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Modzelewski J, Siarkowska I, Pajurek-Dudek J, Feduniw S, Muzyka-Placzyńska K, Baran A, Kajdy A, Bednarek-Jędrzejek M, Cymbaluk-Płoska A, Kwiatkowska E, Kwiatkowski S. Atypical Preeclampsia before 20 Weeks of Gestation-A Systematic Review. Int J Mol Sci 2023; 24:ijms24043752. [PMID: 36835158 PMCID: PMC9964444 DOI: 10.3390/ijms24043752] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
This systematic review was conducted to gather evidence of preeclampsia occurring before the 20th week of gestation, additionally considering the role of PLGF and sFlt-1 in the development of the disease. In the three cases of preeclampsia before the 20th week of gestation presented in the authors' material, all pregnancies ended up with IUFD, and the SFlt-1/PLGF ratios were significantly elevated in all women. Eligible publications were identified with searches in the PubMed, Embase, Scopus, and Web of Science databases. No date or language restrictions were made. All original peer-reviewed scientific reports were included. A total of 30 publications were included in the final report, including case reports and case series. No other publication types regarding this issue were identified. In the literature, 34 cases of preeclampsia with onset occurring before the 20th week of gestation were identified, for a final total of 37 cases. Live births were reported in 5 cases (10.52%), and there were 9 intrauterine fetal demises (24.32%), and 23 terminations of pregnancy (62.16%). Preeclampsia before the 20th week of gestation is rare but can occur. We collected all available evidence regarding this phenomenon, with 37 cases reported worldwide. We call for large-scale cohort or register-based studies to establish revised definitions or develop new ones regarding the currently unrecognized very early onset preeclampsia.
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Affiliation(s)
- Jan Modzelewski
- 1st Clinic of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Żelazna 90 St., 01-004 Warsaw, Poland
| | - Iga Siarkowska
- 1st Clinic of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Żelazna 90 St., 01-004 Warsaw, Poland
| | - Justyna Pajurek-Dudek
- 1st Clinic of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Żelazna 90 St., 01-004 Warsaw, Poland
| | - Stepan Feduniw
- 1st Clinic of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Żelazna 90 St., 01-004 Warsaw, Poland
| | - Katarzyna Muzyka-Placzyńska
- 1st Clinic of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Żelazna 90 St., 01-004 Warsaw, Poland
| | - Arkadiusz Baran
- 1st Clinic of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Żelazna 90 St., 01-004 Warsaw, Poland
| | - Anna Kajdy
- 1st Clinic of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Żelazna 90 St., 01-004 Warsaw, Poland
| | | | - Aneta Cymbaluk-Płoska
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Ewa Kwiatkowska
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Sebastian Kwiatkowski
- Department of Obstetrics and Gynecology, Pomeranian Medical University, 70-111 Szczecin, Poland
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Woolston E, Tang Y, Azizi S, Kando I, Chamley L, Stone P, Chen Q. Comparison of the effects on maternal endothelial cell activation: an in vitro study of anti-hypertensive drugs clinically used in pre-eclampsia. J Hum Hypertens 2022; 36:192-200. [PMID: 33686209 DOI: 10.1038/s41371-021-00497-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 01/20/2021] [Accepted: 01/27/2021] [Indexed: 02/06/2023]
Abstract
Endothelial cell dysfunction in pregnancy, which can be induced by placental factors, is the fundamental component of the pathogenesis of pre-eclampsia. The dysfunctional vascular endothelium disrupts the balance of vasodilatory and vasoconstrictive factors, resulting in increasing blood pressure. There is currently no effective treatment for pre-eclampsia and effective control of hypertension may reduce neonatal morbidity and mortality by prolonging gestation, especially in cases of early onset disease. To date methyldopa, labetalol, nifedipine and metoprolol are recommended for controlling blood pressure in pre-eclampsia. All of these drugs have different mechanisms of action. In this in vitro study we investigated whether different types of anti-hypertensive drugs could have different effects on improving maternal endothelial cell dysfunction. Endothelial cells (HMEC-1) were exposed to phorbol-12-myristate-13-acetate (PMA) or pre-eclamptic sera or extracellular vesicles (EVs) derived from pre-eclamptic placentae, in the presence of each of the studied anti-hypertensive drugs (methyldopa, labetalol, nifedipine and metoprolol) or placebo for 24 h. Endothelial cell-surface adhesion molecule (ICAM-1) and monocyte adhesion were measured. The expression of cell-face ICAM-1 by HMEC-1 cells and THP-1 monocyte adherent to HMEC-1 that were exposed to three separate well-known activators of endothelial cells in the presence of four anti-hypertensive drugs was significantly reduced regardless of the dose. However, the effect on the reduction of ICAM-1 expression and monocyte adhesion was not significantly different between the four medications. Our data suggest that the beneficial effect on improving endothelial cell function by these commonly prescribed anti-hypertensive drugs is seemingly independent of the anti-hypertensive mechanisms of the medication.
