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Alexandrova-Watanabe A, Abadjieva E, Giosheva I, Langari A, Tiankov T, Gartchev E, Komsa-Penkova R, Todinova S. Assessment of Red Blood Cell Aggregation in Preeclampsia by Microfluidic Image Flow Analysis-Impact of Oxidative Stress on Disease Severity. Int J Mol Sci 2024; 25:3732. [PMID: 38612543 PMCID: PMC11011533 DOI: 10.3390/ijms25073732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Preeclampsia (PE) is a hypertensive disease characterized by proteinuria, endothelial dysfunction, and placental hypoxia. Reduced placental blood flow causes changes in red blood cell (RBC) rheological characteristics. Herein, we used microfluidics techniques and new image flow analysis to evaluate RBC aggregation in preeclamptic and normotensive pregnant women. The results demonstrate that RBC aggregation depends on the disease severity and was higher in patients with preterm birth and low birth weight. The RBC aggregation indices (EAI) at low shear rates were higher for non-severe (0.107 ± 0.01) and severe PE (0.149 ± 0.05) versus controls (0.085 ± 0.01; p < 0.05). The significantly more undispersed RBC aggregates were found at high shear rates for non-severe (18.1 ± 5.5) and severe PE (25.7 ± 5.8) versus controls (14.4 ± 4.1; p < 0.05). The model experiment with in-vitro-induced oxidative stress in RBCs demonstrated that the elevated aggregation in PE RBCs can be partially due to the effect of oxidation. The results revealed that RBCs from PE patients become significantly more adhesive, forming large, branched aggregates at a low shear rate. Significantly more undispersed RBC aggregates at high shear rates indicate the formation of stable RBC clusters, drastically more pronounced in patients with severe PE. Our findings demonstrate that altered RBC aggregation contributes to preeclampsia severity.
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Affiliation(s)
| | - Emilia Abadjieva
- Institute of Mechanics, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria; (A.A.-W.); (E.A.); (T.T.)
| | - Ina Giosheva
- University Obstetrics and Gynecology Hospital “Maichin Dom”, 1431 Sofia, Bulgaria; (I.G.); (E.G.)
- Institute of Biophysics and Biomedical Engineering, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria;
| | - Ariana Langari
- Institute of Biophysics and Biomedical Engineering, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria;
| | - Tihomir Tiankov
- Institute of Mechanics, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria; (A.A.-W.); (E.A.); (T.T.)
| | - Emil Gartchev
- University Obstetrics and Gynecology Hospital “Maichin Dom”, 1431 Sofia, Bulgaria; (I.G.); (E.G.)
| | | | - Svetla Todinova
- Institute of Biophysics and Biomedical Engineering, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria;
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Alencar AKN, Swan KF, Pridjian G, Lindsey SH, Bayer CL. Connecting G protein-coupled estrogen receptor biomolecular mechanisms with the pathophysiology of preeclampsia: a review. Reprod Biol Endocrinol 2023; 21:60. [PMID: 37393260 DOI: 10.1186/s12958-023-01112-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/20/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Throughout the course of pregnancy, small maternal spiral arteries that are in contact with fetal tissue undergo structural remodeling, lose smooth muscle cells, and become less responsive to vasoconstrictors. Additionally, placental extravillous trophoblasts invade the maternal decidua to establish an interaction between the fetal placental villi with the maternal blood supply. When successful, this process enables the transport of oxygen, nutrients, and signaling molecules but an insufficiency leads to placental ischemia. In response, the placenta releases vasoactive factors that enter the maternal circulation and promote maternal cardiorenal dysfunction, a hallmark of preeclampsia (PE), the leading cause of maternal and fetal death. An underexplored mechanism in the development of PE is the impact of membrane-initiated estrogen signaling via the G protein-coupled estrogen receptor (GPER). Recent evidence indicates that GPER activation is associated with normal trophoblast invasion, placental angiogenesis/hypoxia, and regulation of uteroplacental vasodilation, and these mechanisms could explain part of the estrogen-induced control of uterine remodeling and placental development in pregnancy. CONCLUSION Although the relevance of GPER in PE remains speculative, this review provides a summary of our current understanding on how GPER stimulation regulates some of the features of normal pregnancy and a potential link between its signaling network and uteroplacental dysfunction in PE. Synthesis of this information will facilitate the development of innovative treatment options.
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Affiliation(s)
| | - Kenneth F Swan
- Department of Obstetrics & Gynecology, Tulane University, New Orleans, LA, 70112, USA
| | - Gabriella Pridjian
- Department of Obstetrics & Gynecology, Tulane University, New Orleans, LA, 70112, USA
| | - Sarah H Lindsey
- Department of Pharmacology, Tulane University, New Orleans, LA, 70112, USA
| | - Carolyn L Bayer
- Department of Biomedical Engineering, Tulane University, 500 Lindy Boggs Center, New Orleans, LA, 70118, USA.
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Serum Collected from Preeclamptic Pregnancies Drives Vasoconstriction of Human Omental Arteries-A Novel Ex Vivo Model of Preeclampsia for Therapeutic Development. Int J Mol Sci 2022; 23:ijms231810852. [PMID: 36142764 PMCID: PMC9504727 DOI: 10.3390/ijms231810852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/11/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
New-onset maternal hypertension is a hallmark of preeclampsia, driven by widespread endothelial dysfunction and systemic vasoconstriction. Here, we set out to create a new ex vivo model using preeclamptic serum to cause injury to the endothelium, mimicking vascular dysfunction in preeclampsia and offering the potential to evaluate candidate therapeutic interventions. Human omental arteries were collected at caesarean section from normotensive pregnant patients at term (n = 9). Serum was collected from pregnancies complicated by preterm preeclampsia (birth < 34 weeks’ gestation, n = 16), term preeclampsia (birth > 37 weeks’ gestation, n = 5), and healthy gestation-matched controls (preterm n = 16, term n = 12). Using wire myography, we performed ex vivo whole vessel assessment where human omental arteries were treated with increasing doses of each serum treatment (2−20%) and vasoreactivity was assessed. All pregnant serum treatments successfully drove vasoconstriction; no significant difference was observed in the degree of vasoconstriction when exposed to preeclamptic or control serum. We further demonstrated the ability of esomeprazole (a candidate therapeutic for preeclampsia; 0.1−100 µM) to drive vasorelaxation of pre-constricted vessels (only with serum from preeclamptic patients). In summary, we describe a novel human physiological model of preeclamptic vascular constriction. We demonstrate its exciting potential to screen drugs for their therapeutic potential as treatment for vasoconstriction induced by preeclampsia.
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Powell JS, Gandley RE, Lackner E, Dolinish A, Ouyang Y, Powers RW, Morelli AE, Hubel CA, Sadovsky Y. Small extracellular vesicles from plasma of women with preeclampsia increase myogenic tone and decrease endothelium-dependent relaxation of mouse mesenteric arteries. Pregnancy Hypertens 2022; 28:66-73. [DOI: 10.1016/j.preghy.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 10/19/2022]
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Opichka MA, Rappelt MW, Gutterman DD, Grobe JL, McIntosh JJ. Vascular Dysfunction in Preeclampsia. Cells 2021; 10:cells10113055. [PMID: 34831277 PMCID: PMC8616535 DOI: 10.3390/cells10113055] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/01/2021] [Accepted: 11/04/2021] [Indexed: 01/22/2023] Open
Abstract
Preeclampsia is a life-threatening pregnancy-associated cardiovascular disorder characterized by hypertension and proteinuria at 20 weeks of gestation. Though its exact underlying cause is not precisely defined and likely heterogenous, a plethora of research indicates that in some women with preeclampsia, both maternal and placental vascular dysfunction plays a role in the pathogenesis and can persist into the postpartum period. Potential abnormalities include impaired placentation, incomplete spiral artery remodeling, and endothelial damage, which are further propagated by immune factors, mitochondrial stress, and an imbalance of pro- and antiangiogenic substances. While the field has progressed, current gaps in knowledge include detailed initial molecular mechanisms and effective treatment options. Newfound evidence indicates that vasopressin is an early mediator and biomarker of the disorder, and promising future therapeutic avenues include mitigating mitochondrial dysfunction, excess oxidative stress, and the resulting inflammatory state. In this review, we provide a detailed overview of vascular defects present during preeclampsia and connect well-established notions to newer discoveries at the molecular, cellular, and whole-organism levels.
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Affiliation(s)
- Megan A. Opichka
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (M.A.O.); (D.D.G.); (J.L.G.)
| | - Matthew W. Rappelt
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | - David D. Gutterman
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (M.A.O.); (D.D.G.); (J.L.G.)
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Justin L. Grobe
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (M.A.O.); (D.D.G.); (J.L.G.)
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
- Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Comprehensive Rodent Metabolic Phenotyping Core, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Jennifer J. McIntosh
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (M.A.O.); (D.D.G.); (J.L.G.)
