghebati-Maleki L, Yousefi M. Toll-like receptors signaling network in pre-eclampsia: An updated review. J Cell Physiol 2018; 234:2229-2240. [PMID: 30221394 DOI: 10.1002/jcp.27189] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 07/17/2018] [Indexed: 01/07/2023]
Abstract
Toll-like receptors (TLRs) are innate immune cells receptors. They are expressed on leukocytes, epithelial cells, and more particularly on placental immune cells and chorion trophoblast. Upregulation of innate immune response occurs during normal pregnancy, but its excessive activity is involved in the pathology of pregnancy complications including pregnancy-induced hypertension and pre-eclampsia (PE). The recent studies about the overmuch inflammatory responses and aberrant placentation are associated with increased expression of TLRs in PE patients. This review has tried to focus on the relationship between some activities of TLRs and the risk of preeclampsia development.
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Affiliation(s)
- Amir Afkham
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shadi Eghbal-Fard
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hanieh Heydarlou
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ramyar Azizi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mehdi Yousefi
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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15
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Jiang K, Wong L, Chen Y, Xing X, Li D, Wang T, Jarvis JN. Soluble inflammatory mediators induce transcriptional re-organization that is independent of dna methylation changes in cultured human chorionic villous trophoblasts. J Reprod Immunol 2018; 128:2-8. [PMID: 29800761 PMCID: PMC6086739 DOI: 10.1016/j.jri.2018.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 04/27/2018] [Accepted: 05/10/2018] [Indexed: 11/23/2022]
Abstract
The studies proposed here were undertaken to test the hypothesis that, under specific circumstances (e.g., a strong enough inflammatory stimulus), genes that are repressed at the maternal-fetal interface via DNA methylation might be de-methylated, allowing either a maternal immune response to the semi-allogenic fetus or the onset of early labor. Chorionic trophoblasts (CT) were isolated from fetal membranes, followed by incubation with medium from LPS-activated PBMC or resting PBMC medium for 2 h. RNA and DNA were isolated from the cells for RNA-seq and DNA methylation studies. Two hrs after being exposed to conditioned medium from LPS-activated PBMC, CT showed differential expression of 114 genes, all but 2 of which showed higher expression in the stimulated cells than is the unstimulated cells. We also identified 318 differentially methylated regions (DMRs) that associated with 306 genes (155 protein coding genes) in the two groups, but the observed methylation changes had negligible impact on the observed transcriptional changes in CT. CT display complex patterns of transcription in response to inflammation. DNA methylation does not appear to be an important regulator of the observed transcriptional changes.
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Affiliation(s)
- Kaiyu Jiang
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Laiping Wong
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Yanmin Chen
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Xiaoyun Xing
- Department of Genetics, Center for Genome Sciences and Systems Biology, Washington University School of Medicine, 4515 McKinley Ave, St. Louis, MO, 63108, USA
| | - Daofeng Li
- Department of Genetics, Center for Genome Sciences and Systems Biology, Washington University School of Medicine, 4515 McKinley Ave, St. Louis, MO, 63108, USA
| | - Ting Wang
- Department of Genetics, Center for Genome Sciences and Systems Biology, Washington University School of Medicine, 4515 McKinley Ave, St. Louis, MO, 63108, USA
| | - James N Jarvis
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA; Genetics, Genomics, & Bioinformatics Program, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
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16
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Kenny LC, Kell DB. Immunological Tolerance, Pregnancy, and Preeclampsia: The Roles of Semen Microbes and the Father. Front Med (Lausanne) 2018; 4:239. [PMID: 29354635 PMCID: PMC5758600 DOI: 10.3389/fmed.2017.00239] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 12/12/2017] [Indexed: 12/18/2022] Open
Abstract
Although it is widely considered, in many cases, to involve two separable stages (poor placentation followed by oxidative stress/inflammation), the precise originating causes of preeclampsia (PE) remain elusive. We have previously brought together some of the considerable evidence that a (dormant) microbial component is commonly a significant part of its etiology. However, apart from recognizing, consistent with this view, that the many inflammatory markers of PE are also increased in infection, we had little to say about immunity, whether innate or adaptive. In addition, we focused on the gut, oral and female urinary tract microbiomes as the main sources of the infection. We here marshall further evidence for an infectious component in PE, focusing on the immunological tolerance characteristic of pregnancy, and the well-established fact that increased exposure to the father's semen assists this immunological tolerance. As well as these benefits, however, semen is not sterile, microbial tolerance mechanisms may exist, and we also review the evidence that semen may be responsible for inoculating the developing conceptus (and maybe the placenta) with microbes, not all of which are benign. It is suggested that when they are not, this may be a significant cause of PE. A variety of epidemiological and other evidence is entirely consistent with this, not least correlations between semen infection, infertility and PE. Our view also leads to a series of other, testable predictions. Overall, we argue for a significant paternal role in the development of PE through microbial infection of the mother via insemination.
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Affiliation(s)
- Louise C. Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- Department of Obstetrics and Gynecology, University College Cork, Cork, Ireland
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Douglas B. Kell
- School of Chemistry, The University of Manchester, Manchester, United Kingdom
- The Manchester Institute of Biotechnology, The University of Manchester, Manchester, United Kingdom
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17
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Olatunji LA, Usman TO, Akinade AI, Adeyanju OA, Kim I, Soladoye AO. Low-dose spironolactone ameliorates insulin resistance and suppresses elevated plasminogen activator inhibitor-1 during gestational testosterone exposure. Arch Physiol Biochem 2017; 123:286-292. [PMID: 28480754 DOI: 10.1080/13813455.2017.1320681] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
CONTEXT Elevated gestational circulating testosterone has been associated with pathological pregnancies that increase the risk of development of cardiometabolic disorder in later life. OBJECTIVE We hypothesised that gestational testosterone exposure, in late pregnancy, causes glucose deregulation and atherogenic dyslipidaemia that would be accompanied by high plasminogen activator inhibitor-1 (PAI-1). The study also hypothesise that low-dose spironolactone treatment would ameliorate these effects. METHODS Pregnant Wistar rats received vehicle, testosterone (0.5 mg/kg; sc), spironolactone (0.5 mg/kg, po) or testosterone and spironolactone daily between gestational days 15 and 19. RESULTS Gestational testosterone exposure led to increased HOMA-IR, circulating insulin, testosterone, 1-h post-load glucose, atherogenic dyslipidaemia, PLR, PAI-1 and MDA. However, all these effects, except that of circulating testosterone, were ameliorated by spironolactone. CONCLUSIONS These results demonstrate that low-dose spironolactone ameliorates glucose deregulation and atherogenic dyslipidaemia during elevated gestational testosterone exposure, at least in part, by suppressing elevated PAI-1.
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Affiliation(s)
- Lawrence A Olatunji
- a Department of Physiology, Cardiovascular Research Laboratory , College of Health Sciences, University of Ilorin , Ilorin , Nigeria
| | - Taofeek O Usman
- a Department of Physiology, Cardiovascular Research Laboratory , College of Health Sciences, University of Ilorin , Ilorin , Nigeria
- b Department of Physiology, Cardiovascular Unit, College of Health sciences , Osun State University , Osogbo , Nigeria
| | - Aminat I Akinade
- a Department of Physiology, Cardiovascular Research Laboratory , College of Health Sciences, University of Ilorin , Ilorin , Nigeria
| | - Oluwaseun A Adeyanju
- a Department of Physiology, Cardiovascular Research Laboratory , College of Health Sciences, University of Ilorin , Ilorin , Nigeria
| | - InKyeom Kim
- c Department of Pharmacology, Cardiovascular Research Institute , Kyungpook National University School of Medicine , Daegu , Republic of Korea
| | - Ayodele O Soladoye
- a Department of Physiology, Cardiovascular Research Laboratory , College of Health Sciences, University of Ilorin , Ilorin , Nigeria
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18
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Sang C, Wang S, Zhang Z, Lu J. Characteristics and outcome of severe preeclampsia/eclampsia concurrent with or complicated by acute pancreatitis: a report of five cases and literature review. J Matern Fetal Neonatal Med 2017; 32:633-640. [PMID: 29041829 DOI: 10.1080/14767058.2017.1387894] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective of this study is to determine the rate of acute pancreatitis in preeclampsia/eclampsia patients and describe the clinical manifestations, treatment characteristics and outcome of five cases of severe preeclampsia concurrent with or complicated by acute pancreatitis. METHODS The clinical data of pregnant women with preexisting or gestational hypertension who sought medical care between January 2002 and December 2015 at the Pregnant Women Critical Care Unit of Chaoyang Hospital, Capital Medical University, Beijing, China were retrieved. The rate of acute pancreatitis in preeclampsia/eclampsia patients was calculated and patients with preeclampsia/eclampsia and acute pancreatitis were included for further analysis. RESULTS Totally 1703 pregnant women who received medical care at our institution during the review period were diagnosed with hypertension. Four hundred and seven (23.9%) of them had severe preeclampsia. Five (1.2%, 5/407) women with severe preeclampsia developed acute pancreatitis. Their median age was 32 (range 25-35) years and the median duration of gestation was 32 (range 28-40) weeks. Mild acute pancreatitis occurred in three cases, and moderately severe and severe acute pancreatitis in one case each. Four patients underwent cesarean resection and one patient underwent vaginal delivery. Conservative therapy was undertaken. No patient received surgical intervention and cure was achieved in all patients. CONCLUSION Acute pancreatitis may complicate severe preeclampsia/eclampsia or may be concurrent with severe preeclampsia/eclampsia, complicating and compromising the management of preeclampsia/eclampsia. Physicians should be alert for the presence of acute pancreatitis as prompt diagnosis and treatment, rapid termination of pregnancy and subsequent conservative management of pancreatitis could lead to a general favorable outcome.
