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Mitra T, Gulati R, Uppal A, Kumari SR, Tripathy S, Ranjan P, Janardhanan R. Prospecting of exosomal-miRNA signatures as prognostic marker for gestational diabetes mellitus and other adverse pregnancy outcomes. Front Endocrinol (Lausanne) 2023; 14:1097337. [PMID: 36843574 PMCID: PMC9946972 DOI: 10.3389/fendo.2023.1097337] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
Exosomal microRNA (ExomiRs) serves as potential cargo molecules responsible for post-translation of gene expression and intracellular communication playing a vital role in acting as clinically relevant prognostic biomarkers for identifying pregnancy-associated complications in patients. ExomiRs are associated with Gestational Diabetes Mellitus (GDM) as potential targets for understanding the pathophysiology of beta-cell dysfunction. ExomiRs (ExomiR 122, ExomiR 16-5p, ExomiR 215-5p, ExomiR 450b-3p, ExomiR 122-5p) aid to act as biomarkers and regulate the progression of diabetes and its related complication. These ExomiRshave been reported to interfere with the regulation of various genes such as ZEB2, IRS1, IRS2, GLUT1, GLUT4, etc. and inhibition of several pathways like PI3K/AKT, Wnt, and mTOR signaling pathways leading to the modulation in the development of GDM affecting the clinical and pathological features of women. These ExomiRs have also been associated with other pregnancy-associated complications, including preeclampsia, hypothyroidism, pregnancy loss, and ectopic pregnancies. On the other hand, overexpression of certain ExomiRs such as Exomir-515-5p, ExomiR-221, and ExomiR-96 serve a regulatory role in overcoming insulin resistance. Taken together, the current review focuses on the prospective capabilities of ExomiRs for diagnosis and clinical prognosis of GDM women with respect to pregnancy outcomes.
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Affiliation(s)
- Tridip Mitra
- Department of Medical Research, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
| | - Richa Gulati
- Department of Medical Research, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
| | | | - Sajeetha R Kumari
- Department of Obstetrics and Gynaecology, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
| | | | - Priya Ranjan
- Department of Electrical Engineering, Biju Patnaik University of Technology, Rourkela, Odisha, India
| | - Rajiv Janardhanan
- Department of Medical Research, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
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2
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Piccoli GB, Torreggiani M, Crochette R, Cabiddu G, Masturzo B, Attini R, Versino E. What a paediatric nephrologist should know about preeclampsia and why it matters. Pediatr Nephrol 2022; 37:1733-1745. [PMID: 34735598 DOI: 10.1007/s00467-021-05235-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/06/2021] [Accepted: 07/13/2021] [Indexed: 12/24/2022]
Abstract
Preeclampsia is a protean syndrome causing a kidney disease characterised by hypertension and proteinuria, usually considered transitory and reversible after delivery. Its prevalence ranges from 3-5 to 10% if all the related disorders are considered. This narrative review, on behalf of the Kidney and Pregnancy Study Group of the Italian Society of Nephrology, focuses on three reasons why preeclampsia should concern paediatric nephrologists and how they can play an important role in its prevention, as well as in the prevention of future kidney and cardiovascular diseases. Firstly, all diseases of the kidney and urinary tract diagnosed in paediatric age are associated with a higher risk of adverse pregnancy-related outcomes, including preeclampsia. Secondly, babies with low birth weights (small for gestational age, born preterm, or both) have an increased risk of developing the full panoply of metabolic diseases (obesity, hypertension, early-onset cardiopathy and chronic kidney disease) and girls are at higher risk of developing preeclampsia when pregnant. The risk may be particularly high in cases of maternal preeclampsia, highlighting a familial aggregation of this condition. Thirdly, pregnant teenagers have a higher risk of developing preeclampsia and the hypertensive disorders of pregnancy, and should be followed up as high risk pregnancies. In summary, preeclampsia has come to be seen as a window on the future health of both mother and baby. Identification of subjects at risk, early counselling and careful follow-up can contribute to reducing the high morbidity linked with this disorder.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Néphrologie Et Dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72000, Le Mans, France.
| | - Massimo Torreggiani
- Néphrologie Et Dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72000, Le Mans, France
| | - Romain Crochette
- Néphrologie Et Dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72000, Le Mans, France
| | | | - Bianca Masturzo
- Department of Obstetrics and Gynecology, Città della Salute e della Scienza, Ospedale Sant'Anna, University of Torino, Turin, Italy
| | - Rossella Attini
- Department of Obstetrics and Gynecology, Città della Salute e della Scienza, Ospedale Sant'Anna, University of Torino, Turin, Italy
| | - Elisabetta Versino
- Epidemiology, Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
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3
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Vision for Improving Pregnancy Health: Innovation and the Future of Pregnancy Research. Reprod Sci 2022; 29:2908-2920. [PMID: 35534766 PMCID: PMC9537127 DOI: 10.1007/s43032-022-00951-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/15/2022] [Indexed: 10/25/2022]
Abstract
Understanding, predicting, and preventing pregnancy disorders have been a major research target. Nonetheless, the lack of progress is illustrated by research results related to preeclampsia and other hypertensive pregnancy disorders. These remain a major cause of maternal and infant mortality worldwide. There is a general consensus that the rate of progress toward understanding pregnancy disorders lags behind progress in other aspects of human health. In this presentation, we advance an explanation for this failure and suggest solutions. We propose that progress has been impeded by narrowly focused research training and limited imagination and innovation, resulting in the failure to think beyond conventional research approaches and analytical strategies. Investigations have been largely limited to hypothesis-generating approaches constrained by attempts to force poorly defined complex disorders into a single "unifying" hypothesis. Future progress could be accelerated by rethinking this approach. We advise taking advantage of innovative approaches that will generate new research strategies for investigating pregnancy abnormalities. Studies should begin before conception, assessing pregnancy longitudinally, before, during, and after pregnancy. Pregnancy disorders should be defined by pathophysiology rather than phenotype, and state of the art agnostic assessment of data should be adopted to generate new ideas. Taking advantage of new approaches mandates emphasizing innovation, inclusion of large datasets, and use of state of the art experimental and analytical techniques. A revolution in understanding pregnancy-associated disorders will depend on networks of scientists who are driven by an intense biological curiosity, a team spirit, and the tools to make new discoveries.
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Myatt L. The prediction of preeclampsia: the way forward. Am J Obstet Gynecol 2022; 226:S1102-S1107.e8. [PMID: 33785181 DOI: 10.1016/j.ajog.2020.10.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 10/22/2020] [Accepted: 10/27/2020] [Indexed: 11/17/2022]
Abstract
Despite intensive investigation, we still cannot adequately predict, treat, or prevent preeclampsia. We have gained awareness that preeclampsia is a syndrome not a disease and is heterogeneous in its presentation and pathophysiology, which may indicate differing underlying phenotypes, and that the impact extends beyond pregnancy per se. Effects on the fetus and mother extend many years after pregnancy, as evidenced by fetal programming of adult disease and increased risk of the development of maternal cardiovascular disease. The increased occurrence of preeclampsia in women with preexisting risk factors suggests that the stress of pregnancy may expose subclinical vascular disease as opposed to preeclampsia damaging the vasculature. The heterogeneity of preeclampsia has blighted efforts to predict preeclampsia early in gestation and has thwarted success in attempts at therapy with treatments, such as low-dose aspirin or global antioxidants. There is a critical need to identify the phenotypes to enable their specific prediction and treatment. Such studies require considerably larger collections of patients than employed in past and current studies. This does not necessarily imply much larger patient numbers in single studies but can be facilitated by the ability to easily combine many smaller studies. This can be accomplished by agreeing on a priori standardized and harmonized clinical data and biospecimen collection across new studies. Such standards are being established by international groups of investigators. Leadership by international organizations, perhaps adopting a carrot and stick approach, to overcome investigator, institutional and funder reticence toward data sharing is required to ensure adoption of such standards. Future studies should include women in both low- and high-resource settings and employ social media and novel methods for data collection and analysis, including machine learning and artificial intelligence. The goal is to identify the pathophysiology underlying differing preeclampsia phenotypes, their successful prediction with the design, and the implementation of phenotype-specific therapies.
