1
|
Zhu W, Xu M, Zhu M, Song Y, Zhang J, Zheng C. Cuyun Recipe ameliorates pregnancy loss by regulating macrophage polarization and hypercoagulable state during the peri-implantation period in an ovarian hyperstimulation mouse model. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2023; 119:154974. [PMID: 37523838 DOI: 10.1016/j.phymed.2023.154974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/09/2023] [Accepted: 07/15/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND The Chinese herbal prescription Cuyun Recipe (CYR) has been widely used to treat clinical infertility and has shown good efficacy. Animal experiments have shown that CYR can promote implantation in mice, however, the exact mechanism underlying the implantation has not been elucidated. PURPOSE To investigate the effect and mechanism of CYR on regulating macrophage polarization and hypercoagulability during the peri-implantation period in mice with ovarian hyperstimulation. METHODS An ovarian hyperstimulation mouse model was developed, followed by treatment with CYR. Mice were sacrificed on day (D)4.5, D6, or D8 of gestation. The number of implantation sites, the pathological changes of the uterus and ovaries were assessed. The polarization of monocytes/macrophages in the spleen and endometrium, the expression and localization of cytokines were further detected. Furthermore, analyses of hypercoagulable state of the blood were also performed. RESULTS Treatment with CYR increased the average number of implantation sites, promoted angiogenesis in endometrial, and regulated monocytes/macrophages and the cytokine levels. Moreover, CYR downregulated the overexpression of D-dimer and fgl2 after ovarian hyperstimulation. CONCLUSION CYR facilitates embryo implantation by alleviating ovarian hyperstimulation, promoting endometrial decidualization and angiogenesis, regulating macrophage polarization, and reversing the hypercoagulable state of the blood.
Collapse
Affiliation(s)
- Wenxin Zhu
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan 430030, China
| | - Menghao Xu
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan 430030, China
| | - Mengdi Zhu
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan 430030, China
| | - Yufan Song
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan 430030, China
| | - Jinmin Zhang
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan 430030, China
| | - Cuihong Zheng
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan 430030, China.
| |
Collapse
|
2
|
Zheng L, Xia B, Yuan Y, Wang Y, Wang Y. Low-molecular-weight heparin in addition to low-dose aspirin for preventing preeclampsia and its complications: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:1073148. [PMID: 36568564 PMCID: PMC9780488 DOI: 10.3389/fcvm.2022.1073148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
Background In this systematic review, we aimed to investigate the efficacy and safety of adding low-molecular-weight heparin (LMWH) or unfractionated heparin to low-dose aspirin (LDA) started ≤16 weeks'gestation in the prevention of preeclampsia (PE) in high-risk women. Methods PubMed, Cochrane Library, Embase, and ClinicalTrials.gov databases were searched from their inception to April 2022 for randomized controlled trials (RCTs) that to determine whether the combined treatment of LMWH and LDA is better than single anticoagulant drugs in preventing PE and improving live birth rate of fetus in high-risk women with pregnancy ≤16 weeks. We also searched Embase, OVID MEDLINE and OVID MEDLINE in-process using the OVID platform. Results 14 RCTs involving 1,966 women were found. The LMWH (or unfractionated heparin) and LDA groups included 1,165 wemen, and the LDA group included 960 women. The meta-analysis showed that the addition of LMWH to LDA reduced the risk of PE (RR: 0.59, 95% CI: 0.44-0.79, P < 0.05), small-for-gestational age (SGA, RR: 0.71, 95% CI: 0.52-0.97, P = 0.03), fetal and neonatal death (RR: 0.45, 95% CI: 0.23-0.88, P = 0.02) and gestational hypertension (RR: 0.47, 95% CI: 0.25-0.90, P = 0.02). It is worth emphasizing that LMWH (or unfractionated heparin) combined with LDA did not increase the risk of bleeding. Conclusions LMWH combined with LDA can effectively improve the pregnancy outcome of women with high risk factors for PE and its complications. Although this study showed that combined medication also did not increase the risk of bleeding, but such results lack the support of large sample size studies. The clinical safety analysis of LMWH combined with LDA in patients with PE should be more carried out.