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Correspondence: ; Tel.: +1-(414)-805-9019
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Abstract
RATIONALE Pre-eclampsia is a multisystem disorder associated with systemic vascular dysfunction and decreased nitric oxide (NO) bioactivity. Arginase competes with NO synthase (NOS) for l-arginine, and its upregulation may reduce NOS-derived NO formation or induce production of reactive oxygen species (ROS) via uncoupling of NOS, resulting in endothelial dysfunction. Red blood cells (RBCs) have emerged as key players in NO homeostasis via their interactions with the endothelium. Studies have demonstrated that abnormal RBC arginase function in patients with diabetes contributes to oxidative stress and endothelial dysfunction. AIM The aim of the study was to investigate if reduced NO bioavailability and increased ROS in pre-eclampsia is mediated via RBC-dependent mechanisms. METHODS In this translational study, plasma and RBCs were isolated from gestationally matched pre-eclamptic and healthy pregnant women and co-incubated overnight with mouse aortas for vascular reactivity studies. NO bioactivity, that is, nitrate, nitrite and cGMP, was assessed in plasma. Arginase activity and expression were analysed in RBCs. RESULTS Plasma markers of NO homeostasis and signalling were decreased in pre-eclamptic women vs. healthy pregnant women. Co-incubation of aorta with pre-eclamptic RBCs, but not healthy pregnant RBCs, induced endothelial dysfunction, which was ameliorated by pharmacological inhibition of arginase, scavenging of ROS, and by nitrite treatment. This pathological vascular phenotype was not observed following incubation with pre-eclamptic plasma. Arginase expression and activity in RBCs were increased in pre-eclamptic vs. healthy pregnant women and was associated with pre-eclampsia severity. Pre-eclamptic RBC-induced endothelial dysfunction was not because of increased haemolysis/cell-free haemoglobin. CONCLUSION This study demonstrates a novel role of the RBC in mediating the endothelial dysfunction associated with pre-eclampsia through arginase-dependent and oxidative stress-dependent mechanisms. Targeting of RBC arginase may provide a novel treatment modality for pre-eclampsia.
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Smith LR, Salifu MO, McFarlane IM. Non-Obstructive Coronary Artery Disease in Women: Current Evidence and Future Directions. INTERNATIONAL JOURNAL OF CLINICAL RESEARCH & TRIALS 2020; 5:152. [PMID: 33447689 PMCID: PMC7806203 DOI: 10.15344/2456-8007/2020/152] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Over half of women who present with angina are found to have negative coronary angiographic assessments. Of these patients, up to 50% are diagnosed with coronary microvascular dysfunction (CMD), which refers to pathologic changes within the small vessels of the coronary circulation. The hallmark of the pathophysiology of CMD is that endothelial damage, which occurs due to a multitude of conditions and risk factors, is the inciting event for the development and progression of CMD. CMD leads to a mismatch in myocardial demand and perfusion, leading to signs and symptoms of cardiac ischemia in the absence of obstructive lesions in the major vessels. CMD can be diagnosed through a variety of both invasive methods that allow a more specific evaluation of the microvasculature and non-invasive imaging techniques, such as cardiac positron emission tomography (PET) and magnetic resonance imaging (MRI). Risk factors for CMD overlap significantly with those of obstructive coronary artery disease (CAD) - hypertension, hypercholesterolemia, and diabetes remain salient predictors. However, these conditions only account for 20% of CMD cases in females. FINDINGS Women have sex-specific risk factors such as menopause, pregnancy, polycystic ovarian syndrome (PCOS), and a higher proclivity toward chronic inflammatory disorders. Estrogen has a cardioprotective effect by increasing production of nitric oxide, a potent vasodilator released by endothelial cells. As a result, the hormonal changes of menopause may accelerate endothelial damage, and in turn, CMD. Current treatments focus on addressing the risk factors of cardiovascular disease, such as anti-hypertensive drugs, weight loss, and glucose control. CONCLUSION Given the multifactorial nature of CMD in women, and the extensive atypical risk factors for cardiac disease, a more nuanced approach is needed that addresses the varied pathophysiology of CMD.
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Affiliation(s)
| | | | - Isabel M. McFarlane
- Corresponding Author: Dr. Isabel M. McFarlane, Department of Internal Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY 11203, USA, Tel: 718-270-2390, Fax: 718-270-1324;
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Gao Q, Tang J, Li N, Zhou X, Li Y, Liu Y, Wu J, Yang Y, Shi R, He A, Li X, Zhang Y, Chen J, Zhang L, Sun M, Xu Z. A novel mechanism of angiotensin II-regulated placental vascular tone in the development of hypertension in preeclampsia. Oncotarget 2018; 8:30734-30741. [PMID: 28430615 PMCID: PMC5458163 DOI: 10.18632/oncotarget.15416] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 02/06/2017] [Indexed: 12/03/2022] Open
Abstract
The present study tested the hypothesis that angiotensin II plays a role in the regulation of placental vascular tone, which contributes to hypertension in preeclampsia. Functional and molecular assays were performed in large and micro placental and non-placental vessels from humans and animals. In human placental vessels, angiotensin II induced vasoconstrictions in 78.7% vessels in 155 tests, as referenced to KCl-induced contractions. In contrast, phenylephrine only produced contractions in 3.0% of 133 tests. In non-placental vessels, phenylephrine induced contractions in 76.0% of 67 tests, whereas angiotensin II failed to produce contractions in 75 tests. Similar results were obtained in animal placental and non-placental vessels. Compared with non-placental vessels, angiotensin II receptors and β -adrenoceptors were significantly increased in placental vessels. Compared to the vessels from normal pregnancy, angiotensin II-induced vasoconstrictions were significantly reduced in preeclamptic placentas, which was associated with a decrease in angiotensin II receptors. In addition, angiotensin II and angiotensin converting enzyme in the maternal-placenta circulation in preeclampsia were increased, whereas angiotensin I and angiotensin1-7 concentrations were unchanged. The study demonstrates a selective effect of angiotensin II in maintaining placental vessel tension, which may play an important role in development of hypertension in preeclampsia.
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Affiliation(s)
- Qinqin Gao
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Jiaqi Tang
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Na Li
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Xiuwen Zhou
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Yongmei Li
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Yanping Liu
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Jue Wu
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Yuxian Yang
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Ruixiu Shi
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Axin He
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Xiang Li
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Yingying Zhang
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Jie Chen
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Lubo Zhang
- Center for Perinatal Biology, Loma Linda University, Loma Linda, California, USA
| | - Miao Sun
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China
| | - Zhice Xu
- Institute for Fetology, First Hospital of Soochow University, Suzhou, China.,Center for Perinatal Biology, Loma Linda University, Loma Linda, California, USA
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Pre-Eclampsia and Eclampsia: An Update on the Pharmacological Treatment Applied in Portugal. J Cardiovasc Dev Dis 2018; 5:jcdd5010003. [PMID: 29367581 PMCID: PMC5872351 DOI: 10.3390/jcdd5010003] [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: 12/11/2017] [Revised: 01/09/2018] [Accepted: 01/14/2018] [Indexed: 12/13/2022] Open
Abstract
Pre-eclampsia and eclampsia are two hypertensive disorders of pregnancy, considered major causes of maternal and perinatal death worldwide. Pre-eclampsia is a multisystemic disease characterized by the development of hypertension after 20 weeks of gestation, with the presence of proteinuria or, in its absence, of signs or symptoms indicative of target organ injury. Eclampsia represents the consequence of brain injuries caused by pre-eclampsia. The correct diagnosis and classification of the disease are essential, since the therapies for the mild and severe forms of pre-eclampsia are different. Thus, this review aims to describe the most advisable antepartum pharmacotherapy for pre-eclampsia and eclampsia applied in Portugal and based on several national and international available guidelines. Slow-release nifedipine is the most recommended drug for mild pre-eclampsia, and labetalol is the drug of choice for the severe form of the disease. Magnesium sulfate is used to prevent seizures caused by eclampsia. Corticosteroids are used for fetal lung maturation. Overall, the pharmacological prevention of these diseases is limited to low-dose aspirin, so it is important to establish the safest and most effective available treatment.
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Kusmiwiyati A, Baktiyani SC, Nurdiana N. Effects of Theobroma cacao on heat shock protein 90 and asymmetric dimethylarginine of endothelial cells under the influence of plasma of pre-eclamptic patients. J Taibah Univ Med Sci 2017; 13:129-134. [PMID: 31435315 PMCID: PMC6695082 DOI: 10.1016/j.jtumed.2017.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/21/2017] [Accepted: 11/27/2017] [Indexed: 11/28/2022] Open
Abstract
Objectives This study was conducted to investigate the modulatory role of an ethanol extract of Theobroma cacao beans on heat shock protein 90 (HSP90) and asymmetric dimethylarginine (ADMA) levels of endothelial cells under the influence of plasma of pre-eclamptic patients. Methods The endothelial cells were obtained from a human umbilicus. In the confluent phase, the cells were subdivided into groups: the control group (no treatment), the endothelial cell group that was exposed to 2% pre-eclamptic patients' plasma, and the endothelial cell group that was exposed to 2% pre-eclamptic patients' plasma and treated with the ethanol extract of T. cacao at various doses (25, 50, or 100 ppm). Analysis of HSP90 levels was carried out by an enzyme-linked immunosorbent assay. Quantification of ADMA was conducted by immunocytochemistry. Results There was a decreased HSP90 level in the group exposed to the pre-eclamptic patients' plasma. This decrease was significantly attenuated by the extract of T. cacao at the doses of 50 and 100 ppm. The pre-eclamptic patients' plasma significantly increased ADMA level as compared with the control group. This increase was significantly attenuated by the administration of the T. cacao extract at the two highest doses. Conclusions The extract of T. cacao beans protected the endothelial cells that were exposed to pre-eclamptic patients' plasma by increasing HSP90 levels and reducing ADMA levels.