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Affiliation(s)
- Cuiqin Sang
- a Department of Obstetrics and Gynecology , Chaoyang Hospital affiliated Capital Medical University, Chaoyang District Critical and Intensive Care Center for Pregnant Women, and Beijing Municipal Critical and Intensive Care Center for Pregnant Women , Beijing , China
| | - Shuzhen Wang
- a Department of Obstetrics and Gynecology , Chaoyang Hospital affiliated Capital Medical University, Chaoyang District Critical and Intensive Care Center for Pregnant Women, and Beijing Municipal Critical and Intensive Care Center for Pregnant Women , Beijing , China
| | - Zhenyu Zhang
- a Department of Obstetrics and Gynecology , Chaoyang Hospital affiliated Capital Medical University, Chaoyang District Critical and Intensive Care Center for Pregnant Women, and Beijing Municipal Critical and Intensive Care Center for Pregnant Women , Beijing , China
| | - Junli Lu
- a Department of Obstetrics and Gynecology , Chaoyang Hospital affiliated Capital Medical University, Chaoyang District Critical and Intensive Care Center for Pregnant Women, and Beijing Municipal Critical and Intensive Care Center for Pregnant Women , Beijing , China
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19
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El-Chennawi F, Rageh IM, Mansour AI, Darwish MI, Elghzaly AA, Sakr BES, Elbaz KM. Comparison of the percentages of CD4+
CD25high
FOXP3+
, CD4+
CD25low
FOXP3+
, and CD4+
FOXP3+
Tregs, in the umbilical cord blood of babies born to mothers with and without preeclampsia. Am J Reprod Immunol 2017; 78. [DOI: 10.1111/aji.12761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 08/21/2017] [Indexed: 01/03/2023] Open
Affiliation(s)
- Farha El-Chennawi
- Clinical and Chemical Pathology Department; Faculty of Medicine; Mansoura University; Mansoura Egypt
| | - Ibrahim Mohamed Rageh
- Clinical and Chemical Pathology Department; Faculty of Medicine; Benha University; Benha Egypt
| | - Amira Ibrahim Mansour
- Clinical and Chemical Pathology Department; Faculty of Medicine; Benha University; Benha Egypt
| | - Mohammed Ibrahim Darwish
- Clinical and Chemical Pathology Department; Faculty of Medicine; Mansoura University; Mansoura Egypt
| | - Ashraf Antar Elghzaly
- Clinical and Chemical Pathology Department; Faculty of Medicine; Mansoura University; Mansoura Egypt
| | - Basma El Sayed Sakr
- Gynecology and Obstetrics Department; Faculty of Medicine; Benha University; Benha Egypt
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20
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Graham C, Chooniedass R, Stefura WP, Becker AB, Sears MR, Turvey SE, Mandhane PJ, Subbarao P, HayGlass KT. In vivo immune signatures of healthy human pregnancy: Inherently inflammatory or anti-inflammatory? PLoS One 2017; 12:e0177813. [PMID: 28636613 PMCID: PMC5479559 DOI: 10.1371/journal.pone.0177813] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 05/03/2017] [Indexed: 12/20/2022] Open
Abstract
Changes in maternal innate immunity during healthy human pregnancy are not well understood. Whether basal immune status in vivo is largely unaffected by pregnancy, is constitutively biased towards an inflammatory phenotype (transiently enhancing host defense) or exhibits anti-inflammatory bias (reducing potential responsiveness to the fetus) is unclear. Here, in a longitudinal study of healthy women who gave birth to healthy infants following uncomplicated pregnancies within the Canadian Healthy Infant Longitudinal Development (CHILD) cohort, we test the hypothesis that a progressively altered bias in resting innate immune status develops. Women were examined during pregnancy and again, one and/or three years postpartum. Most pro-inflammatory cytokine expression, including CCL2, CXCL10, IL-18 and TNFα, was reduced in vivo during pregnancy (20-57%, p<0.0001). Anti-inflammatory biomarkers (sTNF-RI, sTNF-RII, and IL-1Ra) were elevated by ~50-100% (p<0.0001). Systemic IL-10 levels were unaltered during vs. post-pregnancy. Kinetic studies demonstrate that while decreased pro-inflammatory biomarker expression (CCL2, CXCL10, IL-18, and TNFα) was constant, anti-inflammatory expression increased progressively with increasing gestational age (p<0.0001). We conclude that healthy resting maternal immune status is characterized by an increasingly pronounced bias towards a systemic anti-inflammatory innate phenotype during the last two trimesters of pregnancy. This is resolved by one year postpartum in the absence of repeat pregnancy. The findings provide enhanced understanding of immunological changes that occur in vivo during healthy human pregnancy.
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Affiliation(s)
- Caroline Graham
- Department of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rishma Chooniedass
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - William P. Stefura
- Department of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Allan B. Becker
- Department of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Malcolm R. Sears
- Department of Medicine, de Groote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Stuart E. Turvey
- Department of Pediatrics, Child & Family Research Institute and BC Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Piush J. Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - CHILD Study Investigators
- CHILD (Canadian Healthy Infant Longitudinal Development Study) Investigators, McMaster University, Hamilton, Canada
| | - Kent T. HayGlass
- Department of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
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21
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Dong X, Shi D. Simvastatin Alleviates Pathology in a Rat Model of Preeclampsia Involving ERK/MAPK Pathway. Reprod Sci 2016; 24:1053-1061. [PMID: 27856999 DOI: 10.1177/1933719116678693] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Preeclampsia (PE) is a pregnancy-specific condition characterized by new-onset hypertension. There is evidence suggesting that imbalances of angiogenic factors, oxidative stress, and inflammation may be central to the pathogenesis of PE. We sought to investigate whether simvastatin would reduce mean arterial pressure, restore the angiogenic balance, and ameliorate inflammation and oxidative stress in a nitric oxide synthase inhibitor NG-nitro-l-arginine methyl ester (l-NAME)-induced rat model of PE. We found that blood pressure was significantly increased in the l-NAME group compared to normal pregnant dams ( P < .01), and simvastatin reduced this difference. In addition, dams from the l-NAME group showed lower vascular endothelial growth factor (VEGF) and interleukin (IL) 10 levels and higher plasma-soluble FMS-like tyrosine kinase 1 (sFlt-1), tumor necrosis factor α (TNF-α), and oxidative stress marker malondialdehyde (MDA) levels as compared to control dams ( P < .01, for all). Interestingly, simvastatin treatment significantly increased VEGF and IL-10 levels while decreased sFlt-1, TNF-α, and MDA levels compared to the untreated l-NAME group. Moreover, simvastatin treatment significantly upregulated protein expression of placental p-extracellular signal-regulated kinase (ERK1), p-p38 mitogen-activated protein kinase (MAPK), p-c-Jun N-terminal kinase, and p-protein kinase B compared to untreated l-NAME control. These results suggest that simvastatin treatment restores angiogenic balance and ameliorates inflammation and oxidative stress in a rat model of PE involving ERK/MAPK pathway.
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Affiliation(s)
- Xiujuan Dong
- 1 Department of Obstetrics, Cangzhou City Central Hospital, Cangzhou, China
| | - Dandan Shi
- 1 Department of Obstetrics, Cangzhou City Central Hospital, Cangzhou, China
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22
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Abstract
OBJECTIVES Preeclampsia is a serious pregnancy-specific hypertensive syndrome that is characterized by widespread maternal endothelial dysfunction. Previous studies have shown that increased levels of circulating cell-free fetal DNA in women with preeclampsia correspond to the degree of disease severity; however, it is unknown whether this DNA is a key signal that contributes to the development of preeclampsia. The detection of DNA is critical to appropriate innate immune responses. The interferon-inducible protein 16 (IFI16) - a member of the HIN-200 family - is an innate immune receptor for intracellular DNA, which is implicated in the control of cell growth, apoptosis, angiogenesis, and immunomodulation; however, its role in preeclampsia remains unresolved. Here, we tested the hypothesis that this DNA can activate IFI16 in the placentas of women with preeclampsia and is sufficient to induce soluble fms-like tyrosine kinase 1 (sFlt-1) and soluble endoglin (sEng) production. METHODS We characterized IFI16 in severe preeclamptic placentas and assessed whether DNA increased the release of sFlt-1 and sEng from trophoblast cells and placental explants. Furthermore, we determined whether IFI16 was involved in DNA-induced sFlt-1 and sEng production. RESULTS Placental immunoreactivity and protein levels of IFI16 were significantly increased in women with preeclampsia compared to matched control women. Treatment of human trophoblasts with the IFI16 agonist poly(dA:dT) significantly increased IFI16 levels. Furthermore, poly(dA:dT) induced sFlt-1 and sEng production by human trophoblasts in an IFI16-dependent manner. CONCLUSIONS We conclude that trophoblast cells respond to cell-free fetal DNA through the IFI16 receptor, resulting in the production of the preeclampsia-related antiangiogenic factors sFlt-1 and sEng.
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Mihu D, Razvan C, Malutan A, Mihaela C. Evaluation of maternal systemic inflammatory response in preeclampsia. Taiwan J Obstet Gynecol 2016; 54:160-6. [PMID: 25951721 DOI: 10.1016/j.tjog.2014.03.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the systemic inflammatory response in preeclampsia compared to normal pregnancy. MATERIALS AND METHODS The following serum parameters were determined in three groups of patients: leukocytes, neutrophils, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), and certain markers of oxidative stress. Fetal status was assessed based on the gestational age at which birth occurred, on the Apgar score, and on fetal weight. RESULTS In preeclampsia, a higher systemic inflammatory status was found compared to normal pregnancy. Gestational age at birth, fetal weight, and Apgar score were significantly lower in the group with preeclampsia compared to normal pregnancy. CONCLUSION In preeclampsia, there is an increased systemic inflammatory response compared to normal pregnancy, which can influence fetal status at birth.