Collapse
Affiliation(s)
- Li Zheng
- Department of Pharmacy, China Aerospace Science & Industry Corporation 731 Hospital, Beijing, China
| | - Binbin Xia
- Department of Pharmacy, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yuan Yuan
- Department of Dermatology, Gansu Provincial Central Hospital, Lanzhou, China
| | - Yuran Wang
- Obstetrics and Gynecology Department, China Aerospace Science & Industry Corporation 731 Hospital, Beijing, China
| | - Yan Wang
- Department of Cardiovascular Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
3
|
Liu T, Guo X, Liao Y, Liu Y, Zhu Y, Chen X. Correlation Between the Presence of Antinuclear Antibodies and Recurrent Pregnancy Loss: A Mini Review. Front Endocrinol (Lausanne) 2022; 13:873286. [PMID: 35600596 PMCID: PMC9114698 DOI: 10.3389/fendo.2022.873286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/29/2022] [Indexed: 12/15/2022] Open
Abstract
In the past decade, the incidence of recurrent pregnancy loss (RPL) has increased significantly, and immunological disorders have been considered as one of the possible causes contributing to RPL. The presence of antinuclear antibodies (ANAs) is regarded as a typical antibody of autoimmunity. However, the relationship between the presence of ANAs and RPL, the underlying mechanism, and the possible role of immunotherapy is still controversial. The aim of this mini review is to assess the association between ANAs and RPL and the effects of immunotherapy on pregnancy outcomes in women with positive ANAs and a history of RPL from the available data and to provide a relevant reference basis for clinical application in this group of women.
Collapse
Affiliation(s)
- Ting Liu
- Department of Obstetrics and Gynaecology, Shenzhen Baoan Women’s and Children’s Hospital, Jinan University, Shenzhen, China
| | - Xi Guo
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ying Liao
- Department of Obstetrics and Gynaecology, Shenzhen Baoan Women’s and Children’s Hospital, Jinan University, Shenzhen, China
| | - Yingyu Liu
- Department of Obstetrics and Gynaecology, Shenzhen Baoan Women’s and Children’s Hospital, Jinan University, Shenzhen, China
| | - Yuanfang Zhu
- Department of Obstetrics and Gynaecology, Shenzhen Baoan Women’s and Children’s Hospital, Jinan University, Shenzhen, China
- *Correspondence: Yuanfang Zhu, ; Xiaoyan Chen, ;
| | - Xiaoyan Chen
- Department of Obstetrics and Gynaecology, Shenzhen Baoan Women’s and Children’s Hospital, Jinan University, Shenzhen, China
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- *Correspondence: Yuanfang Zhu, ; Xiaoyan Chen, ;
| |
Collapse
|
4
|
Prior Preterm Birth and Birthweight Below the 5th Percentile are Independent Risk Factors for Recurrence of a Small for Gestational Age Neonate. MATERNAL-FETAL MEDICINE 2020. [DOI: 10.1097/fm9.0000000000000034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
5
|
SARS-CoV-2 and venous thromboembolic disease. Not everything is new. ANGIOLOGIA 2020. [DOI: 10.20960/angiologia.00173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
6
|
Borgel D, Bianchini E, Lasne D, Pascreau T, Saller F. Inflammation in deep vein thrombosis: a therapeutic target? Hematology 2019; 24:742-750. [DOI: 10.1080/16078454.2019.1687144] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Delphine Borgel
- Laboratoire d’Hématologie, AP-HP, Hôpital Necker-Enfants malades, Paris, France
- INSERM UMR-S1176, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Elsa Bianchini
- INSERM UMR-S1176, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Dominique Lasne
- Laboratoire d’Hématologie, AP-HP, Hôpital Necker-Enfants malades, Paris, France
- INSERM UMR-S1176, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Tiffany Pascreau
- Laboratoire d’Hématologie, AP-HP, Hôpital Necker-Enfants malades, Paris, France
- INSERM UMR-S1176, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - François Saller
- INSERM UMR-S1176, Université Paris Saclay, Le Kremlin-Bicêtre, France
| |
Collapse
|
7
|