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Affiliation(s)
- Ari Kusmiwiyati
- Department of Midwifery, Midwifery Diploma Program, Health Polytechnic of Health Ministry, Malang, Indonesia
- Corresponding address: Department of Midwifery, Midwifery Diploma Program, Health Polytechnic of Health Ministry, Jl. Besar Ijen, No. 77, Malang, East Java, Indonesia.
| | - Siti C.W. Baktiyani
- Department of Obstetric and Gynecology, Saiful Anwar General Hospital, Faculty of Medicine, Universitas Brawijaya, Malang, East Java, Indonesia
| | - Nurdiana Nurdiana
- Department of Pharmacology, Faculty of Medicine, Brawijaya University, Malang, East Java, Indonesia
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Affiliation(s)
- Styliani Goulopoulou
- From the Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth
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Ma SL, Tian XY, Wang YQ, Zhang HF, Zhang L. Vitamin D Supplementation Prevents Placental Ischemia Induced Endothelial Dysfunction by Downregulating Placental Soluble FMS-Like Tyrosine Kinase-1. DNA Cell Biol 2017; 36:1134-1141. [PMID: 28981319 DOI: 10.1089/dna.2017.3817] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Maternal vitamin D deficiency in pregnancy has been associated with an increased risk of preeclampsia. Vascular endothelial dysfunction is a major phenotype of pregnancies with preeclampsia, contributing to increased maternal hypertension and proteinuria. We sought to determine whether vitamin D supplementation would alleviate preeclampsia associated endothelial dysfunction and explore the underlying mechanism using the reduced uterine perfusion pressure (RUPP) rat model. RUPP operated rats were supplemented with 1,25(OH)2D (RUPP+VD) on day 1, 7, and 14 of pregnancy by subcutaneous injection. On day 19 of pregnancy, after the measurement of blood pressure and urine collection, maternal blood serum and placenta samples were collected. 1,25(OH)2D treatment significantly improved endothelial dysfunction by reducing apoptosis and increasing nitric oxide (NO) production in blood vessels of RUPP operated rats compared to untreated RUPP rats. 1,25(OH)2D significantly down-regulated the expression of placental soluble FMS-like tyrosine kinase-1 (sFlt-1) in RUPP rats. Furthermore, the circulating sFlt-1 levels in maternal serum were positively correlated with the expression of placental sFlt-1 and were restored to a normal pregnant level by 1,25(OH)2D treatment in RUPP rats. Incubation of endothelial cell line with rat serum from RUPP+VD group significantly increased NO production and decreased caspase-3 activity compared with serum from untreated RUPP rats. Moreover, neutralization of sFlt-1 using the specific antibody mimicked the effect of 1,25(OH)2D, which abolished the deleterious effect of RUPP rat's serum on NO production and apoptosis. These results suggest that vitamin D supplementation is protective against RUPP induced endothelial dysfunction by downregulating placental sFlt-1, which can possibly alleviate preeclampsia associated symptoms.
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Affiliation(s)
- Su-Ling Ma
- 1 Department of Histology and Embryology, Hebei Medical University , Shijiazhuang, China .,2 Department of Pediatrics, The Second Hospital of Hebei Medical University , Shijiazhuang, China
| | - Xiao-Yu Tian
- 2 Department of Pediatrics, The Second Hospital of Hebei Medical University , Shijiazhuang, China
| | - Ya-Qi Wang
- 1 Department of Histology and Embryology, Hebei Medical University , Shijiazhuang, China
| | - Hui-Feng Zhang
- 2 Department of Pediatrics, The Second Hospital of Hebei Medical University , Shijiazhuang, China
| | - Lei Zhang
- 1 Department of Histology and Embryology, Hebei Medical University , Shijiazhuang, China
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Endothelial Dysfunction in Severe Preeclampsia is Mediated by Soluble Factors, Rather than Extracellular Vesicles. Sci Rep 2017; 7:5887. [PMID: 28725005 PMCID: PMC5517616 DOI: 10.1038/s41598-017-06178-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/09/2017] [Indexed: 11/24/2022] Open
Abstract
In severe early-onset preeclampsia (sPE) the placenta releases soluble angiogenesis-regulating proteins, trophoblast-derived fragments, and extracellular vesicles (EVs). Their relative importance in disease pathogenesis is not presently understood. We explanted placental villi from healthy and sPE women then separated the media into: total-conditioned, EV-depleted and EV-enriched media. Three fractions were compared for; angiogenic protein secretion by ELISA, angiogenic and inflammation gene mRNA expression and leukocyte adhesion assay. sPE placental villi secreted significantly less PlGF (70 ± 18 pg/mL) than preterm controls (338 ± 203; p = 0.03). sFlt-1:PlGF ratios in total-conditioned (115 ± 29) and EV-depleted media (136 ± 40) from sPE placental villi were significantly higher than in EV-enriched media (42 ± 12; p < 0.01) or any preterm or term media. Fluorescent-labeled EVs derived across normal gestation, but not from sPE, actively entered HUVECs. From sPE placental villi, the soluble fraction, but not EV-enriched fraction, significantly repressed angiogenesis (0.83 ± 0.05 fold, p = 0.02), induced HO-1 mRNA (15.3 ± 5.1 fold, p < 0.05) and induced leukocyte adhesion (2.2 ± 0.4 fold, p = 0.04). Soluble media (total-conditioned and EV-depleted media) from sPE placental villi induced endothelial dysfunction in HUVEC, while the corresponding EV-enriched fraction showed no such effects. Our data suggest that soluble factors including angiogenesis-regulating proteins, dominate the vascular pathology of this disease.
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Reyna-Villasmil E, Mejia-Montilla J, Reyna-Villasmil N, Torres-Cepeda D, Santos-Bolívar J, Suárez-Torres I, Valencia-Rincón E. Concentraciones plasmáticas del factor de crecimiento vascular endotelial total en preeclampsia y eclampsia. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2017. [DOI: 10.1016/j.gine.2015.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Boeldt DS, Bird IM. Vascular adaptation in pregnancy and endothelial dysfunction in preeclampsia. J Endocrinol 2017; 232:R27-R44. [PMID: 27729465 PMCID: PMC5115955 DOI: 10.1530/joe-16-0340] [Citation(s) in RCA: 187] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/11/2016] [Indexed: 12/27/2022]
Abstract
Maternal vascular adaptation to pregnancy is critically important to expand the capacity for blood flow through the uteroplacental unit to meet the needs of the developing fetus. Failure of the maternal vasculature to properly adapt can result in hypertensive disorders of pregnancy such as preeclampsia (PE). Herein, we review the endocrinology of maternal adaptation to pregnancy and contrast this with that of PE. Our focus is specifically on those hormones that directly influence endothelial cell function and dysfunction, as endothelial cell dysfunction is a hallmark of PE. A variety of growth factors and cytokines are present in normal vascular adaptation to pregnancy. However, they have also been shown to be circulating at abnormal levels in PE pregnancies. Many of these factors promote endothelial dysfunction when present at abnormal levels by acutely inhibiting key Ca2+ signaling events and chronically promoting the breakdown of endothelial cell-cell contacts. Increasingly, our understanding of how the contributions of the placenta, immune cells, and the endothelium itself promote the endocrine milieu of PE is becoming clearer. We then describe in detail how the complex endocrine environment of PE affects endothelial cell function, why this has contributed to the difficulty in fully understanding and treating this disorder, and how a focus on signaling convergence points of many hormones may be a more successful treatment strategy.
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Affiliation(s)
- D S Boeldt
- Department of Ob/GynPerinatal Research Laboratories, University Wisconsin - Madison, Madison, Wisconsin, USA
| | - I M Bird
- Department of Ob/GynPerinatal Research Laboratories, University Wisconsin - Madison, Madison, Wisconsin, USA
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16
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Does high-density lipoprotein protect vascular function in healthy pregnancy? Clin Sci (Lond) 2016; 130:491-7. [DOI: 10.1042/cs20150475] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The maternal adaptation to pregnancy includes hyperlipidaemia, oxidative stress and chronic inflammation. In non-pregnant individuals, these processes are usually associated with poor vascular function. However, maternal vascular function is enhanced in pregnancy. It is not understood how this is achieved in the face of the adverse metabolic and inflammatory environment. Research into cardiovascular disease demonstrates that plasma HDL (high-density lipoprotein), by merit of its functionality rather than its plasma concentration, exerts protective effects on the vascular endothelium. HDL has vasodilatory, antioxidant, anti-thrombotic and anti-inflammatory effects, and can protect against endothelial cell damage. In pregnancy, the plasma HDL concentration starts to rise at 10 weeks of gestation, peaking at 20 weeks. The initial rise in plasma HDL occurs around the time of the establishment of the feto-placental circulation, a time when the trophoblast plugs in the maternal spiral arteries are released, generating oxidative stress. Thus there is the intriguing possibility that new HDL of improved function is synthesized around the time of the establishment of the feto-placental circulation. In obese pregnancy and, to a greater extent, in pre-eclampsia, plasma HDL levels are significantly decreased and maternal vascular function is reduced. Wire myography studies have shown an association between the plasma content of apolipoprotein AI, the major protein constituent of HDL, and blood vessel relaxation. These observations lead us to hypothesize that HDL concentration, and function, increases in pregnancy in order to protect the maternal vascular endothelium and that in pre-eclampsia this fails to occur.
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17
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Mechanism of vascular dysfunction due to circulating factors in women with pre-eclampsia. Clin Sci (Lond) 2016; 130:539-49. [DOI: 10.1042/cs20150678] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 01/05/2016] [Indexed: 02/07/2023]
Abstract
Circulating factors in the plasma of pre-eclamptic women contribute to vascular dysfunction by increasing oxidative stress, which is associated with a reduction in nitric oxide bioavailability and an increase in prostaglandin H synthase-dependent vasoconstrictors.