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Affiliation(s)
- Dan Mihu
- 2nd Department of Obstetrics and Gynecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012, Cluj-Napoca, Romania
| | - Ciortea Razvan
- 2nd Department of Obstetrics and Gynecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012, Cluj-Napoca, Romania
| | - Andrei Malutan
- 2nd Department of Obstetrics and Gynecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012, Cluj-Napoca, Romania.
| | - Carmen Mihaela
- Department of Histology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012, Cluj-Napoca, Romania
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24
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Elliot MG, Crespi BJ. Genetic recapitulation of human pre-eclampsia risk during convergent evolution of reduced placental invasiveness in eutherian mammals. Philos Trans R Soc Lond B Biol Sci 2016; 370:20140069. [PMID: 25602073 DOI: 10.1098/rstb.2014.0069] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The relationship between phenotypic variation arising through individual development and phenotypic variation arising through diversification of species has long been a central question in evolutionary biology. Among humans, reduced placental invasion into endometrial tissues is associated with diseases of pregnancy, especially pre-eclampsia, and reduced placental invasiveness has also evolved, convergently, in at least 10 lineages of eutherian mammals. We tested the hypothesis that a common genetic basis underlies both reduced placental invasion arising through a developmental process in human placental disease and reduced placental invasion found as a derived trait in the diversification of Euarchontoglires (rodents, lagomorphs, tree shrews, colugos and primates). Based on whole-genome analyses across 18 taxa, we identified 1254 genes as having evolved adaptively across all three lineages exhibiting independent evolutionary transitions towards reduced placental invasion. These genes showed strong evidence of enrichment for associations with pre-eclampsia, based on genetic-association studies, gene-expression analyses and gene ontology. We further used in silico prediction to identify a subset of 199 genes that are likely targets of natural selection during transitions in placental invasiveness and which are predicted to also underlie human placental disorders. Our results indicate that abnormal ontogenies can recapitulate major phylogenetic shifts in mammalian evolution, identify new candidate genes for involvement in pre-eclampsia, imply that study of species with less-invasive placentation will provide useful insights into the regulation of placental invasion and pre-eclampsia, and recommend a novel comparative functional-evolutionary approach to the study of genetically based human disease and mammalian diversification.
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Affiliation(s)
| | - Bernard J Crespi
- Human Evolutionary Studies Program and Department of Biological Sciences, Simon Fraser University, Burnaby, British Columbia, Canada V5A 1S6
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25
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van Rijn BB, Bruinse HW, Veerbeek JH, Post Uiterweer ED, Koenen SV, van der Bom JG, Rijkers GT, Roest M, Franx A. Postpartum Circulating Markers of Inflammation and the Systemic Acute-Phase Response After Early-Onset Preeclampsia. Hypertension 2015; 67:404-14. [PMID: 26711734 DOI: 10.1161/hypertensionaha.115.06455] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 11/30/2015] [Indexed: 01/18/2023]
Abstract
Preeclampsia is an inflammatory-mediated hypertensive disorder of pregnancy and seems to be an early indicator of increased cardiovascular risk, but mechanisms underlying this association are unclear. In this study, we identified levels of circulating inflammatory markers and dynamic changes in the systemic acute-phase response in 44 women with a history of severe early-onset preeclampsia, compared with 29 controls with only uneventful pregnancies at 1.5 to 3.5 years postpartum. Models used were in vivo seasonal influenza vaccination and in vitro whole-blood culture with T-cell stimulants and the toll-like receptor-4 ligand lipopolysaccharide. Outcome measures were C-reactive protein, interleukin-6 (IL-6), IL-18, fibrinogen, myeloperoxidase, and a panel of 13 cytokines representative of the innate and adaptive inflammatory response, in addition to established cardiovascular markers. The in vivo acute-phase response was higher for women with previous preeclampsia than that for controls without such a history, although only significant for C-reactive protein (P=0.04). Preeclampsia was associated with higher IL-1β (P<0.05) and IL-8 (P<0.01) responses to T-cell activation. Hierarchical clustering revealed 2 distinct inflammatory clusters associated with previous preeclampsia: an adaptive response cluster associated with increased C-reactive protein and IL-6 before and after vaccination, increased weight, and low high-density lipoprotein cholesterol; and a toll-like receptor-4 mediated the cluster associated with increased IL-18 before and after vaccination but not associated with other cardiovascular markers. Furthermore, we found interactions between previous preeclampsia, common TLR4 gene variants, and the IL-18 response to vaccination. In conclusion, preeclampsia is associated with alterations in the inflammatory response postpartum mostly independent of other established cardiovascular risk markers.
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Affiliation(s)
- Bas B van Rijn
- From the Division of Woman and Baby (B.B.v.R., H.W.B., J.H.V., E.D.P.U., S.V.K., A.F.) and Laboratory for Clinical Chemistry and Hematology, University Medical Center Utrecht (M.R.), Utrecht, The Netherlands; Centre for Trophoblast Disease, University of Cambridge, Cambridge, United Kingdom (J.H.V.); Department of Clinical Epidemiology and Hematology, Leiden University Medical Center, Leiden, The Netherlands (J.G.v.d.B.); Department of Medical Microbiology, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (G.T.R.); Department of Science, University College Roosevelt, Middelburg, The Netherlands (G.T.R.); and Academic Unit of Human Development and Health, University of Southampton, Southampton, United Kingdom (B.B.v.R.).
| | - Hein W Bruinse
- From the Division of Woman and Baby (B.B.v.R., H.W.B., J.H.V., E.D.P.U., S.V.K., A.F.) and Laboratory for Clinical Chemistry and Hematology, University Medical Center Utrecht (M.R.), Utrecht, The Netherlands; Centre for Trophoblast Disease, University of Cambridge, Cambridge, United Kingdom (J.H.V.); Department of Clinical Epidemiology and Hematology, Leiden University Medical Center, Leiden, The Netherlands (J.G.v.d.B.); Department of Medical Microbiology, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (G.T.R.); Department of Science, University College Roosevelt, Middelburg, The Netherlands (G.T.R.); and Academic Unit of Human Development and Health, University of Southampton, Southampton, United Kingdom (B.B.v.R.)
| | - Jan H Veerbeek
- From the Division of Woman and Baby (B.B.v.R., H.W.B., J.H.V., E.D.P.U., S.V.K., A.F.) and Laboratory for Clinical Chemistry and Hematology, University Medical Center Utrecht (M.R.), Utrecht, The Netherlands; Centre for Trophoblast Disease, University of Cambridge, Cambridge, United Kingdom (J.H.V.); Department of Clinical Epidemiology and Hematology, Leiden University Medical Center, Leiden, The Netherlands (J.G.v.d.B.); Department of Medical Microbiology, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (G.T.R.); Department of Science, University College Roosevelt, Middelburg, The Netherlands (G.T.R.); and Academic Unit of Human Development and Health, University of Southampton, Southampton, United Kingdom (B.B.v.R.)
| | - Emiel D Post Uiterweer
- From the Division of Woman and Baby (B.B.v.R., H.W.B., J.H.V., E.D.P.U., S.V.K., A.F.) and Laboratory for Clinical Chemistry and Hematology, University Medical Center Utrecht (M.R.), Utrecht, The Netherlands; Centre for Trophoblast Disease, University of Cambridge, Cambridge, United Kingdom (J.H.V.); Department of Clinical Epidemiology and Hematology, Leiden University Medical Center, Leiden, The Netherlands (J.G.v.d.B.); Department of Medical Microbiology, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (G.T.R.); Department of Science, University College Roosevelt, Middelburg, The Netherlands (G.T.R.); and Academic Unit of Human Development and Health, University of Southampton, Southampton, United Kingdom (B.B.v.R.)
| | - Steven V Koenen
- From the Division of Woman and Baby (B.B.v.R., H.W.B., J.H.V., E.D.P.U., S.V.K., A.F.) and Laboratory for Clinical Chemistry and Hematology, University Medical Center Utrecht (M.R.), Utrecht, The Netherlands; Centre for Trophoblast Disease, University of Cambridge, Cambridge, United Kingdom (J.H.V.); Department of Clinical Epidemiology and Hematology, Leiden University Medical Center, Leiden, The Netherlands (J.G.v.d.B.); Department of Medical Microbiology, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (G.T.R.); Department of Science, University College Roosevelt, Middelburg, The Netherlands (G.T.R.); and Academic Unit of Human Development and Health, University of Southampton, Southampton, United Kingdom (B.B.v.R.)
| | - Johanna G van der Bom
- From the Division of Woman and Baby (B.B.v.R., H.W.B., J.H.V., E.D.P.U., S.V.K., A.F.) and Laboratory for Clinical Chemistry and Hematology, University Medical Center Utrecht (M.R.), Utrecht, The Netherlands; Centre for Trophoblast Disease, University of Cambridge, Cambridge, United Kingdom (J.H.V.); Department of Clinical Epidemiology and Hematology, Leiden University Medical Center, Leiden, The Netherlands (J.G.v.d.B.); Department of Medical Microbiology, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (G.T.R.); Department of Science, University College Roosevelt, Middelburg, The Netherlands (G.T.R.); and Academic Unit of Human Development and Health, University of Southampton, Southampton, United Kingdom (B.B.v.R.)
| | - Ger T Rijkers
- From the Division of Woman and Baby (B.B.v.R., H.W.B., J.H.V., E.D.P.U., S.V.K., A.F.) and Laboratory for Clinical Chemistry and Hematology, University Medical Center Utrecht (M.R.), Utrecht, The Netherlands; Centre for Trophoblast Disease, University of Cambridge, Cambridge, United Kingdom (J.H.V.); Department of Clinical Epidemiology and Hematology, Leiden University Medical Center, Leiden, The Netherlands (J.G.v.d.B.); Department of Medical Microbiology, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (G.T.R.); Department of Science, University College Roosevelt, Middelburg, The Netherlands (G.T.R.); and Academic Unit of Human Development and Health, University of Southampton, Southampton, United Kingdom (B.B.v.R.)
| | - Mark Roest
- From the Division of Woman and Baby (B.B.v.R., H.W.B., J.H.V., E.D.P.U., S.V.K., A.F.) and Laboratory for Clinical Chemistry and Hematology, University Medical Center Utrecht (M.R.), Utrecht, The Netherlands; Centre for Trophoblast Disease, University of Cambridge, Cambridge, United Kingdom (J.H.V.); Department of Clinical Epidemiology and Hematology, Leiden University Medical Center, Leiden, The Netherlands (J.G.v.d.B.); Department of Medical Microbiology, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (G.T.R.); Department of Science, University College Roosevelt, Middelburg, The Netherlands (G.T.R.); and Academic Unit of Human Development and Health, University of Southampton, Southampton, United Kingdom (B.B.v.R.)
| | - Arie Franx
- From the Division of Woman and Baby (B.B.v.R., H.W.B., J.H.V., E.D.P.U., S.V.K., A.F.) and Laboratory for Clinical Chemistry and Hematology, University Medical Center Utrecht (M.R.), Utrecht, The Netherlands; Centre for Trophoblast Disease, University of Cambridge, Cambridge, United Kingdom (J.H.V.); Department of Clinical Epidemiology and Hematology, Leiden University Medical Center, Leiden, The Netherlands (J.G.v.d.B.); Department of Medical Microbiology, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (G.T.R.); Department of Science, University College Roosevelt, Middelburg, The Netherlands (G.T.R.); and Academic Unit of Human Development and Health, University of Southampton, Southampton, United Kingdom (B.B.v.R.)