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Affiliation(s)
- Leslie Myatt
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR.
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Redman CW, Staff AC, Roberts JM. Syncytiotrophoblast stress in preeclampsia: the convergence point for multiple pathways. Am J Obstet Gynecol 2022; 226:S907-S927. [PMID: 33546842 DOI: 10.1016/j.ajog.2020.09.047] [Citation(s) in RCA: 126] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/14/2020] [Accepted: 09/19/2020] [Indexed: 12/29/2022]
Abstract
Preeclampsia evolves in 2 stages: a placental problem that generates signals to the mother to cause a range of responses that comprise the second stage (preeclampsia syndrome). The first stage of early-onset preeclampsia is poor placentation, which we here call malplacentation. The spiral arteries are incompletely remodeled, leading to later placental malperfusion, relatively early in the second half of pregnancy. The long duration of the first stage (several months) is unsurprisingly associated with fetal growth restriction. The first stage of late-onset preeclampsia, approximately 80% of total cases, is shorter (several weeks) and part of a process that is common to all pregnancies. Placental function declines as it outgrows uterine capacity, with increasing chorionic villous packing, compression of the intervillous space, and fetal hypoxia, and causes late-onset clinical presentations such as "unexplained" stillbirths, late-onset fetal growth restriction, or preeclampsia. The second stages of early- and late-onset preeclampsia share syncytiotrophoblast stress as the most relevant feature that causes the maternal syndrome. Syncytiotrophoblast stress signals in the maternal circulation are probably the most specific biomarkers for preeclampsia. In addition, soluble fms-like tyrosine kinase-1 (mainly produced by syncytiotrophoblast) is the best-known biomarker and is routinely used in clinical practice in many locations. How the stress signals change over time in normal pregnancies indicates that syncytiotrophoblast stress begins on average at 30 to 32 weeks' gestation and progresses to term. At term, syncytiotrophoblast shows increasing markers of stress, including apoptosis, pyroptosis, autophagy, syncytial knots, and necrosis. We label this phenotype the "twilight placenta" and argue that it accounts for the clinical problems of postmature pregnancies. Senescence as a stress response differs in multinuclear syncytiotrophoblast from that of mononuclear cells. Syncytiotrophoblast irreversibly acquires part of the senescence phenotype (cell cycle arrest) when it is formed by cell fusion. The 2 pathways converge on the common pathologic endpoint, syncytiotrophoblast stress, and contribute to preeclampsia subtypes. We highlight that the well-known heterogeneity of the preeclampsia syndrome arises from different pathways to this common endpoint, influenced by maternal genetics, epigenetics, lifestyle, and environmental factors with different fetal and maternal responses to the ensuing insults. This complexity mandates a reassessment of our approach to predicting and preventing preeclampsia, and we summarize research priorities to maximize what we can learn about these important issues.
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Cabiddu G, Longhitano E, Cataldo E, Lepori N, Chatrenet A, Torreggiani M, Attini R, Masturzo B, Rossini M, Versino E, Moroni G, Pani A, Gesualdo L, Santoro D, Piccoli GB. History of Preeclampsia in Patients Undergoing a Kidney Biopsy: A Biphasic, Multiple-Hit Pathogenic Hypothesis. Kidney Int Rep 2021; 7:547-557. [PMID: 35257067 PMCID: PMC8897305 DOI: 10.1016/j.ekir.2021.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- Gianfranca Cabiddu
- Nephrology, Department of Medical Science and Public Health, San Michele Hospital, ARNAS G. Brotzu, University of Cagliari, Cagliari, Italy
| | - Elisa Longhitano
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, A.O.U. “G. Martino,” University of Messina, Messina, Italy
| | | | - Nicola Lepori
- Nephrology, Department of Medical Science and Public Health, San Michele Hospital, ARNAS G. Brotzu, University of Cagliari, Cagliari, Italy
| | | | | | - Rossella Attini
- Department of Surgery, Obstetrics, University of Torino, Torino, Italy
| | - Bianca Masturzo
- Department of Surgery, Obstetrics, University of Torino, Torino, Italy
| | | | - Elisabetta Versino
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Gabriella Moroni
- Division of Nephrology and Dialysis, Humanitas Research Hospital, Milan, Italy
| | - Antonello Pani
- Nephrology, Department of Medical Science and Public Health, San Michele Hospital, ARNAS G. Brotzu, University of Cagliari, Cagliari, Italy
| | | | - Domenico Santoro
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, A.O.U. “G. Martino,” University of Messina, Messina, Italy
| | - Giorgina Barbara Piccoli
- Néphrologie et Dialyse, Centre Hospitalier, Le Mans, France
- Correspondence: Giorgina Barbara Piccoli, Nephrology and Dialysis Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037 Le Mans, France.
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7
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Zhou F, Sun Y, Chi Z, Gao Q, Wang H. Long noncoding RNA SNHG12 promotes the proliferation, migration, and invasion of trophoblast cells by regulating the epithelial-mesenchymal transition and cell cycle. J Int Med Res 2021; 48:300060520922339. [PMID: 32529873 PMCID: PMC7294383 DOI: 10.1177/0300060520922339] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Objective The deficient placental blood perfusion caused by the attenuated infiltration of trophoblast cells is a key factor in the occurrence of preeclampsia (PE). Furthermore, the long noncoding (lnc)RNA SNHG12 (small nucleolar RNA host gene 12) can promote the proliferation and metastasis of multiple tumor cells. However, whether lncRNA SNHG12 affects proliferation and metastasis of trophoblast cells is unclear. Methods We examined the level of lncRNA SNHG12 in plasma and placenta of patients with PE and constructed trophoblast cells with overexpressed or knocked down SNHG12. CCK-8, wound healing, and Transwell assays were used to detect alterations in proliferation, migration, and invasion of trophoblast cells. Western blotting was used to detect proteins related to the epithelial–mesenchymal transition (EMT), and cell cycle assays clarified cell cycle distribution. Results LncRNA SNHG12 promoted the proliferation, migration, and invasion of trophoblast cells. The expression of matrix metalloproteinase-2 (MMP-2) and MMP-9, β-catenin, and vimentin were positively correlated with SNHG12, and expression of E-cadherin was negatively correlated with SNHG12. SNHG12 also promoted the transition of trophoblast cells from G0/G1 to S phase. Conclusion Overall, lncRNA SNHG12 promoted the migration and invasion of trophoblast cells by inducing the progression of EMT.
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Affiliation(s)
- Fenmei Zhou
- Department of Obstetrics, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu Province, China
| | - Yanlan Sun
- Department of Obstetrics, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu Province, China
| | - Zhenjing Chi
- Department of Obstetrics, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu Province, China
| | - Qiong Gao
- Department of Obstetrics, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu Province, China
| | - Hairong Wang
- Department of Obstetrics, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu Province, China
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8
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Roberts JM, Rich-Edwards JW, McElrath TF, Garmire L, Myatt L. Subtypes of Preeclampsia: Recognition and Determining Clinical Usefulness. Hypertension 2021; 77:1430-1441. [PMID: 33775113 DOI: 10.1161/hypertensionaha.120.14781] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The concept that preeclampsia is a multisystemic syndrome is appreciated in both research and clinical care. Our understanding of pathophysiology recognizes the role of inflammation, oxidative and endoplasm reticulum stress, and angiogenic dysfunction. Yet, we have not progressed greatly toward clinically useful prediction nor had substantial success in prevention or treatment. One possibility is that the maternal syndrome may be reached through different pathophysiological pathways, that is, subtypes of preeclampsia, that in their specificity yield more clinical utility. For example, early and late onset preeclampsia are increasingly acknowledged as different pathophysiological processes leading to a common presentation. Other subtypes of preeclampsia are supported by disparate clinical outcomes, long-range prognosis, organ systems involved, and risk factors. These insights have been supplemented by discovery-driven methods, which cluster preeclampsia cases into groups indicating different pathophysiologies. In this presentation, we review likely subtypes based on current knowledge and suggest others. We present a consideration of the requirements for a clinically meaningful preeclampsia subtype. A useful subtype should (1) identify a specific pathophysiological pathway or (2) specifically indicate maternal or fetal outcome, (3) be recognizable in a clinically useful time frame, and (4) these results should be reproducible and generalizable (but at varying frequency) including in low resource settings. We recommend that the default consideration be that preeclampsia includes several subtypes rather than trying to force all cases into a single pathophysiological pathway. The recognition of subtypes and deciphering their different pathophysiologies will provide specific targets for prevention, prediction, and treatment directing personalized care.