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18
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Goulopoulou S, Davidge ST. Molecular mechanisms of maternal vascular dysfunction in preeclampsia. Trends Mol Med 2014; 21:88-97. [PMID: 25541377 DOI: 10.1016/j.molmed.2014.11.009] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/11/2014] [Accepted: 11/26/2014] [Indexed: 12/13/2022]
Abstract
In preeclampsia, as a heterogeneous syndrome, multiple pathways have been proposed for both the causal as well as the perpetuating factors leading to maternal vascular dysfunction. Postulated mechanisms include imbalance in the bioavailability and activity of endothelium-derived contracting and relaxing factors and oxidative stress. Studies have shown that placenta-derived factors [antiangiogenic factors, microparticles (MPs), cell-free nucleic acids] are released into the maternal circulation and act on the vascular wall to modify the secretory capacity of endothelial cells and alter the responsiveness of vascular smooth muscle cells to constricting and relaxing stimuli. These molecules signal their deleterious effects on the maternal vascular wall via pathways that provide the molecular basis for novel and effective therapeutic interventions.
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Affiliation(s)
- Styliani Goulopoulou
- Department of Integrative Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA; Department of Obstetrics and Gynecology, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Sandra T Davidge
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Canada; Department of Physiology, University of Alberta, Edmonton, Canada; Women and Children's Health Research Institute, Edmonton, Canada.
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Brennan LJ, Morton JS, Davidge ST. Vascular dysfunction in preeclampsia. Microcirculation 2014; 21:4-14. [PMID: 23890192 DOI: 10.1111/micc.12079] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 07/22/2013] [Indexed: 12/30/2022]
Abstract
Preeclampsia is a complex disorder which affects an estimated 5% of all pregnancies worldwide. It is diagnosed by hypertension in the presence of proteinuria after the 20th week of pregnancy and is a prominent cause of maternal morbidity and mortality. As delivery is currently the only known treatment, preeclampsia is also a leading cause of preterm delivery. Preeclampsia is associated with maternal vascular dysfunction, leading to serious cardiovascular risk both during and following pregnancy. Endothelial dysfunction, resulting in increased peripheral resistance, is an integral part of the maternal syndrome. While the cause of preeclampsia remains unknown, placental ischemia resulting from aberrant placentation is a fundamental characteristic of the disorder. Poor placentation is believed to stimulate the release of a number of factors including pro- and antiangiogenic factors and inflammatory activators into the maternal systemic circulation. These factors are critical mediators of vascular function and impact the endothelium in distinctive ways, including enhanced endothelial oxidative stress. The mechanisms of action and the consequences on the maternal vasculature will be discussed in this review.
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Affiliation(s)
- Lesley J Brennan
- Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, Alberta, Canada; Women and Children's Health Research Institute and the Cardiovascular Research Centre, Edmonton, Alberta, Canada
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Anbazhagan A, Ong S. Hepatic portal vein flow and three dimensional indices of hepatic perfusion in pre-eclampsia compared with normal pregnancy. J OBSTET GYNAECOL 2014; 33:817-20. [PMID: 24219721 DOI: 10.3109/01443615.2013.829028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
It has been suggested that the origins of pre-eclampsia arise from the maternal venous system dysfunction. This study aimed to test this hypothesis by assessing hepatic perfusion in pre-eclampsia using three-dimensional (3D) ultrasound. The hepatic portal vein flow in 12 women with normal pregnancy and 11 women with pre-eclampsia was measured using standard Doppler ultrasound. The 3D indices of hepatic perfusion: flow index (FI), vascular index (VI) and vascularisation flow index (VFI), which are believed to reflect vascularity and flow intensity were also measured. Because of small numbers, a non-parametric test was used to test differences between groups. Hepatic portal vein flow was no different between women with normal pregnancy compared with women with pre-eclampsia (228.1 (215.5-270.6) vs. 283.0 (145.9-344.6); p = 0.90). The 3D indices of hepatic perfusion were as follows (FI: 36.3(30.7-42.5) vs. 39.7 (27.7-44.2), p = 1.00; VI: 11.7 (3.6-21.2) vs. 3.0 (0.5-7.6), p = 0.04; VFI: 4.7 (1.2-8.3) vs. 1.2 (0.1-3.2), p = 0.06, respectively). This study was not able to support or refute the suggestion that the genesis of pre-eclampsia arises from the maternal venous circulation. There may be biological differences in the 3D indices of hepatic perfusion in women with pre-eclampsia compared with normal pregnant women.
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Affiliation(s)
- A Anbazhagan
- Department of Obstetrics and Gynaecology, Royal Jubilee Maternity Hospital , Belfast , UK
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Pregnancy Programming and Preeclampsia: Identifying a Human Endothelial Model to Study Pregnancy-Adapted Endothelial Function and Endothelial Adaptive Failure in Preeclamptic Subjects. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 814:27-47. [DOI: 10.1007/978-1-4939-1031-1_4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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22
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Krupp J, Boeldt DS, Yi FX, Grummer MA, Bankowski Anaya HA, Shah DM, Bird IM. The loss of sustained Ca(2+) signaling underlies suppressed endothelial nitric oxide production in preeclamptic pregnancies: implications for new therapy. Am J Physiol Heart Circ Physiol 2013; 305:H969-79. [PMID: 23893163 PMCID: PMC3798749 DOI: 10.1152/ajpheart.00250.2013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 07/23/2013] [Indexed: 01/12/2023]
Abstract
Approximately 8% of pregnancies are complicated by preeclampsia (PE), a hypertensive condition characterized by widespread endothelial dysfunction. Reduced nitric oxide (NO) output in PE subjects has been inferred but not directly measured, and there is little understanding of why this occurs. To address this we have used direct imaging of changes in intracellular Ca(2+) concentration ([Ca(2+)]i) and NO in umbilical vein endothelium of normal and PE subjects that is still intact and on the vessel luminal surface. This was achieved by dissection and preloading with fura 2 and DAF-2 imaging dyes, respectively, before subsequent challenge with ATP (100 μM, 30 min). As a control to reveal the content of active endothelial nitric oxide synthase (eNOS) per vessel segment, results were compared with a maximal stimulus with ionomycin (5 μM, 30 min). We show for the first time that normal umbilical vein endothelial cells respond to ATP with sustained bursting that parallels sustained NO output. Furthermore, in subjects with PE, a failure of sustained [Ca(2+)]i bursting occurs in response to ATP and is associated with blunted NO output. In contrast, NO responses to maximal [Ca(2+)]i elevation using ionomycin and the levels of eNOS protein are more similar between groups than the responses to ATP. When the endothelial cells from PE subjects are isolated and allowed to recover in culture, they regain the ability under fura 2 imaging to show multiple [Ca(2+)]i bursts otherwise seen in the cells from normal subjects. Thus novel clinical therapy aimed at restoring function in vivo may be possible.
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Affiliation(s)
- Jennifer Krupp
- Perinatal Research Laboratories, Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin Madison, Madison, Wisconsin; and
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Kovacheva V, Soens M, Tsen L. Serum uric acid as a novel marker for uterine atony and post-spinal vasopressor use during cesarean delivery. Int J Obstet Anesth 2013; 22:200-8. [DOI: 10.1016/j.ijoa.2013.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 03/14/2013] [Accepted: 04/05/2013] [Indexed: 11/15/2022]
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English FA, McCarthy FP, McSweeney CL, Quon AL, Morton JS, Sawamura T, Davidge ST, Kenny LC. Inhibition of lectin-like oxidized low-density lipoprotein-1 receptor protects against plasma-mediated vascular dysfunction associated with pre-eclampsia. Am J Hypertens 2013; 26:279-86. [PMID: 23382414 DOI: 10.1093/ajh/hps035] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pre-eclampsia (PE) is associated with vascular endothelial dysfunction and oxidative stress initiated by impaired trophoblast invasion. Oxidative stress modifies circulating low-density lipoprotein (LDL) to oxidized LDL (oxLDL). Lectin-like oxLDL receptor-1 (LOX-1) is a scavenger receptor for oxLDL. We hypothesized that plasma from patients with PE alters LOX-1 in normal human vessels during pregnancy, causing oxLDL-induced impairment of vascular function. METHODS Control-matched plasma was obtained from women with PE (n = 6). Oxidized LDL and soluble LOX-1 levels were determined by enzyme-linked immunoassay (ELISA). Remaining plasma was pooled and stored at -80ºC. Human omental arteries were incubated in 3% plasma from normal pregnant (NP) women or plasma from women with PE. Expression of LOX-1 in these vessels was determined by immunohistochemistry with antibodies against LOX-1. The omental vessels were exposed to oxLDL and the LOX-1 inhibitor TS20. Vascular function was assessed in response to the vasoconstrictor U46619 and the vasodilators bradykinin (BK) and sodium nitroprusside (SNP). RESULTS No significant differences in the concentrations of oxLDL or soluble LOX-1 (sLOX-1) were found in plasma from women with PE as compared with NP women. The expression of LOX-1 was not significantly different in either the NP or PE incubated omental vessels. Incubation of vessels from NP women in plasma from women with PE impaired their relaxation in response to BK as compared with that of NP vessels incubated in plasma from NP women. Exposure to oxLDL further impaired relaxation in NP vessels incubated with plasma from women with PE. Inhibition of LOX-1 protected against the impairment of vascular relaxation induced by plasma from women with PE. CONCLUSION Inhibition of LOX-1 prevents endothelial dysfunction in an in vitro model of PE and may prove useful as a therapeutic target in the treatment of PE.
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Affiliation(s)
- Fred A English
- Anu Research Centre, University College Cork, Cork, Ireland.