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Rahimzadeh M, Norouzian M, Arabpour F, Naderi N. Regulatory T-cells and preeclampsia: an overview of literature. Expert Rev Clin Immunol 2015; 12:209-27. [PMID: 26580672 DOI: 10.1586/1744666x.2016.1105740] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Regulatory T-cells (Tregs) are key players in successful pregnancy and their deficiencies are implicated in pregnancy complications such as preeclampsia (PE), but the results are inconsistent among studies. This study aims to compile an overview of the studies about the associations of Tregs and PE risk and to provide recommendations for future research. A sensitive search of three databases including PubMed, Scopus and Google scholar (from 1995 to January 9, 2015) identified 636 unique titles. An accurate process of study selection, data extraction and method qualification were independently conducted by authors on retrieved papers. Seventeen papers met the inclusion criteria and were included in quality assessment. Regarding the source of Tregs, 14 studies assessed Tregs in peripheral blood, 2 studies in peripheral blood and decidua and one study in peripheral blood and umbilical cord blood. Despite variation in the combinations of markers and other aspects of the studies designs, remarkable constancy in the results of studies that measured Tregs as CD4+FoxP3+ or CD4+CD25+FoxP3+ cells (but not CD4+CD25(high/low)FoxP3+ markers) was found, which in broad terms showed a shift towards fewer Treg cells in PE. This review revealed an association between lower percentage of circulating CD4+FoxP3+ or CD4+CD25+FoxP3+ Tregs and the risk of PE. Given the above issue and regarding the high consistency of studies on reduction of suppressive activity of Tregs in PE, we have proposed a model in which the Tregs deficiency is a reflection of immune endocrine imbalance, which reverses maternal tolerance and results in development of preeclampsia.
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Affiliation(s)
- Mahsa Rahimzadeh
- a Department of Biochemistry, Faculty of Medicine , Hormozgan University of Medical Sciences , Bandar Abbas, Iran.,c Molecular Medicine Research Center , Hormozgan University of Medical Sciences , Bandar Abbas , Iran
| | - Marzieh Norouzian
- b Department of Immunology, Faculty of Medicine , Hormozgan University of Medical Sciences , Bandar Abbas , Iran
| | - Fahimeh Arabpour
- b Department of Immunology, Faculty of Medicine , Hormozgan University of Medical Sciences , Bandar Abbas , Iran
| | - Nadereh Naderi
- b Department of Immunology, Faculty of Medicine , Hormozgan University of Medical Sciences , Bandar Abbas , Iran.,c Molecular Medicine Research Center , Hormozgan University of Medical Sciences , Bandar Abbas , Iran
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27
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Koster MPH, de Wilde MA, Veltman-Verhulst SM, Houben ML, Nikkels PGJ, van Rijn BB, Fauser BCJM. Placental characteristics in women with polycystic ovary syndrome. Hum Reprod 2015; 30:2829-37. [PMID: 26498178 DOI: 10.1093/humrep/dev265] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 09/21/2015] [Indexed: 01/14/2023] Open
Abstract
STUDY QUESTION Are macroscopic and microscopic placental characteristics in a heterogeneous group of women diagnosed with polycystic ovary syndrome (PCOS) different from those of a low-risk general population? SUMMARY ANSWER Women with PCOS have significantly different microscopic placental characteristics compared with control women, independently from pregnancy complications. WHAT IS KNOWN ALREADY Non-obese women with PCOS who conceived spontaneously have a significantly reduced placental volume and weight, with more chronic villitis and intervillositis compared with healthy controls. STUDY DESIGN, SIZE, DURATION A subset of a large prospective cohort study of pregnant women with PCOS was used. Healthy (low-risk) women who delivered at term after an uncomplicated pregnancy were used as the reference population. The placentas of 73 women with PCOS were analysed and compared with 209 placentas of healthy women. PARTICIPANTS/MATERIALS, SETTING, METHODS Placentas were collected after delivery from women with PCOS who were followed from prior to conception until delivery. The placentas were macroscopically and microscopically analysed and compared with placentas of healthy women with either a spontaneous start of labour who delivered at term or who had an elective Caesarean section. MAIN RESULTS AND THE ROLE OF CHANCE After adjusting for potential confounders, placentas from women with PCOS showed more chorioamnionitis (P < 0.001), funisitis (P = 0.019), villitis (P = 0.045), thrombosis (P = 0.018), infarction (P = 0.010), villous immaturity (P = 0.009) and nucleated fetal red blood cells (P < 0.001). In a subgroup analysis, among women with and without pregnancy complications within the PCOS group, only the occurrence of thrombosis was increased in pregnancies complicated by pregnancy-induced hypertension or pre-eclampsia (30%, versus 0% in gestational diabetes pregnancies and 13% in uncomplicated pregnancies; P = 0.008). LIMITATIONS, REASONS FOR CAUTION There might be a small proportion of women with PCOS in the reference group, since this group was not screened for PCOS. As a result, the observed difference may be an underestimation of the true difference. Placentas were stored for up to 72 h at 4°C, this is common practice but some degenerative changes cannot be ruled out absolutely. Also, there is possibility that baseline differences between the groups may in part explain some of the differences in placental pathology. WIDER IMPLICATIONS OF THE FINDINGS Our findings suggest that, in general, women with PCOS can have placental alterations associated with an increased hypoxic state, which seems not to be caused by the increased incidence of pregnancy complications.
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Affiliation(s)
- Maria P H Koster
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands Department of Obstetrics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marlieke A de Wilde
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Susanne M Veltman-Verhulst
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Michiel L Houben
- Department of Paediatrics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Peter G J Nikkels
- Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Bas B van Rijn
- Department of Obstetrics, University Medical Centre Utrecht, Utrecht, The Netherlands Academic Unit of Human Development and Health, University of Southampton, Princess Anne Hospital, MP 815, Southampton SO16 5YA, UK
| | - Bart C J M Fauser
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
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First-Trimester Serum Acylcarnitine Levels to Predict Preeclampsia: A Metabolomics Approach. DISEASE MARKERS 2015; 2015:857108. [PMID: 26146448 PMCID: PMC4471382 DOI: 10.1155/2015/857108] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 05/27/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To expand the search for preeclampsia (PE) metabolomics biomarkers through the analysis of acylcarnitines in first-trimester maternal serum. METHODS This was a nested case-control study using serum from pregnant women, drawn between 8 and 14 weeks of gestational age. Metabolites were measured using an UPLC-MS/MS based method. Concentrations were compared between controls (n = 500) and early-onset- (EO-) PE (n = 68) or late-onset- (LO-) PE (n = 99) women. Metabolites with a false discovery rate <10% for both EO-PE and LO-PE were selected and added to prediction models based on maternal characteristics (MC), mean arterial pressure (MAP), and previously established biomarkers (PAPPA, PLGF, and taurine). RESULTS Twelve metabolites were significantly different between EO-PE women and controls, with effect levels between -18% and 29%. For LO-PE, 11 metabolites were significantly different with effect sizes between -8% and 24%. Nine metabolites were significantly different for both comparisons. The best prediction model for EO-PE consisted of MC, MAP, PAPPA, PLGF, taurine, and stearoylcarnitine (AUC = 0.784). The best prediction model for LO-PE consisted of MC, MAP, PAPPA, PLGF, and stearoylcarnitine (AUC = 0.700). CONCLUSION This study identified stearoylcarnitine as a novel metabolomics biomarker for EO-PE and LO-PE. Nevertheless, metabolomics-based assays for predicting PE are not yet suitable for clinical implementation.
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Veerbeek JHW, Nikkels PGJ, Torrance HL, Gravesteijn J, Post Uiterweer ED, Derks JB, Koenen SV, Visser GHA, Van Rijn BB, Franx A. Placental pathology in early intrauterine growth restriction associated with maternal hypertension. Placenta 2014; 35:696-701. [PMID: 25052232 DOI: 10.1016/j.placenta.2014.06.375] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 06/25/2014] [Accepted: 06/30/2014] [Indexed: 11/18/2022]
Abstract
INTRODUCTION To identify key pathological characteristics of placentas from pregnancies complicated by early intrauterine growth restriction, and to examine their relations with maternal hypertensive disease and umbilical artery Doppler waveform abnormalities. METHODS Single-center retrospective cohort study of singleton pregnancies with abnormal umbilical artery Doppler flow patterns resulting in a live birth <34 weeks of a baby with a weight <10th percentile for gestational age. Umbilical artery end diastolic flow was classified as being either present or absent/reversed (AREDF). Data were stratified into intrauterine growth restriction with or without hypertensive disease and pathological characteristics were compared between these various conditions according to predefined scoring criteria. RESULTS Among 164 placentas studied, we found high rates of characteristic histopathological features that were associated with intrauterine growth restriction, including infarction (>5% in 42%), chronic villitis (21%), chronic chorioamnionitis (36%), membrane necrosis (20%), elevated nucleated red blood cells (89%), increased syncytial knotting (93%), increased villous maturation (98%), fetal thrombosis (32%) and distal villous hypoplasia (35%). Chronic inflammation of fetal membranes and syncytial knotting were more common in women with concomitant hypertensive disease as compared to women with normotensive IUGR (p < 0.05). Placentas from women with umbilical artery AREDF were more likely to show increased numbers of nucleated red blood cells and distal villous hypoplasia (p < 0.05). DISCUSSION Placentas of women with early IUGR show high rates of several histological aberrations. Further, concomitant maternal hypertension is associated with characteristic inflammatory changes and umbilical artery AREDF with signs of chronic hypoxia.