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Affiliation(s)
- Esther Woolston
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
| | - Yunhui Tang
- The Hospital of Obstetrics and Gynaecology, Fudan University, Shanghai, China. .,National Women's Health, Auckland City Hospital, Auckland, New Zealand.
| | - Sonia Azizi
- National Women's Health, Auckland City Hospital, Auckland, New Zealand
| | - Ian Kando
- National Women's Health, Auckland City Hospital, Auckland, New Zealand
| | - Larry Chamley
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
| | - Peter Stone
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
| | - Qi Chen
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand.,The Hospital of Obstetrics and Gynaecology, Fudan University, Shanghai, China
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3
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Vahedian-Azimi A, Karimi L, Reiner Ž, Makvandi S, Sahebkar A. Effects of statins on preeclampsia: A systematic review. Pregnancy Hypertens 2021; 23:123-130. [DOI: 10.1016/j.preghy.2020.11.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/03/2020] [Accepted: 11/28/2020] [Indexed: 12/15/2022]
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4
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Zhao J, Chow RP, McLeese RH, Hookham MB, Lyons TJ, Yu JY. Modelling preeclampsia: a comparative analysis of the common human trophoblast cell lines. FASEB Bioadv 2021; 3:23-35. [PMID: 33521587 PMCID: PMC7805545 DOI: 10.1096/fba.2020-00057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/08/2020] [Accepted: 09/28/2020] [Indexed: 12/03/2022] Open
Abstract
Preeclampsia remains a challenge without an effective therapy. Evidence supports targetability of soluble fms‐like tyrosine kinase‐1 (sFlt‐1) and soluble endoglin (sEng), which are released excessively from the placenta under ischemic and hypoxic stresses. We compared four trophoblast cell lines, BeWo, Jar, Jeg‐3, and HTR‐8/SVneo, in order to identify a suitable model for drug screening. Cultured trophoblasts were exposed to 1% oxygen vs. normoxia for 24‐48 hr; human umbilical vein and aortic endothelial cells were included for comparison. Supernatant sFlt‐1 and sEng concentrations were measured by ELISA, and sFlt‐1 mRNA expression determined by RT‐PCR. Cellular responses to experimental therapeutics were explored. All four trophoblast lines secreted sEng, which did not increase by hypoxia. BeWo, Jar, and Jeg‐3 exhibited significantly enhanced expression of sFlt‐1 i13 and e15a mRNA in response to hypoxia; however, only BeWo released a detectable level of sFlt‐1 protein, which was doubled by hypoxia. In contrast, hypoxia decreased sFlt‐1 mRNA expression and protein release in HTR‐8/SVneo, similarly to endothelial cells. The cellular mechanism involved HIFα. BeWo responded to representative agents similarly to human primary placental tissues in the literature. These data support that the BeWo‐hypoxia model mimics a key pathogenic mechanism of preeclampsia and has potential value for translational drug discovery.