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25
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Walsh SK, English FA, Crocker IP, Johns EJ, Kenny LC. Contribution of PARP to endothelial dysfunction and hypertension in a rat model of pre-eclampsia. Br J Pharmacol 2012; 166:2109-16. [PMID: 22339234 DOI: 10.1111/j.1476-5381.2012.01906.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Under conditions of increased oxidative stress, such as pre-eclampsia and diabetes, overstimulation of PARP leads to endothelial dysfunction. Inhibition of PARP has been demonstrated to reverse the vascular dysfunction associated with diabetes in vivo. The present study was carried out to investigate the role of PARP in mediating the endothelial dysfunction associated with pre-eclampsia. EXPERIMENTAL APPROACH Uteroplacental perfusion was surgically reduced in pregnant rats to produce the reduced uterine perfusion pressure (RUPP) rat model of pre-eclampsia and the PARP inhibitor, PJ34, was administered either before or after surgery. Mean arterial BP and vascular function were measured in normal pregnant (NP) and both control and PJ34-treated RUPP rats. Mesenteric vessels from NP rats were incubated with either 3% RUPP or NP plasma alone or in combination with PJ34. Finally, immunohistochemical staining was carried out to measure nitrotyrosine (byproduct of peroxynitrite) immunoreactivity. KEY RESULTS RUPP rats were characterized by hypertension, fetal growth restriction and endothelial dysfunction when compared with NP rats. PJ34 administered in vivo before, but not after, surgery prevented the development of both endothelial dysfunction and hypertension. RUPP plasma-induced impaired vasorelaxation was prevented following co-incubation with PJ34 in vitro. Furthermore, the protective effect of PARP inhibition in vivo was accompanied by a reduction in nitrotyrosine immunoreactivity. CONCLUSIONS AND IMPLICATIONS PJ34 prevented the development of both endothelial dysfunction and hypertension and reduced vascular nitrotyrosine immunoreactivity, thus suggesting a role for oxidative-nitrosative stress/PARP activation in the aberration in both vascular and haemodynamic function in this rat model of pre-eclampsia.
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Affiliation(s)
- S K Walsh
- Anu Research Centre, Department of Obstetrics & Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland.
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26
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Abstract
The pathogenesis of pre-eclampsia is still not completely known; however, in the recent decade, there have been tremendous research efforts leading to impressive results highlighting the role of a disturbed angiogenic balance as one of the key features of the disease. Numerous studies have shown the key role of the placenta in the pathogenesis of pre-eclampsia. A shift in the sFlt-1 (soluble Fms-like tyrosine kinase-1)/PlGF (placental growth factor) ratio is associated with the disease. Although pre-eclampsia seems to be a clearly defined disease, clinical presentation, and particularly the dynamics of the clinical course, can vary enormously. The only available tools to diagnose pre-eclampsia are blood pressure measurement and urine protein sampling. However, these tools have a low sensitivity and specificity regarding the prediction of the course of the disease or maternal and perinatal outcomes. The only cure for the disease is delivery, although a timely diagnosis helps in decreasing maternal and fetal morbidity and mortality. The sFlt1/PlGF ratio is able to give additional valuable information on the status and progression of the disease and is apt to be implemented in the diagnostic algorithm of pre-eclampsia. In the present review, we aim to provide an overview of the vast literature on angiogenesis and anti-angiogenesis factors in pre-eclampsia that have been published over the last decade. We introduce work from basic research groups who have focused on the pathophysiological basis of the disease. Furthermore, we review studies with a clinical focus in which the sFlt-1/PlGF ratio has been analysed along with other candidates for routine clinical assessment of pre-eclampsia.
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27
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Boeldt DS, Yi FX, Bird IM. eNOS activation and NO function: pregnancy adaptive programming of capacitative entry responses alters nitric oxide (NO) output in vascular endothelium--new insights into eNOS regulation through adaptive cell signaling. J Endocrinol 2011; 210:243-58. [PMID: 21555345 PMCID: PMC4059042 DOI: 10.1530/joe-11-0053] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In pregnancy, vascular nitric oxide (NO) production is increased in the systemic and more so in the uterine vasculature, thereby supporting maximal perfusion of the uterus. This high level of functionality is matched in the umbilical vein, and in corresponding disease states such as pre-eclampsia, reduced vascular responses are seen in both uterine artery and umbilical vein. In any endothelial cell, NO actually produced by endothelial NO synthase (eNOS) is determined by the maximum capacity of the cell (eNOS expression levels), eNOS phosphorylation state, and the intracellular [Ca(2+)](i) concentration in response to circulating hormones or physical forces. Herein, we discuss how pregnancy-specific reprogramming of NO output is determined as much by pregnancy adaptation of [Ca(2+)](i) signaling responses as it is by eNOS expression and phosphorylation. By examining the changes in [Ca(2+)](i) signaling responses from human hand vein endothelial cells, uterine artery endothelial cells, and human umbilical vein endothelial cells in (where appropriate) nonpregnant, normal pregnant, and pathological pregnant (pre-eclamptic) state, it is clear that pregnancy adaptation of NO output occurs at the level of sustained phase 'capacitative entry' [Ca(2+)](i) response, and the adapted response is lacking in pre-eclamptic pregnancies. Moreover, gap junction function is an essential permissive regulator of the capacitative response and impairment of NO output results from any inhibitor of gap junction function, or capacitative entry using TRPC channels. Identifying these [Ca(2+)](i) signaling mechanisms underlying normal pregnancy adaptation of NO output not only provides novel targets for future treatment of diseases of pregnancy but may also apply to other common forms of hypertension.
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Affiliation(s)
- D S Boeldt
- Perinatal Research Laboratories, Department of Obstetrics and Gynecology, University of Wisconsin-Madison, 7E Meriter Hospital/Park, 202 South Park Street, Madison, WI 53715, USA
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28
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Blankley RT, Robinson NJ, Aplin JD, Crocker IP, Gaskell SJ, Whetton AD, Baker PN, Myers JE. A gel-free quantitative proteomics analysis of factors released from hypoxic-conditioned placentae. Reprod Sci 2009; 17:247-57. [PMID: 19907055 DOI: 10.1177/1933719109351320] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Characterizing the protein factors released from placentae during pathogenesis remains a key objective toward understanding preeclampsia and related pregnancy disorders. Gel-free proteomics technologies applied to placental explant-conditioned media offers the potential of identifying these factors. Relative quantification mass spectrometry using isobaric tagging for relative and absolute quantification (iTRAQ) labeling was employed to compare the ''secretome'' between healthy term placental tissue cultured under both normoxic and hypoxic oxygen tensions. Of the 499 proteins identified, 45 were differentially expressed (P < .01 level), including interleukin 8 (IL-8) which was significantly upregulated under hypoxia. Global protein level changes are suggestive of decreased extracellular matrix remodeling under the same conditions. A significant enrichment of soluble liberated placental factors is achieved using this model system. Identifying these changes resulting from hypoxic conditioning is hypothesis generating and may provide new mechanistic insights into preeclampsia.
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Affiliation(s)
- Richard T Blankley
- Maternal and Fetal Health Research Group, St Mary's Hospital, Manchester, UK.
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29
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Amburgey OA, Reeves SA, Bernstein IM, Cipolla MJ. Resistance artery adaptation to pregnancy counteracts the vasoconstricting influence of plasma from normal pregnant women. Reprod Sci 2009; 17:29-39. [PMID: 19767537 DOI: 10.1177/1933719109345288] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Using a rat model, we investigated the effects of circulating factors in pregnancy on cerebrovascular and systemic vascular function by comparing myogenic reactivity, tone, and endothelial vasodilator production of the posterior cerebral artery (PCA) and mesenteric artery (MA) of nonpregnant (NP) animals perfused with nonpregnant and pregnant human plasma. Arteries from late pregnant (LP) animals were then perfused similarly to evaluate a potential adaptive effect of pregnancy on vessel function. A 3-hour exposure to pregnant plasma caused increased myogenic reactivity and tone in vessels from NP animals and produced a decreased endothelium-derived hyperpolarizing factor response in NP PCAs, findings that were not seen with MAs. The increased reactivity and tone noted in NP vessels was abolished when pregnant plasma was perfused through LP arteries, suggesting these vessels adapt during pregnancy to the vasoconstricting influence of pregnant plasma.
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Affiliation(s)
- Odül A Amburgey
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont College of Medicine, Burlington, Vermont 05405, USA
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30
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Abstract
OBJECTIVE Pregnant women with the vascular complication of preeclampsia show altered lipid metabolism characterized by elevated circulating triglycerides and nonesterified free fatty acids. We have compared the effect of maternal plasma from women with and without preeclampsia on cultured vascular endothelial cells and determined whether these plasma-induced changes were reproduced with free fatty acid solutions of palmitic, oleic and linoleic acid, representative of circulating levels reported in preeclampsia. METHODS Lipid accumulation was quantified by oil-red O staining, apoptosis by terminal dUTP nick-end labelling (TUNEL) and the measurement of mitochondrial redox capacity, and membrane potential recorded using MTT reduction and JC-1 accumulation for human umbilical vein endothelial cells (HUVECs) exposed to plasma and free fatty acids. RESULTS Lipid droplet accumulation was significantly increased in cultured HUVECs conditioned with maternal plasma from pregnancies with preeclampsia compared with normal uncomplicated controls. This increase was replicated following exposure to free fatty acids at the combined concentrations defined in preeclampsia. Plasma from these women also caused a significant decrease in mitochondrial dehydrogenase activity, a marked reduction in mitochondrial membrane potential and an increase in apoptosis compared with normal pregnancy. Again these effects were reproduced using free fatty acids in combination at the levels previously associated with preeclampsia. CONCLUSION These findings support the concept of a circulating pathogenic factor for preeclampsia and highlight the possibility that this factor is not a single compound but perhaps the combined elevation of the free fatty acids palmitic, oleic and linoleic acid in the maternal circulation.