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Affiliation(s)
- J H W Veerbeek
- University Medical Center Utrecht, Division of Perinatology, Department of Obstetrics, The Netherlands.
| | - P G J Nikkels
- University Medical Center Utrecht, Division of Perinatology, Department of Obstetrics, The Netherlands; University Medical Center Utrecht, Department of Pathology, The Netherlands
| | - H L Torrance
- University Medical Center Utrecht, Division of Perinatology, Department of Obstetrics, The Netherlands
| | - J Gravesteijn
- University Medical Center Utrecht, Division of Perinatology, Department of Obstetrics, The Netherlands
| | - E D Post Uiterweer
- University Medical Center Utrecht, Division of Perinatology, Department of Obstetrics, The Netherlands
| | - J B Derks
- University Medical Center Utrecht, Division of Perinatology, Department of Obstetrics, The Netherlands
| | - S V Koenen
- University Medical Center Utrecht, Division of Perinatology, Department of Obstetrics, The Netherlands
| | - G H A Visser
- University Medical Center Utrecht, Division of Perinatology, Department of Obstetrics, The Netherlands
| | - B B Van Rijn
- University of Southampton, Academic Unit of Human Development and Health, Southampton, United Kingdom
| | - A Franx
- University Medical Center Utrecht, Division of Perinatology, Department of Obstetrics, The Netherlands
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Kuc S, Koster MPH, Pennings JLA, Hankemeier T, Berger R, Harms AC, Dane AD, Schielen PCJI, Visser GHA, Vreeken RJ. Metabolomics profiling for identification of novel potential markers in early prediction of preeclampsia. PLoS One 2014; 9:e98540. [PMID: 24873829 PMCID: PMC4038585 DOI: 10.1371/journal.pone.0098540] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 05/05/2014] [Indexed: 01/15/2023] Open
Abstract
Objective The first aim was to investigate specific signature patterns of metabolites that are significantly altered in first-trimester serum of women who subsequently developed preeclampsia (PE) compared to healthy pregnancies. The second aim of this study was to examine the predictive performance of the selected metabolites for both early onset [EO-PE] and late onset PE [LO-PE]. Methods This was a case-control study of maternal serum samples collected between 8+0 and 13+6 weeks of gestation from 167 women who subsequently developed EO-PE n = 68; LO-PE n = 99 and 500 controls with uncomplicated pregnancies. Metabolomics profiling analysis was performed using two methods. One has been optimized to target eicosanoids/oxylipins, which are known inflammation markers and the other targets compounds containing a primary or secondary biogenic amine group. Logistic regression analyses were performed to predict the development of PE using metabolites alone and in combination with first trimester mean arterial pressure (MAP) measurements. Results Two metabolites were significantly different between EO-PE and controls (taurine and asparagine) and one in case of LO-PE (glycylglycine). Taurine appeared the most discriminative biomarker and in combination with MAP predicted EO-PE with a detection rate (DR) of 55%, at a false-positive rate (FPR) of 10%. Conclusion Our findings suggest a potential role of taurine in both PE pathophysiology and first trimester screening for EO-PE.
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Affiliation(s)
- Sylwia Kuc
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht (UMCU), Utrecht, the Netherlands
- * E-mail:
| | - Maria P. H. Koster
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht (UMCU), Utrecht, the Netherlands
| | - Jeroen L. A. Pennings
- Laboratory for Health Protection Research (GBO), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Thomas Hankemeier
- Leiden Academic Center for Drug Research, Division of Analytical Biosciences, Leiden University, Leiden, The Netherlands
- The Netherlands Metabolomics Centre, Leiden University, Leiden, the Netherlands
| | - Ruud Berger
- Leiden Academic Center for Drug Research, Division of Analytical Biosciences, Leiden University, Leiden, The Netherlands
- The Netherlands Metabolomics Centre, Leiden University, Leiden, the Netherlands
| | - Amy C. Harms
- The Netherlands Metabolomics Centre, Leiden University, Leiden, the Netherlands
| | - Adrie D. Dane
- The Netherlands Metabolomics Centre, Leiden University, Leiden, the Netherlands
| | - Peter C. J. I. Schielen
- Laboratory for Infectious Diseases and Perinatal Screening (LIS), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Gerard H. A. Visser
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht (UMCU), Utrecht, the Netherlands
| | - Rob J. Vreeken
- Leiden Academic Center for Drug Research, Division of Analytical Biosciences, Leiden University, Leiden, The Netherlands
- The Netherlands Metabolomics Centre, Leiden University, Leiden, the Netherlands
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Schminkey DL, Groer M. Imitating a stress response: a new hypothesis about the innate immune system's role in pregnancy. Med Hypotheses 2014; 82:721-9. [PMID: 24698849 DOI: 10.1016/j.mehy.2014.03.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 03/08/2014] [Indexed: 11/24/2022]
Abstract
Recent research challenges long-held hypotheses about mechanisms through which pregnancy induces maternal immune suppression or tolerance of the embryo/fetus. It is now understood that normal pregnancy engages the immune system and that the immune milieu changes with advancing gestation. We suggest that pregnancy mimics the innate immune system's response to stress, causing a sterile inflammatory response that is necessary for successful reproduction. The relationship between external stressors and immunomodulation in pregnancy has been acknowledged, but the specific mechanisms are still being explicated. Implantation and the first trimester are times of immune activation and intensive inflammation in the uterine environment. A period of immune quiescence during the second trimester allows for the growth and development of the maturing fetus. Labor is also an inflammatory event. The length of gestation and timing of parturition can be influenced by environmental stressors. These stressors affect pregnancy through neuroendocrine interaction with the immune system, specifically through the hypothalamic-pituitary-adrenal (HPA) axis and the hypothalamic-pituitary-ovarian axis. Trophoblastic cells that constitute the maternal-fetal interface appear to harness the maternal immune system to promote and maximize the reproductive success of the mother and fetus. Pregnancy is a time of upregulated innate immune responses and decreased adaptive, cell-mediated responses. The inflammatory processes of pregnancy resemble an immune response to brief naturalistic stressors: there is a shift from T helper (Th) 1 to T helper (Th) 2 dominant adaptive immunity with a concomitant shift in cytokine production, decreased proliferation of T cells, and decreased cytotoxicity of natural killer (NK) cells. Inclusion of both murine and human studies, allows an exploration of insights into how trophoblasts influence the activity of the maternal innate immune system during gestation.
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Xu L, Lee M, Jeyabalan A, Roberts JM. The relationship of hypovitaminosis D and IL-6 in preeclampsia. Am J Obstet Gynecol 2014; 210:149.e1-7. [PMID: 24080305 DOI: 10.1016/j.ajog.2013.09.037] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/30/2013] [Accepted: 09/25/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Vitamin D deficiency has been linked to the pathogenesis of preeclampsia. Given the demonstrated antiinflammatory function of vitamin D in multiple organ systems including trophoblast cells and placenta, we hypothesized that vitamin D deficiency contributes to the development of preeclampsia through increased inflammation, as indicated by elevated interleukin (IL)-6 concentrations. STUDY DESIGN Plasma samples from a large preeclampsia cohort study were examined in 100 preeclamptic and 100 normotensive pregnant women. Comparisons of vitamin D and IL-6 concentrations used Student t test and χ(2) test or their nonparametric counterparts. A logistic regression model assessed the association among vitamin D, IL-6 concentrations, and preeclampsia risk. RESULTS The mean concentration of 25-hydroxyvitamin D was 49.4 ± 22.6 nmol/L in normotensives and 42.3 ± 17.3 nmol/L in preeclamptic women (P = .01). The median (interquartile range: Q1, Q3) concentrations of IL-6 were 2.0 (1.3, 3.4) pg/mL and 4.4 (2.2, 10.0) pg/mL in the control and preeclampsia groups, respectively (P < .01). We observed a significant association between IL-6 elevation and preeclampsia (odds ratio, 4.4; 95% confidence interval, 1.8-10.8; P < .01) and between vitamin D deficiency and preeclampsia (odds ratio, 4.2; 95% confidence interval, 1.4-12.8; P = .04). However, there was no association between vitamin D deficiency and IL-6 elevation. CONCLUSION Third-trimester IL-6 elevation and vitamin D deficiency were independently associated with the risk of preeclampsia. We found no evidence to support the hypothesis that vitamin D deficiency alters the pathogenesis of preeclampsia by activation of inflammation as assessed by IL-6 concentration.
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Affiliation(s)
- Lai Xu
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Minjae Lee
- Biostatistics/Epidemiology/Research Design Core, Center for Clinical and Translational Sciences, University of Texas Health Science Center, Houston, TX
| | - Arun Jeyabalan
- Magee-Womens Research Institute and Foundation, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - James M Roberts
- Magee-Womens Research Institute and Foundation, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA; Clinical and Translational Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA.