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Affiliation(s)
- James M Roberts
- Magee-Womens Research Institute, Department of Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, University of Pittsburgh (J.M.R.)
| | - Janet W Rich-Edwards
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA (J.W.R.-E.).,Division of Women's Health, Department of Medicine (J.W.R.-E.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Thomas F McElrath
- Division of Maternal-Fetal Medicine (T.F.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Lana Garmire
- Department of Computational Medicine and Bioinformatics, Medical School, University of Michigan (L.G.)
| | - Leslie Myatt
- Department of Obstetrics and Gynecology, Moore Institute of Nutrition and Wellness, Oregon Health and Science University (L.M.)
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9
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Differences in Placental Imprinted Gene Expression across Preeclamptic and Non-Preeclamptic Pregnancies. Genes (Basel) 2020; 11:genes11101146. [PMID: 33003346 PMCID: PMC7601230 DOI: 10.3390/genes11101146] [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: 08/12/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 11/16/2022] Open
Abstract
Preeclampsia is a multi-systemic syndrome that presents in approximately 5% of pregnancies worldwide and is associated with a range of subsequent postpartum and postnatal outcomes, including fetal growth restriction. As the placenta plays a critical role in the development of preeclampsia, surveying genomic features of the placenta, including expression of imprinted genes, may reveal molecular markers that can further refine subtypes to aid targeted disease management. In this study, we conducted a comprehensive survey of placental imprinted gene expression across early and late onset preeclampsia cases and preterm and term normotensive controls. Placentas were collected at delivery from women recruited at the Magee-Womens Hospital prenatal clinics, and expression levels were profiled across 109 imprinted genes. We observed downregulation of placental Mesoderm-specific transcript (MEST) and Necdin (NDN) gene expression levels (false discovery rate (FDR) < 0.05) among early onset preeclampsia cases compared to preterm controls. No differences in placental imprinted gene expression were observed between late onset preeclampsia cases and term controls. While few studies have linked NDN to pregnancy complications, reductions in MEST expression levels, as observed in our study, are consistently reported in the literature in relation to various pregnancy complications, including fetal growth restriction, suggesting a potential role for placental MEST expression as a biosensor of an adverse in utero environment.
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10
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Carrilho TRB, Farias DR, Batalha MA, Costa NCF, Rasmussen KM, Reichenheim ME, Ohuma EO, Hutcheon JA, Kac G. Brazilian Maternal and Child Nutrition Consortium: establishment, data harmonization and basic characteristics. Sci Rep 2020; 10:14869. [PMID: 32913200 PMCID: PMC7483530 DOI: 10.1038/s41598-020-71612-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/18/2020] [Indexed: 12/03/2022] Open
Abstract
Pooled data analysis in the field of maternal and child nutrition rarely incorporates data from low- and middle-income countries and existing studies lack a description of the methods used to harmonize the data and to assess heterogeneity. We describe the creation of the Brazilian Maternal and Child Nutrition Consortium dataset, from multiple pooled longitudinal studies, having gestational weight gain (GWG) as an example. Investigators of the eligible studies published from 1990 to 2018 were invited to participate. We conducted consistency analysis, identified outliers, and assessed heterogeneity for GWG. Outliers identification considered the longitudinal nature of the data. Heterogeneity was performed adjusting multilevel models. We identified 68 studies and invited 59 for this initiative. Data from 29 studies were received, 21 were retained for analysis, resulting in a final sample of 17,344 women with 72,616 weight measurements. Fewer than 1% of all weight measurements were flagged as outliers. Women with pre-pregnancy obesity had lower values for GWG throughout pregnancy. GWG, birth length and weight were similar across the studies and remarkably similar to a Brazilian nationwide study. Pooled data analyses can increase the potential of addressing important questions regarding maternal and child health, especially in countries where research investment is limited.
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Affiliation(s)
- Thaís Rangel Bousquet Carrilho
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho 373/CCS, bloco J, 2 andar, sala 29, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Dayana Rodrigues Farias
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho 373/CCS, bloco J, 2 andar, sala 29, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Mônica Araújo Batalha
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho 373/CCS, bloco J, 2 andar, sala 29, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Nathalia Cristina Freitas Costa
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho 373/CCS, bloco J, 2 andar, sala 29, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Kathleen M Rasmussen
- Division of Nutritional Sciences, Cornell University, 227 Savage Hall, Ithaca, NY, 14850, USA
| | - Michael E Reichenheim
- Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rua São Francisco Xavier, 524, 7 andar, Bloco D, Sala 7018, Maracanã, Rio de Janeiro, RJ, 20550-013, Brazil
| | - Eric O Ohuma
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Research (PMB), South Parks Road, Oxford, OX1 3SY, UK
| | - Jennifer A Hutcheon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC, V6Z 2K8, Canada
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Avenida Carlos Chagas Filho 373/CCS, bloco J, 2 andar, sala 29, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ, 21941-902, Brazil.
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11
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Roberts JM, Countouris M. White Coat Hypertension in Pregnancy: The Challenge of Combining Inconsistent Data. Hypertension 2020; 76:35-37. [PMID: 32520624 DOI: 10.1161/hypertensionaha.120.15056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- James M Roberts
- From the Magee-Womens Research Institute, Obstetrics Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research (J.M.R.), University of Pittsburgh, PA
| | - Malamo Countouris
- UPMC Heart and Vascular Institute (M.C.), University of Pittsburgh, PA
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12
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Nagraj S, Kennedy SH, Norton R, Jha V, Praveen D, Hinton L, Hirst JE. Cardiometabolic Risk Factors in Pregnancy and Implications for Long-Term Health: Identifying the Research Priorities for Low-Resource Settings. Front Cardiovasc Med 2020; 7:40. [PMID: 32266293 PMCID: PMC7099403 DOI: 10.3389/fcvm.2020.00040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/03/2020] [Indexed: 12/17/2022] Open
Abstract
Cardiometabolic disorders (CMDs), including ischemic heart disease, stroke and type 2 diabetes are the leading causes of mortality and morbidity in women worldwide. The burden of CMDs falls disproportionately on low and middle-income countries (LMICs), placing substantial demands on already pressured health systems. Cardiometabolic disorders may present up to a decade earlier in some LMIC settings, and are associated with high-case fatality rates. Early identification and ongoing postpartum follow-up of women with pregnancy complications such as hypertensive disorders of pregnancy (HDPs), and gestational diabetes mellitus (GDM) may offer opportunities for prevention, or help delay onset of CMDs. This mini-review paper presents an overview of the key challenges faced in the early identification, referral and management of pregnant women at increased risk of CMDs, in low-resource settings worldwide. Evidence-based strategies, including novel diagnostics, technology and innovations for early detection, screening and management for pregnant women at high-risk of CMDs are presented. The review highlights the key research priorities for addressing cardiometabolic risk in pregnancy in low-resource settings.
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Affiliation(s)
- Shobhana Nagraj
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom.,The George Institute for Global Health, Oxford, United Kingdom
| | - Stephen H Kennedy
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Robyn Norton
- The George Institute for Global Health, Oxford, United Kingdom.,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Vivekananda Jha
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom.,The George Institute for Global Health, New Delhi, India.,Manipal Academy of Higher Education, Manipal, India
| | | | - Lisa Hinton
- The Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.,THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, United Kingdom
| | - Jane E Hirst
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom.,The George Institute for Global Health, Oxford, United Kingdom
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Li X, Yang H, Wen K, Zhong X, Xia X, Liu L, Qin D. A Method for Analyzing Two-locus Epistasis of Complex Diseases based on Decision Tree and Mutual Entropy. CURR PROTEOMICS 2019. [DOI: 10.2174/1570164616666190123150236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Epistasis makes complex diseases difficult to understand, especially when
heterogeneity also exists. Heterogeneity of complex diseases makes the distribution of case population
more confused. However, the traditional methods proposed to detect epistasis often ignore heterogeneity,
resulting in low power of association studies.