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Harris L, Clancy O, Myers J, Baker P. Plasma From Women With Preeclampsia Inhibits Trophoblast Invasion. Reprod Sci 2009; 16:1082-90. [DOI: 10.1177/1933719109341842] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- L.K. Harris
- Maternal and Fetal Health Research Group, University of Manchester, St. Mary's Hospital, Oxford Road, Manchester, M13 9WL, United Kingdom,
| | - O.H. Clancy
- Maternal and Fetal Health Research Group, University of Manchester, St. Mary's Hospital, Oxford Road, Manchester, M13 9WL, United Kingdom
| | - J.E. Myers
- Maternal and Fetal Health Research Group, University of Manchester, St. Mary's Hospital, Oxford Road, Manchester, M13 9WL, United Kingdom
| | - P.N. Baker
- Maternal and Fetal Health Research Group, University of Manchester, St. Mary's Hospital, Oxford Road, Manchester, M13 9WL, United Kingdom
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Walsh SK, English FA, Johns EJ, Kenny LC. Plasma-Mediated Vascular Dysfunction in the Reduced Uterine Perfusion Pressure Model of Preeclampsia. Hypertension 2009; 54:345-51. [DOI: 10.1161/hypertensionaha.109.132191] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Preeclampsia is associated with widespread maternal vascular dysfunction, which is thought to be mediated by circulating factor(s). The aim of the study was to characterize vascular function in the reduced uterine perfusion pressure (RUPP) rat model of preeclampsia and to investigate the role of plasma factors in mediating any observed changes in vascular reactivity. Mean arterial blood pressure and vascular function were measured in RUPP and control rats. Mesenteric vessels from both virgin and pregnant rats were exposed for 1 hour or overnight to plasma from both RUPP and control rats and their vascular function assessed. RUPP rats were characterized by severe hypertension, restricted fetal growth, and reduced placental weight (
P
<0.001). Vasorelaxation was impaired in resistance vessels from RUPP compared with control rats (acetylcholine:
R
max
70±3 versus 92±1 [NP] and 93±3% [sham],
P
<0.01; bradykinin: 40±2 versus 62±2 [NP] and 59±4% [sham],
P
<0.001). Incubation of vessels from pregnant (but not virgin) animals with RUPP plasma overnight resulted in an attenuation of vasorelaxant responses (acetylcholine: 63±7 versus 86±2%,
P
<0.05; bradykinin: 35±5 versus 55±6%,
P
<0.001). The residual relaxant response in RUPP plasma-treated vessels was not further attenuated after treatment with
N
ω
-nitro-
l
-arginine methyl ester (acetylcholine: 57±7 versus 63±7%, ns; bradykinin: 37±5 versus 35±5%, ns). The RUPP rat model is characterized by an impaired response to vasodilators which may be attributable to one or more circulating factors. This plasma-mediated endothelial dysfunction appears to be a pregnancy-dependent effect. Furthermore, nitric oxide–mediated vasorelaxation appears to be absent in RUPP plasma-treated vessels.
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Affiliation(s)
- Sarah K. Walsh
- From the Anu Research Centre, Department of Obstetrics and Gynaecology (S.K.W., F.A.E., L.C.K.), University College Cork, Cork University Maternity Hospital and the Department of Physiology (E.J.J.), University College Cork, Ireland
| | - Fred A. English
- From the Anu Research Centre, Department of Obstetrics and Gynaecology (S.K.W., F.A.E., L.C.K.), University College Cork, Cork University Maternity Hospital and the Department of Physiology (E.J.J.), University College Cork, Ireland
| | - Edward J. Johns
- From the Anu Research Centre, Department of Obstetrics and Gynaecology (S.K.W., F.A.E., L.C.K.), University College Cork, Cork University Maternity Hospital and the Department of Physiology (E.J.J.), University College Cork, Ireland
| | - Louise C. Kenny
- From the Anu Research Centre, Department of Obstetrics and Gynaecology (S.K.W., F.A.E., L.C.K.), University College Cork, Cork University Maternity Hospital and the Department of Physiology (E.J.J.), University College Cork, Ireland
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Baker PN, Myers JE. Preeclamptic toxemia: a disease ripe for proteomic discovery. Expert Rev Proteomics 2009; 6:107-10. [PMID: 19385936 DOI: 10.1586/epr.09.5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Yousefneja K, Moslemizad N. Serum B-hCG Levels in Diagnosis and Management of Preeclampsia. JOURNAL OF MEDICAL SCIENCES 2008. [DOI: 10.3923/jms.2008.722.727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Robinson NJ, Wareing M, Hudson NK, Blankley RT, Baker PN, Aplin JD, Crocker IP. Oxygen and the liberation of placental factors responsible for vascular compromise. J Transl Med 2008; 88:293-305. [PMID: 18227808 DOI: 10.1038/labinvest.3700746] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Maternal endothelial activation in pre-eclampsia is attributed to the release of unknown factors from a hypoperfused placenta. To further characterize these factors, we have used a serum-free placental villous explant culture model and investigated the effect of the liberated soluble factors produced on human endothelial cell cultures. Term placental villous explants from uncomplicated pregnancies were cultured for 4 days in 20, 6 or 1% O2 to mimic placental hyperoxia, normoxia and hypoxia. Medium collected from viable explants was applied to cultured human uterine microvascular endothelial cells. Medium conditioned by hypoxic explants caused a significant decrease in endothelial cell ATP levels and mitochondrial dehydrogenase activity, suggestive of a reduced metabolic rate. An additional reduction in mitochondrial membrane potential and increased endothelial cell death occurred as the oxygen concentration to which explants had been exposed decreased. Effects of the hypoxic explant medium were also seen ex vivo in a wire myography model of myometrial artery function, with increased vasoconstriction and attenuated vasodilation following exposure to hypoxic explant medium. These results suggest that hypoxia (1% O2) may stimulate the release of soluble factors from the placenta, which have an adverse effect on endothelial cell metabolism and mitochondrial integrity in vitro. These potentially pathogenic factors are now being characterized.
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Affiliation(s)
- Nicola J Robinson
- Maternal and Fetal Health Research Group, School of Clinical and Laboratory Sciences, The University of Manchester, St Mary's Hospital, Manchester, UK.
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Myers JE, Hart S, Armstrong S, Mires GJ, Beynon R, Gaskell SJ, Baker PN. Evidence for multiple circulating factors in preeclampsia. Am J Obstet Gynecol 2007; 196:266.e1-6. [PMID: 17346549 DOI: 10.1016/j.ajog.2006.10.875] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2006] [Revised: 08/30/2006] [Accepted: 10/11/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to enrich vasoactive factors that are present in the plasma of women with preeclampsia by the application of sequential fractionation and determination of the activity of each fraction in a bioassay. STUDY DESIGN Pooled plasma from women with preeclampsia (n = 23) and matched control subjects (n = 23) was subjected to fractionation with ultrafiltration, targeted immunodepletion, or size exclusion chromatography. Myometrial arteries that were isolated from healthy cesarean section biopsy specimens (n = 28) were incubated with plasma fractions (2%, volume/volume), and their endothelial function was assessed by wire myography. RESULTS Incubation of arteries with preeclampsia plasma or immunodepleted preeclampsia plasma had a deleterious effect on endothelial-dependent relaxation. Bioactivity of the plasma factors was absent in all fractions after either plasma ultrafiltration or separation with the use of size exclusion chromatography; however, activity was restored after recombination of these fractions. CONCLUSION This study provides the first conclusive evidence that multiple synergistic factors, with a combined vasoactive effect, are present in the plasma of women with preeclampsia.
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Affiliation(s)
- Jenny E Myers
- Maternal & Fetal Health Research Centre, The University of Manchester, Manchester, UK.
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Jewsbury S, Sheikh N, Crocker I, Baker PN, Myers JE. Plasma uric acid levels do not correlate to plasma-evoked changes in endothelial function in women with preeclampsia. Eur J Obstet Gynecol Reprod Biol 2006; 137:118-9. [PMID: 17129658 DOI: 10.1016/j.ejogrb.2006.10.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Revised: 10/25/2006] [Accepted: 10/26/2006] [Indexed: 11/20/2022]
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Myers J, Hall C, Wareing M, Gillham J, Baker P. The effect of maternal characteristics on endothelial-dependent relaxation of myometrial arteries. Eur J Obstet Gynecol Reprod Biol 2006; 124:158-63. [PMID: 16139415 DOI: 10.1016/j.ejogrb.2005.05.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2005] [Revised: 02/22/2005] [Accepted: 05/04/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Endothelial dysfunction is central to the pathogenesis of pre-eclampsia (PE). This study aimed to determine if maternal characteristics, such as age, parity, BMI, smoking status and obstetric history, which affect the risk of developing pre-eclampsia, influenced endothelial function in myometrial arteries taken during an uncomplicated pregnancy. STUDY DESIGN As part of ongoing studies investigating endothelial function in normal and compromised pregnancies, myometrial vessels were isolated from biopsies taken at elective Caesarean section. A cohort of 119 women was identified and information regarding past pregnancy outcomes and medical history was obtained. Wire myography was used to compare endothelial-dependent relaxation in response to bradykinin between different patient groups. RESULTS Maternal age, parity and a history of miscarriage did not affect endothelial-dependent relaxation of myometrial small arteries. Attenuated endothelial-dependent relaxation was seen in vessels taken from women with elevated BMI and enhanced relaxation was seen in women who had smoked during pregnancy. Vessels isolated from women with a history of past pregnancy complications did not show any significant difference in endothelial-dependent relaxation compared to women with uncomplicated histories. CONCLUSION Maternal factors may influence endothelial function in the absence of pregnancy complications. Endothelial-dependent relaxation of myometrial arteries, isolated from multiparous women with an uncomplicated index pregnancy, is comparable between women with and without a history of pregnancy complications.