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Pinheiro MB, Carvalho MG, Martins-Filho OA, Freitas LG, Godoi LC, Alpoim PN, Gomes KB, Dusse LM. Severe preeclampsia: Are hemostatic and inflammatory parameters associated? Clin Chim Acta 2014; 427:65-70. [DOI: 10.1016/j.cca.2013.09.050] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 09/27/2013] [Accepted: 09/30/2013] [Indexed: 11/15/2022]
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Siljee JE, Wortelboer EJ, Koster MPH, Imholz S, Rodenburg W, Visser GHA, de Vries A, Schielen PCJI, Pennings JLA. Identification of interleukin-1 beta, but no other inflammatory proteins, as an early onset pre-eclampsia biomarker in first trimester serum by bead-based multiplexed immunoassays. Prenat Diagn 2013; 33:1183-8. [PMID: 23943085 DOI: 10.1002/pd.4219] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 07/25/2013] [Accepted: 08/10/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study aimed to determine the predictive value of growth factors, cardiovascular, and immunological markers for first trimester identification of early onset pre-eclampsia (PE). METHODS In a retrospective case-control study, maternal serum samples of 35 early onset PE cases and 35 controls were analysed by multiplexed immunoassays, to determine serum concentrations of 41 proteins whose functionality can be associated with PE pathogenesis. All levels were converted into multiples of the gestation-specific normal median. For prediction modelling, proteins that were found to be significant were combined with previously obtained values of three established PE markers, that is, placental growth factor, placental protein 13, and pregnancy-associated plasma protein A. Prediction modelling was used to determine predicted detection rates for 5% and 10% false-positive rates. RESULTS Three of the proteins examined in this study, interleukin-1 beta (IL-1β), fibrinogen, and carcinoembryonic antigen, showed significantly different serum levels at p < 0.05. In prediction modelling, only IL-1β added predictive value to the three previously established biomarkers, by increasing detection from 38.2% to 44.1% at a 5% false-positive rate. CONCLUSIONS This study indicates that IL-1β has potential to improve first trimester prediction of pre-eclampsia. Studies on larger cohorts will be needed to validate these findings.
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Affiliation(s)
- Jacqueline E Siljee
- Centre for Infectious Disease Research, Diagnostics and Screening (IDS), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Best LG, Saxena R, Anderson CM, Barnes MR, Hakonarson H, Falcon G, Martin C, Castillo BA, Karumanchi A, Keplin K, Pearson N, Lamb F, Bercier S, Keating BJ. Two variants of the C-reactive protein gene are associated with risk of pre-eclampsia in an American Indian population. PLoS One 2013; 8:e71231. [PMID: 23940726 PMCID: PMC3733916 DOI: 10.1371/journal.pone.0071231] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 06/27/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The etiology of pre-eclampsia (PE) is unknown; but it is accepted that normal pregnancy represents a distinctive challenge to the maternal immune system. C-reactive protein is a prominent component of the innate immune system; and we previously reported an association between PE and the CRP polymorphism, rs1205. Our aim was to explore the effects of additional CRP variants. The IBC (Cardiochip) genotyping microarray focuses on candidate genes and pathways related to the pathophysiology of cardiovascular disease. METHODS This study recruited 140 cases of PE and 270 matched controls, of which 95 cases met criteria as severe PE, from an American Indian community. IBC array genotypes from 10 suitable CRP SNPs were analyzed. A replication sample of 178 cases and 427 controls of European ancestry was also genotyped. RESULTS A nominally significant difference (p value <0.05) was seen in the distribution of discordant matched pairs for rs3093068; and Bonferroni corrected differences (P<0.005) were seen for rs876538, rs2794521, and rs3091244. Univariate conditional logistic regression odds ratios (OR) were nominally significant for rs3093068 and rs876538 models only. Multivariate logistic models with adjustment for mother's age, nulliparity and BMI attenuated the effect (OR 1.58, P = 0.066, 95% CI 0.97-2.58) for rs876538 and (OR 2.59, P = 0.050, 95% CI 1.00-6.68) for rs3093068. An additive risk score of the above two risk genotypes shows a multivariate adjusted OR of 2.04 (P = 0.013, 95% CI 1.16-3.56). The replication sample also demonstrated significant association between PE and the rs876538 allele (OR = 1.55, P = 0.01, 95% CI 2.16-1.10). We also show putative functionality for the rs876538 and rs3093068 CRP variants. CONCLUSION The CRP variants, rs876538 and rs3093068, previously associated with other cardiovascular disease phenotypes, show suggestive association with PE in this American Indian population, further supporting a possible role for CRP in PE.
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Affiliation(s)
- Lyle G Best
- Science Department, Turtle Mountain Community College, Belcourt, North Dakota, United States of America.
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Kuc S, Koster MPH, Franx A, Schielen PCJI, Visser GHA. Maternal characteristics, mean arterial pressure and serum markers in early prediction of preeclampsia. PLoS One 2013; 8:e63546. [PMID: 23717445 PMCID: PMC3661579 DOI: 10.1371/journal.pone.0063546] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 04/04/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES In a previous study, we have described the predictive value of first-trimester Pregnancy-Associated Plasma Protein-A (PAPP-A), free β-subunit of human Chorionic Gonadotropin (fβ-hCG), Placental Growth Factor (PlGF) and A Disintegrin And Metalloprotease 12 (ADAM12) for early onset preeclampsia (EO-PE; delivery <34 weeks). The objective of the current study was to obtain the predictive value of these serum makers combined with maternal characteristics and first-trimester maternal mean arterial blood pressure (MAP) in a large series of patients, for both EO-PE and late onset PE (LO-PE; delivery ≥ 34 weeks). METHODS This was a nested case-control study, using stored first-trimester maternal serum from women who developed EO-PE (n = 68) or LO-PE (n = 99), and 500 uncomplicated singleton pregnancies. Maternal characteristics, MAP, and pregnancy outcome were collected for each individual woman and used to calculate prior risks for PE in a multiple logistic regression model. Models containing prior PE risks, serum markers, and MAP were developed for the prediction of EO-PE and LO-PE. The model-predicted detection rates (DR) for fixed 10% false-positive rates were calculated for EO-PE and LO-PE with or without the presence of a small-for-gestational age infant (SGA, birth weight <10(th) centile). RESULTS The best prediction model included maternal characteristics, MAP, PAPP-A, ADAM12, and PlGF, with DR of 72% for EO-PE and 49% for LO-PE. Prediction for PE with concomitant SGA was better than for PE alone (92% for EO-PE and 57% for LO-PE). CONCLUSION First-trimester MAP, PAPP-A, ADAM12, and PlGF combined with maternal characteristics and MAP are promising markers in the risk assessment of PE, especially for EO-PE complicated by SGA.
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Affiliation(s)
- Sylwia Kuc
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
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van Rijn BB, Nijdam ME, Bruinse HW, Roest M, Uiterwaal CS, Grobbee DE, Bots ML, Franx A. Cardiovascular Disease Risk Factors in Women With a History of Early-Onset Preeclampsia. Obstet Gynecol 2013; 121:1040-1048. [DOI: 10.1097/aog.0b013e31828ea3b5] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Lee SM, Romero R, Lee YJ, Park IS, Park CW, Yoon BH. Systemic inflammatory stimulation by microparticles derived from hypoxic trophoblast as a model for inflammatory response in preeclampsia. Am J Obstet Gynecol 2012; 207:337.e1-8. [PMID: 23021701 DOI: 10.1016/j.ajog.2012.06.047] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 05/03/2012] [Accepted: 06/25/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether trophoblast-derived microparticles can induce different inflammatory responses of the peripheral blood mononuclear cells depending upon the state of trophoblast when the microparticles are generated. STUDY DESIGN A trophoblast-derived cell line (ATCC no. CRL-1584) was cultured under normal or hypoxic conditions. Microparticles were isolated from the cell culture supernatants (microparticles from normal trophoblast; microparticles from hypoxic trophoblast). Peripheral blood mononuclear cells were cultured alone or cocultured with either microparticles from normal trophoblast or microparticles from hypoxic trophoblast. RESULTS After 48 hours, the peripheral blood mononuclear cells cocultured with microparticles from normal trophoblast released higher concentrations of interleukin-6 than peripheral blood mononuclear cells cultured alone. The peripheral blood mononuclear cells cocultured with microparticles from hypoxic trophoblast showed higher concentration of interleukin-6 and tumor necrosis factor alpha than peripheral blood mononuclear cells cocultured with microparticles from normal trophoblast, after 24 hours and 48 hours. CONCLUSION More intense and rapid inflammatory response of peripheral blood mononuclear cells was observed with microparticles from hypoxic trophoblast than with microparticles from normal trophoblast. This difference might explain the exaggerated systemic inflammatory response as a result of placental hypoxia in preeclampsia.
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Affiliation(s)
- Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Chatterjee P, Weaver LE, Doersch KM, Kopriva SE, Chiasson VL, Allen SJ, Narayanan AM, Young KJ, Jones KA, Kuehl TJ, Mitchell BM. Placental Toll-like receptor 3 and Toll-like receptor 7/8 activation contributes to preeclampsia in humans and mice. PLoS One 2012; 7:e41884. [PMID: 22848646 PMCID: PMC3407075 DOI: 10.1371/journal.pone.0041884] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 06/29/2012] [Indexed: 12/22/2022] Open
Abstract
Preeclampsia (PE) is a pregnancy-specific hypertensive syndrome characterized by excessive maternal immune system activation, inflammation, and endothelial dysfunction. Toll-like receptor (TLR) 3 activation by double-stranded RNA (dsRNA) and TLR7/8 activation by single-stranded RNA (ssRNA) expressed by viruses and/or released from necrotic cells initiates a pro-inflammatory immune response; however it is unknown whether viral/endogenous RNA is a key initiating signal that contributes to the development of PE. We hypothesized that TLR3/7/8 activation will be evident in placentas of women with PE, and sufficient to induce PE-like symptoms in mice. Placental immunoreactivity and mRNA levels of TLR3, TLR7, and TLR8 were increased significantly in women with PE compared to normotensive women. Treatment of human trophoblasts with the TLR3 agonist polyinosine-polycytidylic acid (poly I:C), the TLR7-specific agonist imiquimod (R-837), or the TLR7/8 agonist CLO97 significantly increased TLR3/7/8 levels. Treatment of mice with poly I:C, R-837, or CLO97 caused pregnancy-dependent hypertension, endothelial dysfunction, splenomegaly, and placental inflammation. These data demonstrate that RNA-mediated activation of TLR3 and TLR7/8 plays a key role in the development of PE.