Methods:
In this study, we firstly use rank information in the Classification Decision Tree and Mutual
Entropy (CTME) to construct two different evaluation scores, namely multiple objectives. In addition, we
improve the calculation of joint entropy between SNPs and disease label, which elevates the efficiency of
CTME. Then, the ant colony algorithm is applied to search two-locus epistatic combination space. To
handle the potential heterogeneity, all candidate two-locus SNPs are merged to recognize multiple different
epistatic combinations. Finally, all these solutions are tested by χ2 test.
Results and Conclusion:
Experiments show that our method CTME improves the power of association
study. More importantly, CTME also detects multiple epistatic SNPs contributing to heterogeneity. The
experimental results show that CTME has advantages on power and efficiency.
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Affiliation(s)
- Xiong Li
- Key Laboratory of Advanced Control & Optimization of Jiangxi Province, East China Jiaotong University, Nanchang, 330013, China
| | - Hui Yang
- Key Laboratory of Advanced Control & Optimization of Jiangxi Province, East China Jiaotong University, Nanchang, 330013, China
| | - Kaifu Wen
- Postdoctoral Research Station, Jiang Xi Holitech Technology Co., Ltd., Jian, 343700, China
| | - Xiaoming Zhong
- Postdoctoral Research Station, Jiang Xi Holitech Technology Co., Ltd., Jian, 343700, China
| | - Xuewen Xia
- School of Software, East China Jiaotong University, Nanchang, 330013, China
| | - Liyue Liu
- School of Software, East China Jiaotong University, Nanchang, 330013, China
| | - Dehao Qin
- School of Software, East China Jiaotong University, Nanchang, 330013, China
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14
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Impact of Arginine Nutrition and Metabolism during Pregnancy on Offspring Outcomes. Nutrients 2019; 11:nu11071452. [PMID: 31252534 PMCID: PMC6682918 DOI: 10.3390/nu11071452] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 12/12/2022] Open
Abstract
By serving as a precursor for the synthesis of nitric oxide, polyamines, and other molecules with biological importance, arginine plays a key role in pregnancy and fetal development. Arginine supplementation is a potential therapy for treating many human diseases. An impaired arginine metabolic pathway during gestation might produce long-term morphological or functional changes in the offspring, namely, developmental programming to increase vulnerability to developing a variety of non-communicable diseases (NCDs) in later life. In contrast, reprogramming is a strategy that shifts therapeutic interventions from adulthood to early-life, in order to reverse the programming processes, which might counterbalance the rising epidemic of NCDs. This review presented the role of arginine synthesis and metabolism in pregnancy. We also provided evidence for the links between an impaired arginine metabolic pathway and the pathogenesis of compromised pregnancy and fetal programming. This was followed by reprogramming strategies targeting the arginine metabolic pathway, to prevent the developmental programming of NCDs. Despite emerging evidence from experimental studies showing that targeting the arginine metabolic pathway has promise as a reprogramming strategy in pregnancy to prevent NCDs in the offspring, these results need further clinical application.
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15
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Romero R. Giants in Obstetrics and Gynecology Series: A profile of James M. Roberts, MD. Am J Obstet Gynecol 2019; 220:527-536.e1. [PMID: 31151587 PMCID: PMC6656378 DOI: 10.1016/j.ajog.2019.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/02/2019] [Indexed: 10/26/2022]
Abstract
Dr. James Roberts has made seminal contributions to the understanding of the physiology of pregnancy, and, in particular, to the mechanisms of disease responsible for preeclampsia. His research includes endothelial cell dysfunction, oxidative stress, and other factors that play a role in the pathogenesis of preeclampsia; the use of antioxidant therapy to prevent the syndrome; identification of clinical subtypes of preeclampsia; and assessment of the long-term cardiovascular risk of the disorder. Dr. Roberts is currently an investigator at the Magee-Womens Research Institute and a Professor of Obstetrics, Gynecology, and Reproductive Sciences, Endocrinology, and Clinical and Translational Medicine at the University of Pittsburgh. He was the founding Director of the Magee-Womens Research Institute, and formerly the Elsie Hilliard Hillman Chair in Women’s and Infants’ Health Research at the University of Pittsburgh. For his many original contributions to the understanding of preeclampsia and other obstetrical syndromes, Dr. Roberts is herein recognized as a “Giant in Obstetrics and Gynecology.”
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Affiliation(s)
- Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI.
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16
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Zhang L, Wang K, Wu Q, Jin L, Lu H, Shi Y, Liu L, Yang L, Lv L. Let-7 inhibits the migration and invasion of extravillous trophoblast cell via targeting MDM4. Mol Cell Probes 2019; 45:48-56. [DOI: 10.1016/j.mcp.2019.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/23/2019] [Accepted: 05/09/2019] [Indexed: 01/12/2023]
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17
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Covella B, Vinturache AE, Cabiddu G, Attini R, Gesualdo L, Versino E, Piccoli GB. A systematic review and meta-analysis indicates long-term risk of chronic and end-stage kidney disease after preeclampsia. Kidney Int 2019; 96:711-727. [PMID: 31352975 DOI: 10.1016/j.kint.2019.03.033] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/23/2019] [Accepted: 03/28/2019] [Indexed: 11/30/2022]
Abstract
Preeclampsia is a pregnancy-related syndrome of variable severity, classically characterized by acute kidney involvement, with hypertension and/or proteinuria and reduced kidney function. Once considered a self-limited disease healed by delivery, it is now acknowledged that preeclampsia can affect cardiovascular and kidney health in the long term. The entity of risk has not been established and consequently follow-up policies have not been defined. Here we undertook a systematic review to gain better insights into the need for post-preeclampsia follow-up. Articles published between January 2000 and March 2018 were selected, dealing with at least 20 preeclampsia patients, with follow-up of 4 years or more (MEDLINE, Embase, and Cochrane Library). No quality selection or language restriction was performed. Of the 10,510 titles and abstracts originally considered, 21 papers were selected, providing information on 110,803 cases with and 2,680,929 controls without preeclampsia, with partial overlap between studies on the same databases. Heterogeneity was high, and a random meta-analytic model selected. The increase in risk of end stage renal disease after preeclampsia was significant (meta-analytic risk ratios (95% confidence interval) 6.35 (2.73-14.79)); the risk of albuminuria and chronic kidney disease increased but statistical significance was not reached (4.31 (0.95-19.58) and 2.03 (0.58-7.32), respectively). Translating meta-analytic risk into the number of patients who need follow-up to detect one adverse event, 310 patients with preeclampsia are needed to identify one woman with end stage renal disease or four to identify one woman with albuminuria. Heterogeneity in definitions, insufficient follow-up and incomplete recruitment may account for discrepancies. Thus, preeclampsia significantly increases the risk of end stage renal disease. However, there is lack of sufficient data to show a relationship between preeclampsia, albuminuria and chronic kidney disease, underlining the need for further prospective studies.