Karadağ C, Akar B, Gönenç G, Aslancan R, Yılmaz N, Çalışkan E. Aspirin, low molecular weight heparin, or both in preventing pregnancy complications in women with recurrent pregnancy loss and factor V Leiden mutation. J Matern Fetal Neonatal Med 2019; 33:1934-1939. [PMID: 31550962 DOI: 10.1080/14767058.2019.1671348] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: The aim of this study was to compare the effects of low molecular weight heparin (LMWH), LMWH plus low dose aspirin, or low dose aspirin only on pregnancy outcomes in recurrent pregnancy loss (RPL) patients with factor V Leiden mutation (FVLM).Materials and methods: A total of 2764 RPL patients were evaluated in for the etiology of RPL. Mutations in factor V Leiden homozygous and heterozygous were determined. Subsequently, 196 of these patients were diagnosed with FVLM and included in the study; of these 174 completed the study. At the sixth week of gestation of subsequent pregnancy participants were randomly distributed into three groups. Group A (n = 61) was composed of patients with an oral dose of 100 mg aspirin daily, Group B (n = 59) consisted of patients using 40 mg enoxaparin and 100 mg orally aspirin daily, and Group C (n = 54) included patients using 40 mg enoxaparin daily during pregnancy.Results: Among the 174 patients who completed the study, the live birth and miscarriage rates were similar for the three groups (p = .843 and p = .694, respectively). There was no significant difference among the groups in rates of eclampsia, placental abruption, intrauterine fetal growth restriction and gestational diabetes mellitus. The number of preeclamptic patients was significantly higher in Group A than Groups B and C. The levels of preterm birth was significantly higher in Group A than Groups B and C.Conclusion: Using low dose aspirin, LMWH plus aspirin, or LMWH alone yielded comparable live birth rates in RPL patients with FVLM. However, LMWH decreased the risk of preeclampsia in this group of patients. LMWH might therefore have a preventive role regarding preeclampsia.
Collapse
Affiliation(s)
- Cihan Karadağ
- Department of Obstetrics and Gynecology, Okan University School of Medicine, İstanbul, Turkey
| | - Bertan Akar
- Department of Obstetrics and Gynecology, İstinye University School of Medicine, İstanbul, Turkey
| | - Gökçenur Gönenç
- Department of Obstetrics and Gynecology, Okan University School of Medicine, İstanbul, Turkey
| | - Reyhan Aslancan
- Department of Obstetrics and Gynecology, Bahçeşehir University School of Medicine, İstanbul, Turkey
| | - Nagihan Yılmaz
- Department of Obstetrics and Gynecology, İstanbul Aydın University School of Medicine, İstanbul, Turkey
| | - Eray Çalışkan
- Department of Obstetrics and Gynecology, Okan University School of Medicine, İstanbul, Turkey
| |
Collapse
|
8
|
Kamrani A, Alipourfard I, Ahmadi-Khiavi H, Yousefi M, Rostamzadeh D, Izadi M, Ahmadi M. The role of epigenetic changes in preeclampsia. Biofactors 2019; 45:712-724. [PMID: 31343798 DOI: 10.1002/biof.1542] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 06/13/2019] [Indexed: 12/11/2022]
Abstract
Preeclampsia (PE) is a disorder affecting 2-10% of pregnancies and has a major role for perinatal and maternal mortality and morbidity. PE can be occurred by initiation of new hypertension combined with proteinuria after 20 weeks gestation, as well as various reasons such as inflammatory cytokines, poor trophoblast invasion can be related with PE disease. Environmental factors can cause epigenetic changes including DNA methylation, microRNAs (miRNAs), and histone modification that may be related to different diseases such as PE. Abnormal DNA methylation during placentation is the most important epigenetic factor correlated with PE. Moreover, changes in histone modification like acetylation and also the effect of overregulation or low regulation of miRNAs or long noncoding RNAs on variety signaling pathways can be resulted in PE. The aim of this review is to describe of studies about epigenetic changes in PE and its therapeutic strategies.