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Affiliation(s)
- Piyali Chatterjee
- Department of Internal Medicine, Texas A&M Health Science Center/Scott and White Memorial Hospital, Temple, Texas, United States of America
| | - Laura E. Weaver
- Department of Internal Medicine, Texas A&M Health Science Center/Scott and White Memorial Hospital, Temple, Texas, United States of America
| | - Karen M. Doersch
- Department of Internal Medicine, Texas A&M Health Science Center/Scott and White Memorial Hospital, Temple, Texas, United States of America
| | - Shelley E. Kopriva
- Department of Internal Medicine, Texas A&M Health Science Center/Scott and White Memorial Hospital, Temple, Texas, United States of America
| | - Valorie L. Chiasson
- Department of Internal Medicine, Texas A&M Health Science Center/Scott and White Memorial Hospital, Temple, Texas, United States of America
| | - Samantha J. Allen
- Department of Internal Medicine, Texas A&M Health Science Center/Scott and White Memorial Hospital, Temple, Texas, United States of America
| | - Ajay M. Narayanan
- Department of Internal Medicine, Texas A&M Health Science Center/Scott and White Memorial Hospital, Temple, Texas, United States of America
| | - Kristina J. Young
- Department of Internal Medicine, Texas A&M Health Science Center/Scott and White Memorial Hospital, Temple, Texas, United States of America
| | - Kathleen A. Jones
- Department of Pathology, Texas A&M Health Science Center/Scott and White Memorial Hospital, Temple, Texas, United States of America
| | - Thomas J. Kuehl
- Department of Obstetrics and Gynecology, Texas A&M Health Science Center/Scott and White Memorial Hospital, Temple, Texas, United States of America
| | - Brett M. Mitchell
- Department of Internal Medicine, Texas A&M Health Science Center/Scott and White Memorial Hospital, Temple, Texas, United States of America
- * E-mail:
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Evaluation of 7 serum biomarkers and uterine artery Doppler ultrasound for first-trimester prediction of preeclampsia: a systematic review. Obstet Gynecol Surv 2011; 66:225-39. [PMID: 21756405 DOI: 10.1097/ogx.0b013e3182227027] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Preeclampsia (PE) affects 1% to 2% of pregnant women and is a leading cause of maternal and perinatal morbidity and mortality worldwide. The clinical syndrome of PE arises in the second half of pregnancy. However, many underlying factors including defective placentation may already be apparent in the first and early second trimester in many patients. In clinical practice, there is currently no reliable screening method in the first trimester of pregnancy with sufficient accuracy to identify women at high risk to develop PE. Early identification of high-risk pregnancy may facilitate the development of new strategies for antenatal surveillance or prevention and thus improve maternal and perinatal outcome. The aim of this systematic review was to study the literature on the predictive potential of first-trimester serum markers and of uterine artery Doppler velocity waveform assessment (Ut-A Doppler). Literature on the 7 most studied serum markers (ADAM12, fβ-hCG, Inhibin A, Activin A, PP13, PlGF, and PAPP-A) and Ut-A Doppler was primarily selected. In the selected literature, a combination of these markers was analyzed, and where relevant, the value of maternal characteristics was added. Measurements of serum markers and Ut-A Doppler were performed between week 8 + 0 and 14 + 0 GA. Low levels of PP13, PlGF, and PAPP-A and elevated level of Inhibin A have been found to be significantly associated with the development of PE later in pregnancy. The detection rates of single markers, fixed at 10% false-positive rate, in the prediction of early-onset PE were relatively low, and ranged from 22% to 83%. Detection rates for combinations of multiple markers varied between 38% and 100%. Therefore, a combination of multiple markers yields high detection rates and is promising to identify patients at high risk of developing PE. However, large scale prospective studies are required to evaluate the power of this integrated approach in clinical practice. TARGET AUDIENCE Obstetricians and Gynecologists, Family physicians Learning Objectives: After completion of this article, the reader should be better able to appraise the recent literature on the development of preeclampsia in the first-trimester, evaluate the predictive value of first-trimester markers and use first-trimester markers, either individually or in combination, to assess the risk of preeclampsia.
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Chitotriosidase, interleukin-1 beta and tumor necrosis factor alpha levels in mild preeclampsia. Arch Gynecol Obstet 2011; 285:1505-11. [DOI: 10.1007/s00404-011-2157-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 11/23/2011] [Indexed: 10/14/2022]
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Pennings JLA, Kuc S, Rodenburg W, Koster MPH, Schielen PCJI, de Vries A. Integrative data mining to identify novel candidate serum biomarkers for pre-eclampsia screening. Prenat Diagn 2011; 31:1153-9. [PMID: 21948255 DOI: 10.1002/pd.2850] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 07/28/2011] [Accepted: 08/02/2011] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Pre-eclampsia (PE) is a serious complication that affects approximately 2% of pregnant women worldwide. At present, there is no sufficiently reliable test for early detection of PE in a screening setting that would allow timely intervention. To help future experimental identification of serum biomarkers for early onset PE, we applied a data mining approach to create a set of candidate biomarkers. METHODS We started from the disease etiology, which involves impaired trophoblast invasion into the spiral arteries. On the basis of this, we used a three-stage filtering strategy consisting of selection of tissue-specific genes, textmining for further gene prioritization, and identifying blood-detectable markers. RESULTS This approach resulted in 38 candidate biomarkers. These include the best three first-trimester serum biomarkers for PE found to date LGALS13 (placental protein 13, PP13), PAPPA (pregnancy-associated plasma protein-A, PAPP-A), and PGF (placental growth factor, PlGF), as well as five proteins previously identified as biomarker after the first-trimester or disease onset. This substantiates the effectiveness of our approach and provides an important indication that the list will contain several new biomarkers for PE. CONCLUSIONS We anticipate this list can serve in prioritization of future experimental studies on serum biomarkers for early onset PE.
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Affiliation(s)
- Jeroen L A Pennings
- Laboratory for Health Protection Research, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
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Chatterjee P, Chiasson VL, Kopriva SE, Young KJ, Chatterjee V, Jones KA, Mitchell BM. Interleukin 10 deficiency exacerbates toll-like receptor 3-induced preeclampsia-like symptoms in mice. Hypertension 2011; 58:489-96. [PMID: 21768525 DOI: 10.1161/hypertensionaha.111.172114] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Preeclampsia may result from overactivation of the maternal immune system and is characterized by endothelial dysfunction and excessive inflammation. Given the importance of maternal immune system regulation and anti-inflammatory cytokines in normotensive pregnancies, we hypothesized that maternal immune system activation via Toll-like receptor 3 during pregnancy would cause preeclampsia-like symptoms in mice, which would be made worse by deficiency of the anti-inflammatory cytokine interleukin 10. The Toll-like receptor 3 agonist polyinosine-polycytidylic acid (poly I:C) caused hypertension, endothelial dysfunction, and proteinuria in mice only when pregnant. In the absence of poly I:C, pregnant interleukin 10 knockout mice exhibited a significant increase in systolic blood pressure, endothelial dysfunction, and serum proinflammatory cytokines, as well as aortic and placental platelet-endothelial cell adhesion molecule expression compared with pregnant wild-type mice. Deficiency of interleukin 10 further augmented these measures in poly I:C-treated pregnant mice. In addition, sera from poly I:C-treated pregnant wild-type mice significantly decreased relaxation responses and increased platelet-endothelial cell adhesion molecule expression in isolated aortas from nonpregnant wild-type mice, and these effects were augmented by sera from poly I:C-treated interleukin 10 knockout mice. Coincubation with recombinant interleukin 10 normalized relaxation responses and platelet-endothelial cell adhesion molecule expression in all of the groups. Collectively, Toll-like receptor 3 activation during pregnancy causes preeclampsia-like symptoms, which are exacerbated by the absence of interleukin 10. Exogenous interleukin 10 treatment had beneficial effects on endothelial function and may be beneficial in women with preeclampsia.
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Affiliation(s)
- Piyali Chatterjee
- Department of Internal Medicine, Texas A&M Health Science Center/Scott & White Memorial Hospital, 702 SW HK Dodgen Loop, Temple, TX 76504, USA
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Lashley LEELO, van der Hoorn MLP, van der Mast BJ, Tilburgs T, van der Lee N, van der Keur C, van Beelen E, Roelen DL, Claas FHJ, Scherjon SA. Changes in cytokine production and composition of peripheral blood leukocytes during pregnancy are not associated with a difference in the proliferative immune response to the fetus. Hum Immunol 2011; 72:805-11. [PMID: 21708204 DOI: 10.1016/j.humimm.2011.05.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 05/24/2011] [Accepted: 05/25/2011] [Indexed: 12/22/2022]
Abstract
We analyzed peripheral blood from women at term pregnancy for leukocyte composition, in vitro proliferative responses and cytokine production after nonspecific and fetus-specific stimulation. Maternal peripheral blood mononuclear cells (PBMCs) were collected and stimulated with umbilical cord blood (UCB) of the mother's own child, third-party UCB, nonspecific stimulus phytohemagglutinin, and anti-CD3 antibody, with PBMCs of nonpregnant women (cPBMC) as controls. Nine combinations of patient, child, third party child, and controls were selected on basis of sharing one human leukocyte antigen (HLA)-DR antigen. The response of mPBMC upon specific stimulation with fetal antigens was similar to that of cPBMC. No differences were found when comparing the mother's response upon stimulation to her own child with stimulation to that with a control child. Nonspecific stimulation with phytohemagglutinin and anti-CD3 antibody did not reveal a difference in proliferation rate between mPBMC and cPBMC. However, mPBMC contained a higher percentage of CD14(+) cells (p = 0.001) and activated T cells (CD25(dim), p < 0.0001), but a lower percentage CD16(-)CD56(bright) natural killer (NK) cells (p = 0.001) and CD16(+)CD56(+) NK cells (p = 0.003). mPBMC produced more interleukin (IL)-6, IL-10, and IL-17 compared with cPBMC (p < 0.05). We found differences in lymphocyte composition and cytokine production between mPBMC and cPBMC. These differences did not result in quantitative changes in proliferative responses during pregnancy compared with responses in nonpregnant controls.