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Affiliation(s)
- Jenny Myers
- Clinical Research Fellow, Maternal and Fetal Health Research Centre, University of Manchester, Hathersage Rd., Manchester M13 0JH, UK.
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Puschett JB. The role of excessive volume expansion in the pathogenesis of preeclampsia. Med Hypotheses 2006; 67:1125-32. [PMID: 16814939 DOI: 10.1016/j.mehy.2006.04.059] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Revised: 04/17/2006] [Accepted: 04/24/2006] [Indexed: 11/15/2022]
Abstract
Preeclampsia is a disorder which is responsible for significant maternal morbidity and mortality as well as fetal wastage. Its pathogenesis remains obscure and its only treatment is the delivery of the placenta and the fetus. Over time it has become clear that this syndrome is not a single disease but a disorder with, most likely, multiple etiologic factors that have a common (or similar) phenotype(s). A leading hypothesis, first developed in the early 1970s, is that the hypertension, proteinuria and intrauterine growth restriction are the result of hypoperfusion of the maternal-fetal unit. However, the early events leading to this deranged circulatory event have not been extensively studied. We hypothesize that at least one of the early pathogenetic events is excessive expansion of the extracellular fluid volume. This leads to persistent elaboration of (a) circulating factor(s) that interfere(s) with remodeling of the decidual vasculature preventing normal placentation from occurring. Our experiments have dealt largely with the role that an endogenous bufadienolide, marinobufagenin (MBG), plays in this pathogenetic process. In this report, we provide evidence for this thesis and point to future studies aimed at testing this hypothesis. These will include evaluating large groups of preeclamptic patients to determine their blood and urinary levels of MBG. Efforts will also be made to determine if there are differences in sodium handling in those patients with elevated levels of MBG, compared to other preeclamptic patients and to normal pregnant subjects.
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Affiliation(s)
- Jules B Puschett
- Tulane University School of Medicine, Department of Medicine, Section of Nephrology and Hypertension, 1430 Tulane Avenue, SL-45, New Orleans, LA 70112, USA
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Myers JE, Merchant SJ, Macleod M, Mires GJ, Baker PN, Davidge ST. MMP-2 levels are elevated in the plasma of women who subsequently develop preeclampsia. Hypertens Pregnancy 2005; 24:103-15. [PMID: 16036395 DOI: 10.1081/prg-200059836] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine levels of matrix metalloproteinase (MMP)-2 and MMP-9, and the tissue inhibitors of metalloproteinases (TIMP)-1 and TIMP-2 in the plasma of women destined to develop preeclampsia prior to the onset of clinical disease. STUDY DESIGN Plasma samples were taken from women whose pregnancies were subsequently complicated by preeclampsia and from normal pregnant women at 22 and 26 weeks and at delivery or diagnosis. Following equal protein loading, MMP-2 and 9 and TIMP-1 and 2 were quantified using zymography and Western blot analysis, respectively. RESULTS Plasma MMP-2 levels were significantly elevated at 22 weeks (p = 0.02) and at diagnosis (p = 0.003) in the preeclampsia group, but there was no difference at 26 weeks. TIMP-1 levels were significantly reduced in the preeclampsia group at 26 weeks (p = 0.0002), but TIMP-2 levels were not quantifiable. CONCLUSION At all three gestational time points an imbalance in the MMP-2:TIMP-1 ratio was found in patients who subsequently developed preeclampsia. We speculate that increased net MMP-2 activity may contribute to the endothelial dysfunction that is central to the pathophysiology of preeclampsia.
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Affiliation(s)
- Jenny E Myers
- Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK.
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Crocker IP, Kenny LC, Thornton WA, Szabo C, Baker PN. Excessive stimulation of poly(ADP-ribosyl)ation contributes to endothelial dysfunction in pre-eclampsia. Br J Pharmacol 2005; 144:772-80. [PMID: 15778700 PMCID: PMC1576060 DOI: 10.1038/sj.bjp.0706055] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
1. Pre-eclampsia is a serious pregnancy disorder associated with widespread activation of the maternal vascular endothelium. Recent evidence implicates a role for oxidative stress in the aetiology of this condition. 2. Reactive oxygen species, particularly superoxide anions, invokes endothelial cell activation through many pathways. Oxidant-induced cell injury triggers the activation of nuclear enzyme poly(ADP-ribose) polymerase (PARP) leading to endothelial dysfunction in various pathophysiological conditions (reperfusion, shock, diabetes). 3. We have studied whether the loss of endothelial function in pre-eclampsia is dependent on PARP activity. Endothelium-dependent responses of myometrial arteries were tested following exposure to either plasma from women with pre-eclampsia or normal pregnant women in the presence and absence of a novel potent inhibitor of PARP, PJ34. Additional effects of plasma and PJ34 inhibition were identified in microvascular endothelial cell cultures. 4. In myometrial arteries, PARP inhibition blocked the attenuation of endothelium-dependent responses following exposure to plasma from women with pre-eclampsia. In endothelial cell cultures, plasma from pre-eclamptics induced measurable oxidative stress and a concomitant increase in PARP activity and reduction in cellular ATP. Again, these biochemical changes were reversed by PJ34. 5. These results suggest that PARP activity plays a pathogenic role in the development of endothelial dysfunction in pre-eclampsia and promotes PARP inhibition as a potential therapy in this condition.
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Affiliation(s)
- Ian P Crocker
- Maternal and Fetal Health Research Centre, University of Manchester, St Mary's Hospital, Whitworth Park, Manchester M13 0JH.
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Myers J, Irvine R, Gillham J, Macleod M, Mires G, Taggart M, Baker P. Altered endothelial function in isolated human myometrial vessels induced by plasma from women with pre-eclampsia is not reproducible in isolated mouse vessels. Clin Sci (Lond) 2005; 108:457-62. [PMID: 15673282 DOI: 10.1042/cs20040343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In order to facilitate characterization of the circulating factor(s) in pre-eclampsia, the present study aimed to determine whether plasma from women with pre-eclampsia, which induces attenuated endothelial-dependent relaxation in human myometrial arteries, is also capable of inducing altered endothelial function in mouse vessels. Human vessels were isolated from myometrial biopsies taken from women with uncomplicated pregnancies (n = 6). Mesenteric and uterine arteries were isolated from male, female, non-pregnant and pregnant C57B mice (n = 24). Vessels were studied using a wire myograph and incubated with plasma (2%) from women with pre-eclampsia (n = 12) or controls (n = 12). Incubation of myometrial vessels from normal pregnant women with plasma from women with pre-eclampsia reduced endothelial-dependent relaxation. This effect was not reproduced in male or female mouse mesenteric or uterine vessels incubated with plasma from women with pre-eclampsia. In conclusion, there are species-specific differences in the actions of the circulating factor(s) on endothelial-dependent relaxation of human and mouse small arteries.
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Affiliation(s)
- Jenny Myers
- Maternal and Fetal Health Research Centre, University of Manchester, Hathersage Road, Manchester M13 0JH, UK.
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Maynard SE, Venkatesha S, Thadhani R, Karumanchi SA. Soluble Fms-like tyrosine kinase 1 and endothelial dysfunction in the pathogenesis of preeclampsia. Pediatr Res 2005; 57:1R-7R. [PMID: 15817508 DOI: 10.1203/01.pdr.0000159567.85157.b7] [Citation(s) in RCA: 163] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Preeclampsia, a pregnancy-specific syndrome of hypertension and proteinuria, is characterized by defective placental vasculogenesis and widespread maternal endothelial dysfunction. Although the manifestations of preeclampsia are primarily maternal, the burden of morbidity and mortality is often on the neonate, since the only effective treatment-delivery of the fetus and placenta-often results in iatrogenic prematurity. In this review, we summarize recent advances in our understanding of the pathophysiology of preeclampsia, including normal and aberrant placental vascular development and evidence for endothelial dysfunction. We describe recent evidence that supports a novel mechanism in which a maladaptive shift in placental production of angiogenic factors such as soluble fms-like tyrosine kinase 1 (a circulating antiangiogenic protein) may play an important role in the pathogenesis of preeclampsia.
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Affiliation(s)
- Sharon E Maynard
- Department of Medicine, University of Massachusetts Medical School, Worcester 01655, USA
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Myers J, Mires G, Macleod M, Baker P. In Preeclampsia, the Circulating Factors Capable of Altering In Vitro Endothelial Function Precede Clinical Disease. Hypertension 2005; 45:258-63. [DOI: 10.1161/01.hyp.0000153461.58298.a4] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The pathophysiology of preeclampsia involves the release of a circulating factor(s) from a hypoperfused placenta that activates the maternal endothelium. This study investigated the effect on in vitro endothelial function of plasma taken from women in whom preeclampsia subsequently developed. Women at increased risk for an adverse pregnancy outcome were identified using Doppler waveform analysis. Plasma samples (22 and 26 weeks) were incubated with myometrial vessels taken from women with uncomplicated pregnancies. Wire myography was used to study the effect of plasma on the endothelium-dependent vessel behavior. Incubation of vessels from normal pregnant women with plasma from women in whom preeclampsia subsequently developed (n=19) significantly reduced endothelium-dependent relaxation, compared with vessels incubated with plasma from normal pregnant women (n=48). This effect was demonstrable for plasma taken at 22 weeks (residual constriction 47.1±6.6% versus 32.0±4.4%,
P
=0.004 at 1-hour incubation; and 59.1±8.4% versus 42.3±5.9%,
P
=0.001 at 18-hour incubation) and 26 weeks (59.2±5.2% versus 29.1±5.6%,
P
<0.001 at 1 hour; and 63.3±7.6% versus 31.9 +/-7.2%,
P
<0.0001 at 18 hours). Endothelial-dependent relaxation was unaltered after incubation with plasma taken from women in whom normotensive intrauterine growth restriction subsequently developed (n=19). This study supports the hypothesis that plasma, from women in whom preeclampsia develops, collected weeks before diagnosis is capable of altering endothelial function.