Collapse
Affiliation(s)
- Amin Kamrani
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Student's Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Iraj Alipourfard
- Center of Pharmaceutical Sciences, Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | | | - Mehdi Yousefi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Davood Rostamzadeh
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Morteza Izadi
- Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Majid Ahmadi
- Reproductive Biology Department, Tabriz University of Medical Sciences, Tabriz, Iran
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
9
|
Hemostasis-related gene polymorphisms and their epistatic relationship in women with idiopathic infertility. Blood Coagul Fibrinolysis 2019; 30:253-262. [PMID: 31259774 DOI: 10.1097/mbc.0000000000000830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
: A numerous factor can cause infertility, but around one of four reproductive failure cases remain unexplained and diagnosed as idiopathic infertility. In the past few decades, analysis of gene polymorphisms takes a significant place in pathogenesis of infertility. The aim of this study was to evaluate the possible role of hemostasis-related gene polymorphisms in unexplained infertility. The study includes 117 female patients with idiopathic infertility and 130 fertile women with at least one born child. Eight polymorphisms important for hemostasis (ITGB3 1565T>C, FV 1691G>A, FII 20210G>A, MTHFR 677C>T and 1298A>C, ATIII 786G>A, PAI-14G/5G and ACE I/D) were genotyped by real-time PCR system. The frequencies of alleles and genotypes of examined polymorphisms were analyzed in SPSS statistical program, whereas gene interactions were identified using the GMDR software. Examination of etiological factors has shown that family history is a significant factor in assessing individual risk for infertility. The alleles and genotypes frequency of FV 1691G>A and FII 20210G>A polymorphisms were statistically different between control and patient group leading to a greater risk for infertility. The analysis of epistatic relationship between examined hemostasis-related gene polymorphisms identified more complex high-risk genotypes associated with infertility. Our results suggest that positive family history could be important predictive factor for fertility problems, pointing to the potential hereditary basis of this condition. Polymorphisms FVL and FII prothrombin are independent risk factors for idiopathic infertility, whereas multilocus interactions approach should be taken into consideration for the future research.
Collapse
|
10
|
Lafalla O, Esteban LM, Lou AC, Cornudella R, Domínguez M, Sanz G, Borque-Fernando Á. Clinical utility of thrombophilia, anticoagulant treatment, and maternal variables as predictors of placenta-mediated pregnancy complications: an extensive analysis. J Matern Fetal Neonatal Med 2019; 34:588-598. [PMID: 31018724 DOI: 10.1080/14767058.2019.1611764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: The objective of this study is to analyze the usefulness of thrombophilia and antithrombotic drugs in combination with materno-fetal characteristics to generate a predictive model of placenta-mediated pregnancy complications (PMPC) for counseling treatment.Methods: A retrospective analysis was performed in women with singleton pregnancy that required a thrombophilia study, including 222 patients with unknown cause PMPC and 151 women with no complications at current pregnancy in Hospital Clínico Universitario, Lozano, Blesa, Zaragoza, Spain. Chi-squared and Mann-Whitney test were applied to analyze univariate risk factors. Multivariate analysis was performed using logistic regression model with candidate variables: maternal characteristics, obstetric history, thrombophilia, and treatment with low-molecular-weight heparin (LMWH) and/or with acid acetylsalicylic (ASA). The calibration, discrimination, and best cutoff point for the clinical application of the model was analyzed.Results: Maternal characteristics showed differences in median body mass index (BMI), odds ratio (OR): 0.4, smoking habit, OR: 8.5, and hypertension, OR: 11.4, appearing all of them as risk factors. In our study, a prior pregnancy that ended in a child alive was a protective factor OR: 0.02-0.4, and having a previous preterm child was a strong risk factor OR: 4.2. Thrombophilia was not a risk factor. Patients under LMWH treatment (15%) and/or ASA (6.2%) had better pregnancy outcomes, showing both as protective factors: ASA OR: 0.32 and LMWH OR: 0.16. The model has an AUC value of 0.847, with good calibration. A nomogram and an app is provided for this adjusted model with high discrimination ability in internal validation (AUC = 0.833). Our clinical utility analysis guide us to choose 40% as the best threshold probability.Conclusions: We found risk and protective factors associated with PMPC, but our data were not conclusive to demonstrate its relation with maternal thrombophilia. However, the challenger finding is the clinical utility of antithrombotic drugs as a protective factors in PMPC prevention. It is possible to identify patients with high risk of PMPC through a combined predictive model, for counseling treatment.