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Affiliation(s)
- Bianca Covella
- Department of Medicine, Unit of Nephrology, Dialysis and Transplantation, Polyclinic University Hospital, Bari, Italy
| | - Angela Elena Vinturache
- Department of Obstetrics and Gynaecology Women's Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Rossella Attini
- Department of Surgery, Obstetrics, University of Torino, Torino, Italy
| | - Loreto Gesualdo
- Department of Medicine, Unit of Nephrology, Dialysis and Transplantation, Polyclinic University Hospital, Bari, Italy
| | - Elisabetta Versino
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
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18
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Milic NM, Codsi E, Butler Tobah YS, White WM, Kattah AG, Weissgerber TL, Saiki M, Parashuram S, Vaughan LE, Weaver AL, Savic M, Mielke MM, Garovic VD. Electronic Algorithm Is Superior to Hospital Discharge Codes for Diagnoses of Hypertensive Disorders of Pregnancy in Historical Cohorts. Mayo Clin Proc 2018; 93:1707-1719. [PMID: 30522591 PMCID: PMC6353636 DOI: 10.1016/j.mayocp.2018.08.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 07/02/2018] [Accepted: 08/13/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To develop and validate criteria for the retrospective diagnoses of hypertensive disorders of pregnancy that would be amenable to the development of an electronic algorithm, and to compare the accuracy of diagnoses based on both the algorithm and diagnostic codes with the gold standard, of physician-made diagnoses based on a detailed review of medical records using accepted clinical criteria. PATIENTS AND METHODS An algorithm for hypertensive disorders of pregnancy was developed by first defining a set of criteria for retrospective diagnoses, which included relevant clinical variables and diagnosis of hypertension that required blood pressure elevations in greater than 50% of readings ("the 50% rule"). The algorithm was validated using the Rochester Epidemiology Project (Rochester, Minnesota). A stratified random sample of pregnancies and deliveries between January 1, 1976, and December 31, 1982, with the algorithm-based diagnoses was generated for review and physician-made diagnoses (normotensive, gestational hypertension, and preeclampsia), which served as the gold standard; the targeted cohort size for analysis was 25 per diagnosis category according to the gold standard. Agreements between (1) algorithm-based diagnoses and (2) diagnostic codes and the gold standard were analyzed. RESULTS Sensitivities of the algorithm for 25 normotensive pregnancies, 25 with gestational hypertension, and 25 with preeclampsia were 100%, 88%, and 100%, respectively, and specificities were 94%, 100%, and 100%, respectively. Diagnostic code sensitivities were 96% for normotensive pregnancies, 32% for gestational hypertension, and 96% for preeclampsia, and specificities were 78%, 96%, and 88%, respectively. CONCLUSION The electronic diagnostic algorithm was highly sensitive and specific in identifying and classifying hypertensive disorders of pregnancy and was superior to diagnostic codes.
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Affiliation(s)
- Natasa M Milic
- Division of Nephrology and Hypertension, University of Belgrade, Belgrade, Serbia; Department of Biostatistics, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Elisabeth Codsi
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Yvonne S Butler Tobah
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Wendy M White
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Andrea G Kattah
- Division of Nephrology and Hypertension, University of Belgrade, Belgrade, Serbia
| | - Tracey L Weissgerber
- Division of Nephrology and Hypertension, University of Belgrade, Belgrade, Serbia
| | - Mie Saiki
- Division of Nephrology and Hypertension, University of Belgrade, Belgrade, Serbia
| | - Santosh Parashuram
- Division of Nephrology and Hypertension, University of Belgrade, Belgrade, Serbia
| | - Lisa E Vaughan
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Amy L Weaver
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Marko Savic
- Department of Biostatistics, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Michelle M Mielke
- Department of Health Sciences Research and Department of Neurology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Vesna D Garovic
- Division of Nephrology and Hypertension, University of Belgrade, Belgrade, Serbia; Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN.
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19
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Korzeniewski SJ, Slaughter J, Lenski M, Haak P, Paneth N. The complex aetiology of cerebral palsy. Nat Rev Neurol 2018; 14:528-543. [PMID: 30104744 DOI: 10.1038/s41582-018-0043-6] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cerebral palsy (CP) is the most prevalent, severe and costly motor disability of childhood. Consequently, CP is a public health priority for prevention, but its aetiology has proved complex. In this Review, we summarize the evidence for a decline in the birth prevalence of CP in some high-income nations, describe the epidemiological evidence for risk factors, such as preterm delivery and fetal growth restriction, genetics, pregnancy infection and other exposures, and discuss the success achieved so far in prevention through the use of magnesium sulfate in preterm labour and therapeutic hypothermia for birth-asphyxiated infants. We also consider the complexities of disentangling prenatal and perinatal influences, and of establishing subtypes of the disorder, with a view to accelerating the translation of evidence into the development of strategies for the prevention of CP.
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Affiliation(s)
- Steven J Korzeniewski
- Department of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, MI, USA.
| | - Jaime Slaughter
- Department of Health Systems and Sciences Research and Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA, USA
| | - Madeleine Lenski
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Peterson Haak
- Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Nigel Paneth
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI, USA
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20
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Myers JE, Myatt L, Roberts JM, Redman C. COLLECT, a collaborative database for pregnancy and placental research studies worldwide. BJOG 2018; 126:8-10. [PMID: 29978556 DOI: 10.1111/1471-0528.15393] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2018] [Indexed: 12/31/2022]
Affiliation(s)
- J E Myers
- Maternal and Fetal Health Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - L Myatt
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - J M Roberts
- Department of Obstetrics and Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research, Magee Women's Research Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cwg Redman
- Department of Obstetrics and Gynecology, University of Oxford, Oxford, UK
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21
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Khlestova GV, Romanov AY, Nizyaeva NV, Karapetyan AO, Baev OR, Ivanets TY. Dynamics of Renin, Angiotensin II, and Angiotensin (1-7) during Pregnancy and Predisposition to Hypertension-Associated Complications. Bull Exp Biol Med 2018; 165:438-439. [PMID: 30123953 DOI: 10.1007/s10517-018-4188-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Indexed: 01/06/2023]
Abstract
Changes in the levels of rennin, angiotensin II, and angiotensin (1-7) were studied during normal pregnancy. The blood was taken on gestation days 140-237 and 238-280. No significant changes in renin concentration were observed during normal pregnancy (p=0.423). The level of angiotensin II increased during normal pregnancy from 9.7±1.2 to 14.7±1.9 pg/ml (p=0.019). On the contrary, angiotensin (1-7) concentration decreased from 771.1±44.2 to 390.7±13.9 pg/ml (p<0.001). The shift in the proportion between vasoconstrictor angiotensin II and vasodilaltor angiotensin (1-7) attests to high predisposition of pregnant women to hypertension-related complications.
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Affiliation(s)
- G V Khlestova
- V. I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, Moscow, Russia
| | - A Yu Romanov
- V. I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, Moscow, Russia.
| | - N V Nizyaeva
- V. I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, Moscow, Russia
| | - A O Karapetyan
- V. I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, Moscow, Russia
| | - O R Baev
- V. I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, Moscow, Russia.,Department of Obstetrics, Gynecology, Perinatology, and Reproductology, Faculty of Postgraduate Professional Education, I. M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Moscow, Russia
| | - T Yu Ivanets
- V. I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, Moscow, Russia
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22
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Abstract
Preeclampsia occurs in 3–5% of pregnancies and is a leading cause of deaths of mothers and their infants worldwide. It was initially described over 100 yr ago as a pregnancy abnormality defined by new-onset hypertension and proteinuria. Progress in understanding the pathophysiology was impeded by attention to these diagnostic findings. Hypertension and proteinuria were actually serendipitously recognized components of a complex multisystemic syndrome and not especially pertinent to outcome. With the recognition of inflammatory activation with consequent endothelial dysfunction 30 yr ago redirection of research resulted in an explosive increase in understanding of the disorder. The immunological origins, the role of the placenta and its functional alterations due to endoplasmic reticulum and oxidative stress, identification of placental products linking placental dysfunction to maternal systemic pathophysiology, and the role of the maternal constitution have been elegantly demonstrated by clinical, fundamental, and epidemiological findings and clever animal experimentation. Nonetheless, this increase in knowledge has not translated into improved prediction and prevention of preeclampsia. In this presentation the likelihood is discussed that this is secondary to a much greater complexity than has been previously considered and the existence of subtypes of preeclampsia that may not share an identical pathophysiology. The necessity for collaboration with data, sample, and intellectual sharing is addressed. An approach to addressing the challenges posed to such collaboration exemplified by the Global Pregnancy Collaboration is presented.