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Affiliation(s)
- Jenny Myers
- From the Maternal & Fetal Health Research Centre (J.M., P.B.), University of Manchester; Maternal and Child Health Sciences (G.M., M.M.), Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Gary Mires
- From the Maternal & Fetal Health Research Centre (J.M., P.B.), University of Manchester; Maternal and Child Health Sciences (G.M., M.M.), Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Maureen Macleod
- From the Maternal & Fetal Health Research Centre (J.M., P.B.), University of Manchester; Maternal and Child Health Sciences (G.M., M.M.), Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Philip Baker
- From the Maternal & Fetal Health Research Centre (J.M., P.B.), University of Manchester; Maternal and Child Health Sciences (G.M., M.M.), Ninewells Hospital and Medical School, Dundee, United Kingdom
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Merchant SJ, Davidge ST. The role of matrix metalloproteinases in vascular function: implications for normal pregnancy and pre-eclampsia. BJOG 2004; 111:931-9. [PMID: 15327607 DOI: 10.1111/j.1471-0528.2004.00223.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES (1) To investigate the effects of plasma from non-pregnant, normal pregnant and pre-eclamptic women on myogenic tone and endothelium-dependent relaxation; (2) To investigate the role of matrix metalloproteinases (MMPs) in these parameters of vascular function. DESIGN Analysis of the effects of plasma from non-pregnant, normal pregnant and pre-eclamptic women on myogenic tone and endothelium-dependent relaxation, and the effects of MMP inhibition on these parameters. SETTING University of Alberta, Edmonton, Alberta, Canada. SAMPLES Pooled plasma from non-pregnant (n= 9), normal pregnant (n= 6) and pre-eclamptic women (n= 12). METHODS Mesenteric arteries from virgin female C57BL/6J mice were exposed to pooled plasma from non-pregnant, normal pregnant and pre-eclamptic women in the absence and presence of GM6001 (5 microM; MMP inhibitor), and arterial function was assessed. MAIN OUTCOME MEASURES Myogenic tone and endothelium-dependent relaxation. RESULTS Plasma of women with pre-eclampsia, and interestingly, plasma of non-pregnant women, significantly enhanced myogenic tone at pressures > or =70 mmHg (P < 0.001) and blunted the maximum relaxation to methacholine (P < 0.001; P < 0.005) in isolated arteries. GM6001 altered response only in vessels exposed to the plasma of women with pre-eclampsia; however, contrary to our hypothesis, this further enhanced myogenic tone and further abrogated relaxation. CONCLUSIONS The strikingly similar vascular function profiles of vessels incubated in the plasma of non-pregnant and pre-eclamptic women suggest that pre-eclampsia may be due, in part, to the lack of a necessary adaptation to pregnancy. Despite these similarities, however, there are differential effects of MMP inhibition, suggesting that MMPs play a greater role in the vasculature of women with pre-eclampsia compared with non-pregnant and normal pregnant women.
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Affiliation(s)
- Shaila J Merchant
- Department of Physiology, University of Alberta, Edmonton, Alberta, Canada T6G 2S2
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Myers JE, Baker PN. Isolated microparticles, but not whole plasma, from women with preeclampsia impair endothelium-dependent relaxation in isolated myometrial arteries from healthy pregnant women. Am J Obstet Gynecol 2003; 189:1209; author reply 1209-10. [PMID: 14619830 DOI: 10.1067/s0002-9378(03)00705-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Bartynski WS, Sanghvi A. Neuroimaging of delayed eclampsia. Report of 3 cases and review of the literature. J Comput Assist Tomogr 2003; 27:699-713. [PMID: 14501361 DOI: 10.1097/00004728-200309000-00007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Computed tomography and magnetic resonance imaging findings consistent with eclampsia were recently encountered in 3 patients who developed severe headache days to weeks after uncomplicated delivery. The neurologic presentation was nonspecific, and pre-eclamptic symptoms were not present, including significant hypertension. Variable expression of pre-eclampsia occurred during the course of their observation. Conventional angiography obtained in 2 patients because of a concern for aneurysm demonstrated central and peripheral vasospasm. Magnetic resonance angiography demonstrated central vasospasm in the third patient.
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Affiliation(s)
- Walter S Bartynski
- Department of Radiology, The Western Pennsylvania Hospital, Pittsburgh, USA.
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Sattar N, Ramsay J, Crawford L, Cheyne H, Greer IA. Classic and novel risk factor parameters in women with a history of preeclampsia. Hypertension 2003; 42:39-42. [PMID: 12743016 DOI: 10.1161/01.hyp.0000074428.11168.ee] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Epidemiological studies demonstrate a relation between preeclampsia (PE) and an increased risk of maternal coronary heart disease (CHD) in later life. However, there are few data available to explain any underlying mechanism. We recruited 40 primigravid women with a history of proteinuric PE delivering between 1975 and 1985 and 40 controls, matched as a group for time of index pregnancy, smoking, and current body mass index to assess classic (lipids, blood pressure) and novel (adhesion molecules, insulin, leptin) risk factor pathways. Women with a history of PE had higher diastolic blood pressure compared with controls (83 vs 76 mm Hg, P<0.05), but there were no significant differences in fasting lipoprotein concentrations (P>0.20). However, concentrations of vascular cell adhesion molecule-1 and intercellular adhesion molecule-1 (ICAM-1) in particular were higher in the PE group by 14% (P=0.038) and 44% (P=0.002), respectively. The cases also demonstrated a tendency toward higher fasting insulin (P=0.08) concentrations and had higher glycosylated hemoglobin levels (P=0.004). Leptin concentrations were not significantly elevated. Interestingly, significantly more of the women with history of PE were classified as menopausal (37.55% vs 17.5%, P=0.045). The differences in ICAM-1 concentration persisted (P=0.010) after adjustment for potential confounders, including hormonal use/menopausal status, antihypertensive or lipid-lowering therapy, and social class. We conclude that classic risk factors alone cannot fully explain the elevated CHD risk in women with a history of PE. Rather markedly elevated ICAM-1 concentrations and specific but subtle features of the metabolic syndrome (glucose, blood pressure) are likely to be involved.
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Affiliation(s)
- Naveed Sattar
- Department of Pathological Biochemistry, Glasgow Royal Infirmary University NHS Trust, Glasgow G31 2ER UK
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Wareing M, Bhatti H, O'hara M, Kenny L, Warren AY, Taggart MJ, Baker PN. Vasoactive effects of neurokinin B on human blood vessels. Am J Obstet Gynecol 2003; 188:196-202. [PMID: 12548217 DOI: 10.1067/mob.2003.114] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Preeclampsia (PE) is a multisystem disease unique to human pregnancy. Abnormal placentation results in placental hypoperfusion leading to the secretion of a factor(s) by the placenta. Our aim was to investigate whether neurokinin B (NKB) is the circulating factor associated with PE. STUDY DESIGN Vascular effects of NKB were assessed in blood vessels dissected from myometrial and omental biopsy specimens obtained at caesarean section from normal pregnant women (n = 26) or in mesenteric blood vessels obtained from nonpregnant female Wistar rats (n = 4). RESULTS Incubation with NKB did not alter endothelial-dependent relaxation of omental or myometrial arteries. NKB produced a dose-dependent relaxation in preconstricted omental arteries and veins. NKB did not affect vasoactive responsiveness of rat mesenteric arteries. CONCLUSION We conclude from these observations that NKB is not the circulating factor associated with increased vascular resistance in PE.
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Affiliation(s)
- Mark Wareing
- Maternal and Fetal Health Research Centre, St Mary's Hospital, University of Manchester, Manchester, UK.
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Vanwijk MJ, Svedas E, Boer K, Nieuwland R, Vanbavel E, Kublickiene KR. Isolated microparticles, but not whole plasma, from women with preeclampsia impair endothelium-dependent relaxation in isolated myometrial arteries from healthy pregnant women. Am J Obstet Gynecol 2002; 187:1686-93. [PMID: 12501084 DOI: 10.1067/mob.2002.127905] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was performed to establish whether microparticles from plasma of women with preeclampsia cause endothelial dysfunction, as described for isolated myometrial arteries in preeclampsia. STUDY DESIGN Myometrial arteries were isolated from biopsy specimens obtained at cesarean delivery from healthy pregnant women (n = 22) and mounted in a wire myograph. Bradykinin concentration-response curves were obtained before and after 1-hour incubation or after overnight incubation with one of the following preparations of plasma from individual women with preeclampsia (n = 16): Whole plasma, microparticle-free plasma, isolated microparticles resuspended in physiologic saline solution or physiologic saline solution. Overnight incubation was also performed with microparticles isolated from healthy pregnant women (n = 6). One-hour incubation was performed with 2% or 10% solution and overnight incubation with 5% solution. RESULTS No effect of preeclamptic plasma, with or without microparticles, on bradykinin-mediated relaxation was observed. Overnight, but not 1-hour, incubation with preeclamptic microparticles caused abolishment of bradykinin-mediated relaxation in contrast to healthy pregnant microparticles (P <.005). CONCLUSION Preeclamptic microparticles, but not healthy pregnant microparticles cause endothelial dysfunction in isolated myometrial arteries from healthy pregnant women after overnight incubation, whereas other preeclamptic plasma constituents protect the endothelium from this effect.
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Affiliation(s)
- Marja J Vanwijk
- Departments of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
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