Collapse
Affiliation(s)
- Olivia Lafalla
- Department of Obstetrics and Gynecology, Hospital General San Jorge, Huesca, Spain
| | | | - Ana Cristina Lou
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario Lozano Blesa-IIS Aragón, Zaragoza, Spain
| | - Rosa Cornudella
- Department of Haemathology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Manuel Domínguez
- Unit of Gastroenterology and Hepathology, Hospital General San Jorge, Huesca, Spain
| | - Gerardo Sanz
- Department of Statistical methods, Universidad de Zaragoza, Zaragoza, Spain
| | - Ángel Borque-Fernando
- Department of Urology, Hospital Universitario Miguel Servet-IIS Aragón, Zaragoza, Spain
| |
Collapse
|
11
|
Mikolaiczik K, Praetner M, Rüth M, Mark K. Delayed hemolysis, elevated liver enzymes, low platelet count syndrome in succession of switches of preventive anticoagulant treatment in a 41-year-old patient with a history of recurrent assisted implantation failures: a case report. J Med Case Rep 2019; 13:16. [PMID: 30658715 PMCID: PMC6339357 DOI: 10.1186/s13256-018-1943-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 12/05/2018] [Indexed: 11/13/2022] Open
Abstract
Background For the past decades the mean age of primiparae in Western societies is constantly increasing. At the same time, there is a growing demand for assisted reproductive technologies such as in vitro fertilization and intracytoplasmic sperm injection. Subsequently, a higher prevalence of pregnancy-associated diseases such as gestational hypertension and preeclampsia is observed. To improve pregnancy rates after in vitro fertilization/intracytoplasmic sperm injection and to reduce the risk of pregnancy-associated diseases with a cardiovascular pathophysiology, two anticoagulants are the focus of current research: low molecular weight heparin and acetylsalicylic acid (aspirin). Case presentation A 41-year-old white woman, gravida 3, para 0, received low molecular weight heparin to reduce the risk of abortion after five unsuccessful intracytoplasmic sperm injections and two miscarriages. She autonomously discontinued the medication with low molecular weight heparin at 12 weeks and 2 days of gestation and took aspirin instead until 24 weeks and 2 days of gestation as preeclampsia prophylaxis. However, the pregnancy ended with an urgent cesarean section at 27 weeks and 4 days of gestation due to a fast progressing hemolysis, elevated liver enzyme levels, and low blood platelet count syndrome, a potentially life-threatening variant of preeclampsia. Conclusion Based on the current demographic trend toward late-in-life pregnancy it is mandatory to establish clear guidelines concerning preventive treatment options of preeclampsia for patients with risk factors. The establishment of a special first-trimester screening for these women should be discussed. Moreover, it is necessary to raise the awareness among physicians of these contemporary issues to guarantee the best possible medical care. Electronic supplementary material The online version of this article (10.1186/s13256-018-1943-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Katrin Mikolaiczik
- Rottal-Inn-Kliniken Krankenhaus Eggenfelden, Simonsöder Allee 20, 84307, Eggenfelden, Germany.
| | - Marc Praetner
- Walter Brendel Centre for Experimental Medicine, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, Munich, Germany
| | - Michael Rüth
- Kliniken Nordoberpfalz AG, Krankenhaus Tirschenreuth, St.-Peter-Str. 31, 95643, Tirschenreuth, Germany
| | - Karlheinz Mark
- Kliniken Nordoberpfalz AG, Klinikum Weiden, Söllnerstraße 16, 92637, Weiden, Germany
| |
Collapse
|
12
|
Jawad AK, Alalaf SK, Ali MS, Bawadikji AA. Bemiparin as a Prophylaxis After an Unexplained Stillbirth: Open-Label Interventional Prospective Study. Clin Appl Thromb Hemost 2019; 25:1076029619896629. [PMID: 31880168 PMCID: PMC7019397 DOI: 10.1177/1076029619896629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/11/2019] [Accepted: 11/26/2019] [Indexed: 11/18/2022] Open
Abstract
Stillbirth is a devastating event to the parents, relatives, friends, and families. The role of anticoagulants in the prevention of unexplained stillbirths is uncertain. An open-label interventional prospective cohort study was conducted on 144 women with a history of unexplained stillbirths. The intervention group had a high umbilical artery resistance index (RI) and received bemiparin. The nonintervention group had a normal RI and did not receive any intervention. We measured the adjusted odds ratio (OR) and 95% confidence interval (CI) of the main outcome for these variables using logistic regression analysis. Fresh stillbirth and early neonatal death rates were lower (P = .005, OR = 11.949 and 95% CI = 2.099-68.014) and newborn weight was higher (P = .015, OR = 0.048, 95% CI = 0.004-0.549) in the group that received bemiparin. Bemiparin is effective in decreasing the rate of stillbirth in women with a history of previous unexplained stillbirths.