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Affiliation(s)
- Lisa E E L O Lashley
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
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Kalinderis M, Papanikolaou A, Kalinderi K, Ioannidou E, Giannoulis C, Karagiannis V, Tarlatzis BC. Elevated Serum Levels of Interleukin-6, Interleukin-1β and Human Chorionic Gonadotropin in Pre-eclampsia. Am J Reprod Immunol 2011; 66:468-75. [DOI: 10.1111/j.1600-0897.2011.01019.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Szarka A, Rigó J, Lázár L, Beko G, Molvarec A. Circulating cytokines, chemokines and adhesion molecules in normal pregnancy and preeclampsia determined by multiplex suspension array. BMC Immunol 2010; 11:59. [PMID: 21126355 PMCID: PMC3014878 DOI: 10.1186/1471-2172-11-59] [Citation(s) in RCA: 374] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 12/02/2010] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Preeclampsia is a severe complication of pregnancy characterized by an excessive maternal systemic inflammatory response with activation of both the innate and adaptive arms of the immune system. Cytokines, chemokines and adhesion molecules are central to innate and adaptive immune processes. The purpose of this study was to determine circulating levels of cytokines, chemokines and adhesion molecules in normal pregnancy and preeclampsia in a comprehensive manner, and to investigate their relationship to the clinical features and laboratory parameters of the study participants, including markers of overall inflammation (C-reactive protein), endothelial activation (von Willebrand factor antigen) and endothelial injury (fibronectin), oxidative stress (malondialdehyde) and trophoblast debris (cell-free fetal DNA). RESULTS Serum levels of interleukin (IL)-1beta, IL-1 receptor antagonist (IL-1ra), IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p40, IL-12p70, IL-18, interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, transforming growth factor (TGF)-beta1, interferon-gamma-inducible protein (IP)-10, monocyte chemotactic protein (MCP)-1, intercellular adhesion molecule (ICAM)-1 and vascular cell adhesion molecule (VCAM)-1 were measured in 60 preeclamptic patients, 60 healthy pregnant women and 59 healthy non-pregnant women by multiplex suspension array and ELISA. In normal pregnancy, the relative abundance of circulating IL-18 over IL-12p70 and the relative deficiency of the bioactive IL-12p70 in relation to IL-12p40 might favour Th2-type immunity. Although decreased IL-1ra, TNF-alpha and MCP-1 concentrations of healthy pregnant relative to non-pregnant women reflect anti-inflammatory changes in circulating cytokine profile, their decreased serum IL-10 and increased IP-10 levels might drive pro-inflammatory responses. In addition to a shift towards Th1-type immunity (expressed by the increased IL-2/IL-4 and IFN-gamma/IL-4 ratios), circulating levels of the pro-inflammatory cytokines IL-6 and TNF-alpha, the chemokines IL-8, IP-10 and MCP-1, as well as the adhesion molecules ICAM-1 and VCAM-1, were raised in preeclampsia compared with healthy pregnancy, resulting in an overall pro-inflammatory systemic environment. Increased IP-10, MCP-1, ICAM-1 and VCAM-1 concentrations of preeclamptic patients showed significant correlations with blood pressure values, renal and liver function parameters, as well as with CRP, malondialdehyde, von Willebrand factor antigen and fibronectin levels. CONCLUSIONS According to our findings, preeclampsia was associated with an overall pro-inflammatory systemic environment. Elevated amounts of pro-inflammatory cytokines, chemokines and adhesion molecules in the maternal circulation might play a central role in the excessive systemic inflammatory response, as well as in the generalized endothelial dysfunction characteristics of the maternal syndrome of preeclampsia.
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Affiliation(s)
- András Szarka
- First Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary.
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Chandiramani M, Joash K, Shennan AH. Options and decision-making: hypertensive disorders of pregnancy. Future Cardiol 2010; 6:535-46. [PMID: 20608825 DOI: 10.2217/fca.10.71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Hypertension remains the most commonly encountered medical condition in pregnant women, complicating up to 15% of all pregnancies. It results in frequent hospital admissions, maternal morbidity and mortality and iatrogenic preterm birth with concomitant neonatal morbidity and mortality. Hypertensive disorders of pregnancy comprise a spectrum of severity ranging from a mild elevation of blood pressure to severe pre-eclampsia and hemolysis, elevated liver enzymes and low platelet syndrome that may result in transient or chronic multiorgan failure. As regular antenatal surveillance is the only manner by which to accurately identify those who are at risk, antenatal care schedules have been designed to detect hypertension and proteinuria. Early referral for specialist care for those who are at risk and those who develop hypertension is encouraged in the hope that this will translate into improved management of women with prophylactic, antihypertensive and anticonvulsant therapy. Advances in the understanding of the pathophysiology of the hypertensive disorders of pregnancy are likely to influence future research into both identifying those who are at risk and the role of interventions, and so lead to improved maternal and neonatal outcomes. This article highlights the pathophysiology of these conditions, the classification and identification of high-risk women, clinical manifestations and options for management.
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Affiliation(s)
- Manju Chandiramani
- 10th Floor North Wing, KCL Division of Reproduction & Endocrinology, Westminster Bridge Road, London SE1 7EH, UK.
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Vaisbuch E, Romero R, Mazaki-Tovi S, Kusanovic JP, Chaiworapongsa T, Dong Z, Kim SK, Ogge G, Gervasi MT, Hassan SS. Maternal plasma retinol binding protein 4 in acute pyelonephritis during pregnancy. J Perinat Med 2010; 38:359-66. [PMID: 20163326 PMCID: PMC3034079 DOI: 10.1515/jpm.2010.066] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Adipokines have been implicated in metabolic regulation and the immune response thus providing a molecular mechanism for the interaction between these two systems. Retinol binding protein 4 (RBP4) is a novel adipokine that plays a role in the pathophysiology of obesity-induced insulin resistance, as well as in the modulation of inflammation. The aim of this study was to determine whether there are changes in maternal plasma concentrations of RBP4 in pregnant women with acute pyelonephritis. STUDY DESIGN This cross-sectional study included pregnant women in the following groups: 1) normal pregnancy (n=80); 2) pyelonephritis (n=39). Maternal plasma RBP4 concentrations were determined by enzyme-linked immunoassays. Non-parametric statistics were used for analyses. RESULTS 1) The median maternal plasma RBP4 concentration was lower in patients with acute pyelonephritis than in those with a normal pregnancy (3709.6 ng/mL, interquartile range (IQR) 2917.7-5484.2 vs. 9167.6 ng/mL, IQR 7496.1- 10,384.1, P<0.001; 2) the median maternal plasma RBP4 concentration did not differ significantly between patients with acute pyelonephritis who had a positive blood culture and those with a negative culture (3285.3 ng/mL, IQR 2274.1-4741.1 vs. 3922.6 ng/mL, IQR 3126.8-5547.1, respectively, P=0.2); and 3) lower maternal plasma RBP4 concentrations were independently associated with pyelonephritis after adjustment for confounding factors. CONCLUSIONS In contrast to what has been reported in preeclampsia, acute pyelonephritis during pregnancy is associated with lower maternal plasma RBP4 concentrations than in normal pregnancy. This finding suggests that the acute maternal inflammatory process associated with pyelonephritis is fundamentally different from that of the chronic systemic inflammatory process suggested in preeclampsia, in which RBP4 concentrations were found to be elevated.
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Affiliation(s)
- Edi Vaisbuch
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI
,Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI
| | - Roberto Romero
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI
,Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI
,Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI
| | - Shali Mazaki-Tovi
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI
,Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI
,Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI
,Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI
| | - Zhong Dong
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI
| | - Sun Kwon Kim
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI
| | - Giovanna Ogge
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI
| | - Maria Teresa Gervasi
- Department of Obstetrics and Gynecology, Azienda Ospedaliera of Padova, Padova, Italy
| | - Sonia S. Hassan
- Perinatology Research Branch, Intramural Division, NICHD/NIH/DHHS, Hutzel Women’s Hospital, Bethesda, MD, and Detroit, MI
,Department of Obstetrics and Gynecology, Wayne State University/Hutzel Women’s Hospital, Detroit, MI
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Keski-Nisula L, Heinonen S, Remes S, Pekkanen J. Pre-eclampsia, placental abruption and increased risk of atopic sensitization in male adolescent offspring. Am J Reprod Immunol 2010; 62:293-300. [PMID: 19811463 DOI: 10.1111/j.1600-0897.2009.00738.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PROBLEM The aim of this study was to investigate maternal pre-eclampsia (PE), placental abruption (PA) and atopy among offspring. METHOD OF STUDY Obstetric data was recorded from 378 women who were included into the Caesarean delivery birth cohort during 1990-1992. When their children were 15-17 years old skin prick tests (SPTs) and inhalant allergen-specific (IAS) immunoglobulin E (IgE) were determined among offspring. RESULTS Adolescents whose mothers had either PE or PA at the time of delivery had more atopy and especially more severe atopy as measured by the incidence of SPTs positive for > or = 5 allergens (RR: 4.28, 95% CI: 1.54-11.92; P < 0.005) and elevated IAS IgE levels (> or = 1.0 kU/L) (RR: 4.27, 95% CI: 1.08-16.99; P < 0.039). This increased risk was particularly observed in male adolescents. CONCLUSION Maternal PE and PA were associated with an increased risk of severe atopy, especially in male adolescent offspring.
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Affiliation(s)
- Leea Keski-Nisula
- Department of Environmental Health, National Institute for Health and Welfare, Kuopio, Finland.
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