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Affiliation(s)
- James M. Roberts
- Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
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23
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Kelly CB, Hookham MB, Yu JY, Jenkins AJ, Nankervis AJ, Hanssen KF, Garg SK, Scardo JA, Hammad SM, Menard MK, Aston CE, Lyons TJ. Subclinical First Trimester Renal Abnormalities Are Associated With Preeclampsia in Normoalbuminuric Women With Type 1 Diabetes. Diabetes Care 2018; 41:120-127. [PMID: 29122892 PMCID: PMC5741157 DOI: 10.2337/dc17-1635] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 10/05/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study was conducted to determine the utility of tubular (urinary/plasma neutrophil gelatinase-associated lipocalin [NGAL] and urinary kidney injury molecule 1 [KIM-1]) and glomerular (estimated glomerular filtration rate [eGFR]) biomarkers in predicting preeclampsia (PE) in pregnant women with type 1 diabetes mellitus (T1DM) who were free of microalbuminuria and hypertension at the first trimester. RESEARCH DESIGN AND METHODS This was a prospective study of T1DM pregnancy. Maternal urinary and plasma NGAL, urinary KIM-1 (ELISA of frozen samples), and eGFR (Chronic Kidney Disease Epidemiology Collaboration equation) were determined at three study visits (V1: 12.4 ± 1.8; V2: 21.7 ± 1.4; V3: 31.4 ± 1.5 weeks' gestation [mean ± SD]) in 23 women with T1DM with subsequent PE (DM+PE+), 24 who remained normotensive (DM+PE-), and, for reference, in 19 normotensive pregnant women without diabetes (DM-). The groups with diabetes were matched for age, diabetes duration, and parity. All subjects were normotensive and free of microalbuminuria or albuminuria at V1. All study visits preceded the onset of PE. RESULTS Urinary creatinine-corrected NGAL (uNGALcc, ng/mg) was significantly elevated at V1 in DM+PE+ vs. DM+PE- women (P = 0.01); this remained significant after exclusion of leukocyte-positive samples (5 DM+PE+ and 2 DM+PE-) (P = 0.02). Accounting for BMI, HbA1c, and total daily insulin dose, a doubling of uNGALcc at V1 conferred a sevenfold increase in risk for PE (P = 0.026). In contrast, neither plasma NGAL nor urinary KIM-1 predicted PE. Also at V1, eGFR was elevated in DM+PE+ vs. DM+PE- (P = 0.04). CONCLUSIONS Early tubular and glomerular dysfunction may predict PE in first trimester women with T1DM, even if free of microalbuminuria. These data suggest that subclinical renal tubular and glomerular injury, if present early in pregnancy, may predispose women with T1DM to PE.
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Affiliation(s)
- Clare B Kelly
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland, U.K.,Division of Endocrinology, Medical University of South Carolina, Charleston, SC
| | - Michelle B Hookham
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland, U.K.,The Department of Clinical Biochemistry, Royal Victoria Hospital, Belfast, Northern Ireland, U.K
| | - Jeremy Y Yu
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland, U.K.,Division of Endocrinology, Medical University of South Carolina, Charleston, SC
| | - Alicia J Jenkins
- Division of Endocrinology, Medical University of South Carolina, Charleston, SC.,National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, Sydney, New South Wales, Australia
| | - Alison J Nankervis
- Diabetes Service, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Kristian F Hanssen
- Department of Endocrinology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Satish K Garg
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Denver, CO
| | | | - Samar M Hammad
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC
| | - M Kathryn Menard
- Division of Materno-Fetal Medicine, University of North Carolina, Chapel Hill, NC
| | - Christopher E Aston
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Timothy J Lyons
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland, U.K. .,Division of Endocrinology, Medical University of South Carolina, Charleston, SC
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24
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Quinney SK, Gullapelli R, Haas DM. Translational Systems Pharmacology Studies in Pregnant Women. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2017; 7:69-81. [PMID: 29239132 PMCID: PMC5824114 DOI: 10.1002/psp4.12269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 12/26/2022]
Abstract
Pregnancy involves rapid physiological adaptation and complex interplay between mother and fetus. New analytic technologies provide large amounts of genomic, proteomic, and metabolomics data. The integration of these data through bioinformatics, statistical, and systems pharmacology techniques can improve our understanding of the mechanisms of normal maternal physiologic changes and fetal development. New insights into the mechanisms of pregnancy‐related disorders, such as preterm birth (PTB), may lead to the development of new therapeutic interventions and novel biomarkers.
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Affiliation(s)
- Sara K Quinney
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rakesh Gullapelli
- School of Informatics and Computing, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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25
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Yan JQ, Huang F, Hao F, Su XL, Meng Q, Xu MJ. Oxidative Stress in the Rostral Ventrolateral Medulla Contributes To Cardiovascular Regulation in Preeclampsia. Front Physiol 2017; 8:772. [PMID: 29085302 PMCID: PMC5649191 DOI: 10.3389/fphys.2017.00772] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 09/21/2017] [Indexed: 12/24/2022] Open
Abstract
Background: It has been demonstrated that preeclampsia, a pregnancy-specific hypertension disorder, is characterized by high blood pressure (BP) and sympathetic overactivity. Increased reactive oxygen species (ROS) in the rostral ventrolateral medulla (RVLM), a key region for controlling sympathetic tone, has been reported to contribute to high level of BP and sympathetic outflow. The aim of the present study was to determine the role of the RVLM ROS in mediating the preeclampsia-associated cardiovascular dysfunction. Methods: The animal model of preeclampsia was produced by administration of desoxycorticosterone acetate (DOCA) to pregnant rats. Results: Compared with normal pregnant rats without DOCA treatment (NP), the protein concentration and norepinephrine excretion in 24-h urine, as well as BP in pregnant rats with DOCA treatment (PDS) were significantly increased. The levels of superoxide anion and the protein expression of NADPH oxidase subtype (NOX4) in the RVLM were significantly increased in PDS than in NP groups. Furthermore, microinjection of the superoxide dismutase (SOD) mimic Tempol (5 nmol) into the RVLM significantly decreased BP, heart rate, and renal sympathetic never activity in PDS but not in NP group. Conclusion: The present data suggest that high BP and sympathetic overactivity in preeclampsia rats is associated with increased oxidative stress in the RVLM via upregulation of NOX4 expression.
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Affiliation(s)
- Jiu-Qiong Yan
- Department of Obstetrics and Gynecology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Fang Huang
- Department of Geriatics, Jinling Hospital, Nanjing, China
| | - Fan Hao
- Department of Obstetrics and Gynecology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xiao-Ling Su
- Department of Obstetrics and Gynecology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qi Meng
- Department of Obstetrics and Gynecology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ming-Juan Xu
- Department of Obstetrics and Gynecology, Changhai Hospital, Second Military Medical University, Shanghai, China
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26
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Availability of COLLECT, a database for pregnancy and placental research studies worldwide. Placenta 2017; 57:223-224. [PMID: 28864015 PMCID: PMC5593808 DOI: 10.1016/j.placenta.2017.07.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 07/21/2017] [Indexed: 12/20/2022]
Abstract
Cost and availability of a database often impede research while the lack of compatibility inhibits collaboration by making merging of databases difficult or impossible. The Global Pregnancy Collaboration (CoLab) has promoted harmonization of studies and standardized data collection to facilitate pregnancy and placental research. Its online database, COLLECT, allows collection of minimal and optimal clinical datasets to accompany basic and applied science studies and provides a placental sample inventory system. COLLECT is available free of charge in LMIC and for $100 per month in HIC. Data is the property of the investigator but with permission can be combined into larger studies across centers and countries. High quality clinical data can usefully assist basic placental research studies. Designing a database is expensive and existing databases are usually incompatible. CoLab has designed and made available a tried and tested database at low or no cost. Data is the property of the investigator but can be easily combined with permission.