Collapse
Affiliation(s)
- Ariana Khalis Jawad
- Department of Obstetrics and Gynecology, Kurdistan Board of Medical
Specialty, Erbil, Kurdistan, Iraq
| | - Shahla Kareem Alalaf
- Department of Obstetrics and Gynecology, College of Medicine, Hawler Medical
University, Erbil, Kurdistan, Iraq
| | - Mahabad Salih Ali
- Department of Obstetrics and Gynecology, Ministry of Health, Maternity
Teaching Hospital, Erbil, Kurdistan, Iraq
| | | |
Collapse
|
13
|
Wang X, Gao H. Prevention of preeclampsia in high-risk patients with low-molecular-weight heparin: a meta-analysis. J Matern Fetal Neonatal Med 2018; 33:2202-2208. [PMID: 30458652 DOI: 10.1080/14767058.2018.1543656] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: To assess the secondary preventive effect of low-molecular-weight heparin (LMWH) on pregnant women with prior early-onset or severe preeclampsia (PE).Methods: A systematic literature search of several databases was conducted for randomized controlled trials comparing LMWH with either aspirin or no treatment in pregnant women at a high risk of placental-mediated pregnancy complications (PMPCs). Odds ratios and associated 95% confidence intervals (CI) and weighted mean differences and 95% CI were calculated.Results: Seven studies including 1035 patients were evaluated. These studies showed a risk reduction in composite PMPC outcome (relative risk (RR) 0.635 (95% CI: 0.436-0.925); p=.018), PE (RR 0.522 (95% CI: 0.334-0.815); p=.004), a small-for-gestational-age neonate (RR 0.622 (95% CI: 0.440-0.880); p=.007), and an increase in gestational length (SMD 0.312 (95% CI: 0.017-0.607); p=.038) and neonatal weight (SMD 0.428 (95% CI: 0.066-0.791); p=.020).Conclusions: LMWH has a secondary preventive effect on early or severe PE and improves neonatal outcomes. In the future, additional large multicenter studies will need to focus on high-risk PE groups by more accurate screening to obtain more information before clinical application.
Collapse
Affiliation(s)
- Xiaoyi Wang
- Internal Medicine Department, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Hong Gao
- Internal Medicine Department, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
14
|
Yang J, Liu W, Yi M, Song S, Ai C, Zhao J. Depolymerization of heparin by dielectric barrier discharge: Effect of operating modes and anticoagulant potential analysis of low-molecular-weight products. Chem Phys Lett 2018. [DOI: 10.1016/j.cplett.2018.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
15
|
Vicente-Pascual M, Albano A, Solinís MÁ, Serpe L, Rodríguez-Gascón A, Foglietta F, Muntoni E, Torrecilla J, Pozo-Rodríguez AD, Battaglia L. Gene delivery in the cornea: in vitro & ex vivo evaluation of solid lipid nanoparticle-based vectors. Nanomedicine (Lond) 2018; 13:1847-1854. [PMID: 29792369 DOI: 10.2217/nnm-2018-0112] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIM Inflammation is a process that underlies sight-threatening ocular surface diseases, and gene supplementation with the plasmid that encodes for p-IL10 will allow the sustained de novo synthesis of the cytokine to occur in corneal cells, and provide a long-term anti-inflammatory effect. This work describes the development of solid lipid nanoparticle systems for the delivery of p-IL10 to transfect the cornea. RESULTS In vitro, vectors showed suitable features as nonviral vectors (size, ζ-potential, DNA binding, protection and release), and they were able to enter and transfect human corneal epithelial cells. Ex vivo, the vectors were found to transfect the epithelium, the stroma and the endothelium in rabbit corneal explants. Distribution of gene expression within the cell layers of the cornea depended on the composition of the four vectors evaluated. CONCLUSION Solid lipid nanoparticle-based vectors are promising gene delivery systems for corneal diseases, including inflammation.
Collapse
Affiliation(s)
- Mónica Vicente-Pascual
- Pharmacokinetic, Nanotechnology & Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz, Spain
| | - Andrea Albano
- Pharmacokinetic, Nanotechnology & Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz, Spain.,Università degli Studi di Torino, Dipartimento di Scienza e Tecnologia del Farmaco, via Pietro Giuria 9, Turin, Italy
| | - María Á Solinís
- Pharmacokinetic, Nanotechnology & Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz, Spain
| | - Loredana Serpe
- Università degli Studi di Torino, Dipartimento di Scienza e Tecnologia del Farmaco, via Pietro Giuria 9, Turin, Italy
| | - Alicia Rodríguez-Gascón
- Pharmacokinetic, Nanotechnology & Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz, Spain
| | - Federica Foglietta
- Università degli Studi di Torino, Dipartimento di Scienza e Tecnologia del Farmaco, via Pietro Giuria 9, Turin, Italy
| | - Elisabetta Muntoni
- Università degli Studi di Torino, Dipartimento di Scienza e Tecnologia del Farmaco, via Pietro Giuria 9, Turin, Italy
| | - Josune Torrecilla
- Pharmacokinetic, Nanotechnology & Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz, Spain
| | - Ana Del Pozo-Rodríguez
- Pharmacokinetic, Nanotechnology & Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz, Spain
| | - Luigi Battaglia
- Università degli Studi di Torino, Dipartimento di Scienza e Tecnologia del Farmaco, via Pietro Giuria 9, Turin, Italy
| |
Collapse
|
16
|
Hypomethylation of tissue factor pathway inhibitor 2 in human placenta of preeclampsia. Thromb Res 2017; 152:7-13. [PMID: 28208084 DOI: 10.1016/j.thromres.2017.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/23/2017] [Accepted: 02/07/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate the expression, DNA methylation status and its regulatory mechanism of tissue factor pathway inhibitor 2 (TFPI-2) in human placenta tissues of preeclampsia (PE). MATERIAL AND METHODS We studied the mRNA and protein expression and the promoter methylation levels of TFPI-2 in the PE placentas compared with those in the normal pregnant (NP) women. Quantitative real-time polymerase chain reaction, immunohistochemistry, western blot, and Sequenom MassARRAY were used for placenta tissue detection. RESULTS The expressions of TFPI-2 mRNA and protein were significantly elevated in the PE placentas when compared with those in the NP ones (P<0.05). Hypomethylation of the TFPI-2 promoter was detected both in PE patients and NP women, with a significant decrease in PE placentas (P=0.005). The methylation level was significantly decreased at CpG_6 (-168 to -167), CpG_15 (-98 to -97) and CpG_18.19 (-68 to -65) in PE patients than that in normal placentas (P<0.05). However, the expression of DNMT-1 didn't show significant difference between the two groups (P>0.05). CONCLUSION Over-expression of TFPI-2 and aberrant promoter mythylation status presented in the PE placentas, suggesting that epigenetic mechanism might contribute to the pathogenesis of PE.
Collapse
|
17
|
Heparin exerts anti-apoptotic effects on uterine explants by targeting the endocannabinoid system. Apoptosis 2016; 21:965-76. [PMID: 27364950 DOI: 10.1007/s10495-016-1269-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Miscarriage caused by Gram-negative bacteria infecting the female genital tract is one of the most common complications of human pregnancy. Intraperitoneal administration of LPS to 7-days pregnant mice induces embryo resorption after 24 h. Here, we show that LPS induced apoptosis on uterine explants from 7-days pregnant mice and that CB1 receptor was involved in this effect. On the other hand, heparin has been widely used for the prevention of pregnancy loss in women with frequent miscarriage with or without thrombophilia. Besides its anticoagulant properties, heparin exerts anti-inflammatory, immunomodulatory and anti-apoptotic effects. Here, we sought to investigate whether the administration of heparin prevented LPS-induced apoptosis in uterine explants from 7-days pregnant mice. We found that heparin enhanced cell survival in LPS-treated uterine explants and that this effect was mediated by increasing uterine FAAH activity. Taken together, our results point towards a novel mechanism involved in the protective effects of heparin.