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Huang A, Wu H, Iriyama T, Zhang Y, Sun K, Song A, Liu H, Peng Z, Tang L, Lee M, Huang Y, Ni X, Kellems RE, Xia Y. Elevated Adenosine Induces Placental DNA Hypomethylation Independent of A2B Receptor Signaling in Preeclampsia. Hypertension 2017; 70:209-218. [PMID: 28507174 DOI: 10.1161/hypertensionaha.117.09536] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 04/18/2017] [Accepted: 04/22/2017] [Indexed: 12/20/2022]
Abstract
Preeclampsia is a prevalent pregnancy hypertensive disease with both maternal and fetal morbidity and mortality. Emerging evidence indicates that global placental DNA hypomethylation is observed in patients with preeclampsia and is linked to altered gene expression and disease development. However, the molecular basis underlying placental epigenetic changes in preeclampsia remains unclear. Using 2 independent experimental models of preeclampsia, adenosine deaminase-deficient mice and a pathogenic autoantibody-induced mouse model of preeclampsia, we demonstrate that elevated placental adenosine not only induces hallmark features of preeclampsia but also causes placental DNA hypomethylation. The use of genetic approaches to express an adenosine deaminase minigene specifically in placentas, or adenosine deaminase enzyme replacement therapy, restored placental adenosine to normal levels, attenuated preeclampsia features, and abolished placental DNA hypomethylation in adenosine deaminase-deficient mice. Genetic deletion of CD73 (an ectonucleotidase that converts AMP to adenosine) prevented the elevation of placental adenosine in the autoantibody-induced preeclampsia mouse model and ameliorated preeclampsia features and placental DNA hypomethylation. Immunohistochemical studies revealed that elevated placental adenosine-mediated DNA hypomethylation predominantly occurs in spongiotrophoblasts and labyrinthine trophoblasts and that this effect is independent of A2B adenosine receptor activation in both preeclampsia models. Extending our mouse findings to humans, we used cultured human trophoblasts to demonstrate that adenosine functions intracellularly and induces DNA hypomethylation without A2B adenosine receptor activation. Altogether, both mouse and human studies reveal novel mechanisms underlying placental DNA hypomethylation and potential therapeutic approaches for preeclampsia.
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Affiliation(s)
- Aji Huang
- From the Xiangya Hospital, Central South University, Changsha, China (A.H., Z.P., L.T., Y.X.); Department of Biochemistry and Molecular Biology, McGovern Medical School (A.H., H.W., T.I., Y.Z., K.S., A.S., H.L., Z.P., R.E.K., Y.X.) and Graduate School of Biomedical Sciences (K.S., H.L., R.E.K., Y.X.), University of Texas at Houston; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan (T.I.); Institute of Biosciences and Technology, Texas A&M University, Houston (M.L., Y.H.); and Department of Physiology, The Second Military Medical School, Shanghai, China (X.N.)
| | - Hongyu Wu
- From the Xiangya Hospital, Central South University, Changsha, China (A.H., Z.P., L.T., Y.X.); Department of Biochemistry and Molecular Biology, McGovern Medical School (A.H., H.W., T.I., Y.Z., K.S., A.S., H.L., Z.P., R.E.K., Y.X.) and Graduate School of Biomedical Sciences (K.S., H.L., R.E.K., Y.X.), University of Texas at Houston; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan (T.I.); Institute of Biosciences and Technology, Texas A&M University, Houston (M.L., Y.H.); and Department of Physiology, The Second Military Medical School, Shanghai, China (X.N.)
| | - Takayuki Iriyama
- From the Xiangya Hospital, Central South University, Changsha, China (A.H., Z.P., L.T., Y.X.); Department of Biochemistry and Molecular Biology, McGovern Medical School (A.H., H.W., T.I., Y.Z., K.S., A.S., H.L., Z.P., R.E.K., Y.X.) and Graduate School of Biomedical Sciences (K.S., H.L., R.E.K., Y.X.), University of Texas at Houston; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan (T.I.); Institute of Biosciences and Technology, Texas A&M University, Houston (M.L., Y.H.); and Department of Physiology, The Second Military Medical School, Shanghai, China (X.N.)
| | - Yujin Zhang
- From the Xiangya Hospital, Central South University, Changsha, China (A.H., Z.P., L.T., Y.X.); Department of Biochemistry and Molecular Biology, McGovern Medical School (A.H., H.W., T.I., Y.Z., K.S., A.S., H.L., Z.P., R.E.K., Y.X.) and Graduate School of Biomedical Sciences (K.S., H.L., R.E.K., Y.X.), University of Texas at Houston; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan (T.I.); Institute of Biosciences and Technology, Texas A&M University, Houston (M.L., Y.H.); and Department of Physiology, The Second Military Medical School, Shanghai, China (X.N.)
| | - Kaiqi Sun
- From the Xiangya Hospital, Central South University, Changsha, China (A.H., Z.P., L.T., Y.X.); Department of Biochemistry and Molecular Biology, McGovern Medical School (A.H., H.W., T.I., Y.Z., K.S., A.S., H.L., Z.P., R.E.K., Y.X.) and Graduate School of Biomedical Sciences (K.S., H.L., R.E.K., Y.X.), University of Texas at Houston; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan (T.I.); Institute of Biosciences and Technology, Texas A&M University, Houston (M.L., Y.H.); and Department of Physiology, The Second Military Medical School, Shanghai, China (X.N.)
| | - Anren Song
- From the Xiangya Hospital, Central South University, Changsha, China (A.H., Z.P., L.T., Y.X.); Department of Biochemistry and Molecular Biology, McGovern Medical School (A.H., H.W., T.I., Y.Z., K.S., A.S., H.L., Z.P., R.E.K., Y.X.) and Graduate School of Biomedical Sciences (K.S., H.L., R.E.K., Y.X.), University of Texas at Houston; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan (T.I.); Institute of Biosciences and Technology, Texas A&M University, Houston (M.L., Y.H.); and Department of Physiology, The Second Military Medical School, Shanghai, China (X.N.)
| | - Hong Liu
- From the Xiangya Hospital, Central South University, Changsha, China (A.H., Z.P., L.T., Y.X.); Department of Biochemistry and Molecular Biology, McGovern Medical School (A.H., H.W., T.I., Y.Z., K.S., A.S., H.L., Z.P., R.E.K., Y.X.) and Graduate School of Biomedical Sciences (K.S., H.L., R.E.K., Y.X.), University of Texas at Houston; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan (T.I.); Institute of Biosciences and Technology, Texas A&M University, Houston (M.L., Y.H.); and Department of Physiology, The Second Military Medical School, Shanghai, China (X.N.)
| | - Zhangzhe Peng
- From the Xiangya Hospital, Central South University, Changsha, China (A.H., Z.P., L.T., Y.X.); Department of Biochemistry and Molecular Biology, McGovern Medical School (A.H., H.W., T.I., Y.Z., K.S., A.S., H.L., Z.P., R.E.K., Y.X.) and Graduate School of Biomedical Sciences (K.S., H.L., R.E.K., Y.X.), University of Texas at Houston; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan (T.I.); Institute of Biosciences and Technology, Texas A&M University, Houston (M.L., Y.H.); and Department of Physiology, The Second Military Medical School, Shanghai, China (X.N.)
| | - Lili Tang
- From the Xiangya Hospital, Central South University, Changsha, China (A.H., Z.P., L.T., Y.X.); Department of Biochemistry and Molecular Biology, McGovern Medical School (A.H., H.W., T.I., Y.Z., K.S., A.S., H.L., Z.P., R.E.K., Y.X.) and Graduate School of Biomedical Sciences (K.S., H.L., R.E.K., Y.X.), University of Texas at Houston; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan (T.I.); Institute of Biosciences and Technology, Texas A&M University, Houston (M.L., Y.H.); and Department of Physiology, The Second Military Medical School, Shanghai, China (X.N.)
| | - Minjung Lee
- From the Xiangya Hospital, Central South University, Changsha, China (A.H., Z.P., L.T., Y.X.); Department of Biochemistry and Molecular Biology, McGovern Medical School (A.H., H.W., T.I., Y.Z., K.S., A.S., H.L., Z.P., R.E.K., Y.X.) and Graduate School of Biomedical Sciences (K.S., H.L., R.E.K., Y.X.), University of Texas at Houston; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan (T.I.); Institute of Biosciences and Technology, Texas A&M University, Houston (M.L., Y.H.); and Department of Physiology, The Second Military Medical School, Shanghai, China (X.N.)