Collapse
|
18
|
Roberge S, Demers S, Nicolaides KH, Bureau M, Côté S, Bujold E. Prevention of pre-eclampsia by low-molecular-weight heparin in addition to aspirin: a meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:548-553. [PMID: 26481090 DOI: 10.1002/uog.15789] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/23/2015] [Accepted: 10/08/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To estimate the impact of adding low-molecular-weight heparin (LMWH) or unfractionated heparin to low-dose aspirin started ≤ 16 weeks' gestation on the prevalence of pre-eclampsia (PE) and the delivery of a small-for-gestational-age (SGA) neonate. METHODS A systematic review and meta-analysis of randomized controlled trials (RCTs) was performed by searching the medical databases PubMed, EMBASE, Web of Science and Cochrane Central. Pregnant women randomized to receive LMWH or unfractionated heparin in addition to low-dose aspirin were compared with those who received low-dose aspirin alone. Outcome measures were PE, severe PE, early-onset PE and SGA. Pooled relative risks (RRs) with 95% CI were calculated using a random-effects model. RESULTS Eight RCTs met the inclusion criteria; the indication for recruitment was previous recurrent miscarriage in five studies (three included women with thrombophilia) and a history of severe or early-onset PE in three studies (including women with thrombophilia in one). LMWH was administered in seven studies and unfractionated heparin in one. In women with a history of PE, treatment with LMWH and aspirin, compared with aspirin alone, was associated with a significant reduction in development of PE (three trials (n = 379); RR, 0.54 (95% CI, 0.31-0.92); P = 0.03) and in delivery of SGA neonates (two trials (n = 363); RR, 0.54 (95% CI, 0.32-0.91); P = 0.02). These outcomes were not significantly reduced in women with recurrent miscarriage who received LMWH and aspirin, compared with aspirin alone. The small number of studies precluded sensitivity analyses and the evaluation of publication biases. Blinding to the allocation treatment was absent in all RCTs. CONCLUSIONS Based on limited evidence, the addition of LMWH to low-dose aspirin could reduce the prevalence of PE and SGA in women with a history of PE. This observation should be the basis of a well-conducted future trial rather than a recommendation for immediate clinical application. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- S Roberge
- Department of Social and Preventive Medicine, Université Laval, Québec, Canada
| | - S Demers
- Department of Social and Preventive Medicine, Université Laval, Québec, Canada
- Department of Obstetrics and Gynecology, Université Laval, Québec, Canada
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - M Bureau
- Department of Obstetrics and Gynecology, Université Laval, Québec, Canada
| | - S Côté
- Department of Medicine, Université Laval, Québec, Canada
| | - E Bujold
- Department of Social and Preventive Medicine, Université Laval, Québec, Canada
- Department of Obstetrics and Gynecology, Université Laval, Québec, Canada
| |
Collapse
|
19
|
Khamashta M, Taraborelli M, Sciascia S, Tincani A. Antiphospholipid syndrome. Best Pract Res Clin Rheumatol 2016; 30:133-48. [DOI: 10.1016/j.berh.2016.04.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
20
|
von Tempelhoff GF, Schelkunov O, Demirhan A, Tsikouras P, Rath W, Velten E, Csorba R. Thrombelastometric results and platelet function during pregnancy in women receiving low molecular weight heparin with a history of recurrent/late abortion – A retrospective analysis. Clin Hemorheol Microcirc 2015; 61:99-110. [DOI: 10.3233/ch-151949] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Georg-Friedrich von Tempelhoff
- Department of Obstetrics and Gynaecology, St. Vinzenz Hospital, Hanau, Germany
- Institute of Coagulation Disorders in Obstetrics and Gynaecology, Hausen, Germany
| | - Olga Schelkunov
- Department of Obstetrics and Gynaecology, St. Vinzenz Hospital, Hanau, Germany
- Institute of Coagulation Disorders in Obstetrics and Gynaecology, Hausen, Germany
| | - Attila Demirhan
- Department of Obstetrics and Gynaecology, St. Vinzenz Hospital, Hanau, Germany
- Institute of Coagulation Disorders in Obstetrics and Gynaecology, Hausen, Germany
| | - Panagiotis Tsikouras
- Institute of Coagulation Disorders in Obstetrics and Gynaecology, Hausen, Germany
- Democritus University of Thrace, Department of Obstetrics and Gynecology, Alexandroupolis, Greece
| | - Werner Rath
- Department of Obstetrics and Gynaecology, RWTH University of Aachen, Germany
| | - Eva Velten
- Department of Obstetrics and Gynaecology, City Hospital of Aschaffenburg, Aschaffenburg, Germany
- Institute of Coagulation Disorders in Obstetrics and Gynaecology, Hausen, Germany
| | - Roland Csorba
- Department of Obstetrics and Gynaecology, City Hospital of Aschaffenburg, Aschaffenburg, Germany
- Institute of Coagulation Disorders in Obstetrics and Gynaecology, Hausen, Germany
- Department of Obstetrics and Gynaecology, University of Debrecen, Hungary
| |
Collapse
|