| | - Yun Huang
- From the Xiangya Hospital, Central South University, Changsha, China (A.H., Z.P., L.T., Y.X.); Department of Biochemistry and Molecular Biology, McGovern Medical School (A.H., H.W., T.I., Y.Z., K.S., A.S., H.L., Z.P., R.E.K., Y.X.) and Graduate School of Biomedical Sciences (K.S., H.L., R.E.K., Y.X.), University of Texas at Houston; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan (T.I.); Institute of Biosciences and Technology, Texas A&M University, Houston (M.L., Y.H.); and Department of Physiology, The Second Military Medical School, Shanghai, China (X.N.)
| | - Xin Ni
- From the Xiangya Hospital, Central South University, Changsha, China (A.H., Z.P., L.T., Y.X.); Department of Biochemistry and Molecular Biology, McGovern Medical School (A.H., H.W., T.I., Y.Z., K.S., A.S., H.L., Z.P., R.E.K., Y.X.) and Graduate School of Biomedical Sciences (K.S., H.L., R.E.K., Y.X.), University of Texas at Houston; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan (T.I.); Institute of Biosciences and Technology, Texas A&M University, Houston (M.L., Y.H.); and Department of Physiology, The Second Military Medical School, Shanghai, China (X.N.)
| | - Rodney E Kellems
- From the Xiangya Hospital, Central South University, Changsha, China (A.H., Z.P., L.T., Y.X.); Department of Biochemistry and Molecular Biology, McGovern Medical School (A.H., H.W., T.I., Y.Z., K.S., A.S., H.L., Z.P., R.E.K., Y.X.) and Graduate School of Biomedical Sciences (K.S., H.L., R.E.K., Y.X.), University of Texas at Houston; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan (T.I.); Institute of Biosciences and Technology, Texas A&M University, Houston (M.L., Y.H.); and Department of Physiology, The Second Military Medical School, Shanghai, China (X.N.)
| | - Yang Xia
- From the Xiangya Hospital, Central South University, Changsha, China (A.H., Z.P., L.T., Y.X.); Department of Biochemistry and Molecular Biology, McGovern Medical School (A.H., H.W., T.I., Y.Z., K.S., A.S., H.L., Z.P., R.E.K., Y.X.) and Graduate School of Biomedical Sciences (K.S., H.L., R.E.K., Y.X.), University of Texas at Houston; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Japan (T.I.); Institute of Biosciences and Technology, Texas A&M University, Houston (M.L., Y.H.); and Department of Physiology, The Second Military Medical School, Shanghai, China (X.N.).
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Piccoli GB, Cabiddu G, Castellino S, Gernone G, Santoro D, Moroni G, Spotti D, Giacchino F, Attini R, Limardo M, Maxia S, Fois A, Gammaro L, Todros T. A best practice position statement on the role of the nephrologist in the prevention and follow-up of preeclampsia: the Italian study group on kidney and pregnancy. J Nephrol 2017; 30:307-317. [PMID: 28434090 DOI: 10.1007/s40620-017-0390-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/09/2017] [Indexed: 02/07/2023]
Abstract
Preeclampsia (PE) is a protean syndrome causing a transitory kidney disease, characterised by hypertension and proteinuria, ultimately reversible after delivery. Its prevalence is variously estimated, from 3 to 5% to 10% if all the related disorders, including also pregnancy-induced hypertension (PIH) and HELLP syndrome (haemolysis, increase in liver enzyme, low platelets) are included. Both nephrologists and obstetricians are involved in the management of the disease, according to different protocols, and the clinical management, as well as the role for each specialty, differs worldwide. The increased awareness of the role of chronic kidney disease in pregnancy, complicating up to 3% of pregnancies, and the knowledge that PE is associated with an increased risk for development of CKD later in life have recently increased the interest and redesigned the role of the nephrologists in this context. However, while the heterogeneous definitions of PE, its recent reclassification, an emerging role for biochemical biomarkers, the growing body of epidemiological data and the new potential therapeutic interventions lead to counsel long-term follow-up, the lack of resources for chronic patients and the increasing costs of care limit the potential for preventive actions, and suggest tailoring specific interventional strategies. The aim of the present position statement of the Kidney and Pregnancy Study Group of the Italian Society of Nephrology is to review the literature and to try to identify theoretical and pragmatic bases for an agreed management of PE in the nephrological setting, with particular attention to the prevention of the syndrome (recurrent PE, presence of baseline CKD) and to the organization of the postpartum follow-up.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Turin, Italy. .,Nephrologie, Centre Hospitalier Le Mans, Avenue Roubillard, 72000, Le Mans, France.
| | | | | | | | | | - Gabriella Moroni
- Nephrology, Fondazione Ca' Granda Ospedale Maggiore, Milan, Italy
| | - Donatella Spotti
- Nephrology and Dialysis, IRCCS Ospedale San Raffaele, Milano, Italy
| | | | - Rossella Attini
- Obstetrics, Department of Surgery, University of Torino, Turin, Italy
| | - Monica Limardo
- Nephrology, Azienda Ospedaliera della Provincia di Lecco, Lecco, Italy
| | | | - Antioco Fois
- Nephrology, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Linda Gammaro
- Nephrology Ospedale Fracastoro San Bonifacio, San Bonifacio, Italy
| | - Tullia Todros
- Obstetrics, Department of Surgery, University of Torino, Turin, Italy
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Jääskeläinen T, Heinonen S, Kajantie E, Kere J, Kivinen K, Pouta A, Laivuori H. Cohort profile: the Finnish Genetics of Pre-eclampsia Consortium (FINNPEC). BMJ Open 2016; 6:e013148. [PMID: 28067621 PMCID: PMC5129003 DOI: 10.1136/bmjopen-2016-013148] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE The Finnish Genetics of Pre-eclampsia Consortium (FINNPEC) Study was established to set up a nationwide clinical and DNA database on women with and without pre-eclampsia (PE), including their partners and infants, in order to identify genetic risk factors for PE. PARTICIPANTS FINNPEC is a cross-sectional case-control cohort collected from 5 university hospitals in Finland during 2008-2011. A total of 1450 patients with PE and 1065 pregnant control women without PE (aged 18-47 years) were recruited. Altogether, there were 1377 full triads (625 PE and 752 control triads). FINDINGS TO DATE The established cohort holds both clinical and genetic information of mother-infant-father triads representing a valuable resource for studying the pathogenesis of the disease. Furthermore, maternal biological samples (first and third trimester serum and placenta) will provide additional information for PE research. Until now, research has encompassed studies on candidate genes, Sanger and next-generation sequencing, and various studies on the placenta. FINNPEC has also participated in the InterPregGen study, which is the largest investigation on maternal and fetal genetic factors underlying PE until now. FUTURE PLANS Ongoing studies focus on elucidating the role of immunogenetic and metabolic factors in PE. Data on morbidity and mortality will be collected from mothers and fathers through links to the nationwide health registers.
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Affiliation(s)
- Tiina Jääskeläinen
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Seppo Heinonen
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki Finland
| | - Eero Kajantie
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
- Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juha Kere
- Department of Biosciences and Nutrition, and Science for Life Laboratory, Karolinska Institutet, Stockholm, Sweden
- Molecular Neurology Research Program, University of Helsinki, Helsinki, Finland
- Folkhälsan Institute of Genetics, Helsinki, Finland
| | - Katja Kivinen
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Anneli Pouta
- PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Government Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Hannele Laivuori
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki Finland
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
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Bermúdez-Peñaloza X, Reyna-Villasmil E, Mejía-Montilla J, Santos-Bolívar J, Torres-Cepeda D, Reyna-Villasmil N, Fernández-Ramírez A. Calcio sérico total e ionizado en el segundo trimestre del embarazo como predictor de preeclampsia. PERINATOLOGÍA Y REPRODUCCIÓN HUMANA 2016. [DOI: 10.1016/j.rprh.2016.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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