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Affiliation(s)
- Jiawu Zhao
- Wellcome-Wolfson Institute for Experimental Medicine School of Medicine, Dentistry and Biomedical Sciences Queen's University Belfast Belfast UK
| | - Rebecca P Chow
- Wellcome-Wolfson Institute for Experimental Medicine School of Medicine, Dentistry and Biomedical Sciences Queen's University Belfast Belfast UK.,Division of Endocrinology, Diabetes and Metabolic Diseases Department of Medicine Medical University of South Carolina Charleston SC USA
| | - Rebecca H McLeese
- Wellcome-Wolfson Institute for Experimental Medicine School of Medicine, Dentistry and Biomedical Sciences Queen's University Belfast Belfast UK.,Division of Endocrinology, Diabetes and Metabolic Diseases Department of Medicine Medical University of South Carolina Charleston SC USA
| | - Michelle B Hookham
- Wellcome-Wolfson Institute for Experimental Medicine School of Medicine, Dentistry and Biomedical Sciences Queen's University Belfast Belfast UK
| | - Timothy J Lyons
- Wellcome-Wolfson Institute for Experimental Medicine School of Medicine, Dentistry and Biomedical Sciences Queen's University Belfast Belfast UK.,Division of Endocrinology, Diabetes and Metabolic Diseases Department of Medicine Medical University of South Carolina Charleston SC USA
| | - Jeremy Y Yu
- Wellcome-Wolfson Institute for Experimental Medicine School of Medicine, Dentistry and Biomedical Sciences Queen's University Belfast Belfast UK.,Division of Endocrinology, Diabetes and Metabolic Diseases Department of Medicine Medical University of South Carolina Charleston SC USA
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5
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Fry RC, Bangma J, Szilagyi J, Rager JE. Developing novel in vitro methods for the risk assessment of developmental and placental toxicants in the environment. Toxicol Appl Pharmacol 2019; 378:114635. [PMID: 31233757 DOI: 10.1016/j.taap.2019.114635] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/17/2019] [Accepted: 06/18/2019] [Indexed: 01/12/2023]
Abstract
During pregnancy, the placenta is critical for the regulation of maternal homeostasis and fetal growth and development. Exposures to environmental chemicals during pregnancy can be detrimental to the health of the placenta and therefore adversely impact maternal and fetal health. Though research on placental-derived developmental toxicity is expanding, testing is limited by the resources required for traditional test methods based on whole animal experimentation. Alternative strategies utilizing in vitro methods are well suited to contribute to more efficient screening of chemical toxicity and identification of biological mechanisms underlying toxicity outcomes. This review aims to summarize methods that can be used to evaluate toxicity resulting from exposures during the prenatal period, with a focus on newer in vitro methods centered on placental toxicity. The following key aspects are reviewed: (i) traditional test methods based on animal developmental toxicity testing, (ii) in vitro methods using monocultures and explant models, as well as more recently developed methods, including co-cultures, placenta-on-a-chip, and 3-dimensional (3D) cell models, (iii) endpoints that are commonly measured using in vitro designs, and (iv) the translation of in vitro methods into chemical evaluations and risk assessment applications. We conclude that findings from in vitro placental models can contribute to the screening of potentially hazardous chemicals, elucidation of chemical mechanism of action, incorporation into adverse outcome pathways, estimation of doses eliciting toxicity, derivation of extrapolation factors, and characterization of overall risk of adverse outcomes, representing key components of chemical regulation in the 21st century.
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Affiliation(s)
- Rebecca C Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; The Institute for Environmental Health Solutions, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Curriculum in Toxicology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jacqueline Bangma
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - John Szilagyi
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Julia E Rager
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; The Institute for Environmental Health Solutions, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Curriculum in Toxicology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Ngene NC, Moodley J, Naicker T. The performance of pre-delivery serum concentrations of angiogenic factors in predicting postpartum antihypertensive drug therapy following abdominal delivery in severe preeclampsia and normotensive pregnancy. PLoS One 2019; 14:e0215807. [PMID: 31022243 PMCID: PMC6485032 DOI: 10.1371/journal.pone.0215807] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 04/09/2019] [Indexed: 01/07/2023] Open
Abstract
Background The imbalance between circulating concentrations of anti- and pro-angiogenic
factors is usually intense in preeclampsia with severe features (sPE). It is
possible that pre-delivery circulating levels of angiogenic factors in sPE
may be associated with postpartum antihypertensive drug requirements. Objective To determine the predictive association between maternal pre-delivery serum
concentrations of angiogenic factors and the use of ≥3 slow- and/or a
rapid-acting antihypertensive drug therapy in sPE on postpartum days zero to
three following caesarean delivery. Study design Women with sPE (n = 50) and normotensive pregnancies (n = 90) were recruited
prior to childbirth. Serum samples were obtained from each participant <
48 hours before delivery to assess the concentrations of placental growth
factor (PIGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) using the
Roche Elecsys platform. Each participant was followed up on postpartum days
zero, one, two and three to monitor BP and confirm antihypertensive
treatment. The optimal cut-off thresholds of sFlt-1/PIGF ratio from receiver
operating characteristic curve predictive of the antihypertensive therapy
were subjected to diagnostic accuracy assessment. Results The majority 58% (29/50) of sPE had multiple severe features of preeclampsia
in the antenatal period with the commonest presentation being severe
hypertension in 88% (44/50) of this group, followed by features of impending
eclampsia which occurred in 42% (21/50). The median gestational age at
delivery was 38 (Interquartile range, IQR 1) vs 36 (IQR 6)
weeks, p < 0.001 in normotensive and sPE groups
respectively. Notably, the median sFlt-1/PIGF ratio in normotensive and sPE
groups were 7.3 (IQR 17.9) and 179.1 (IQR 271.2) respectively,
p < 0.001. Of the 50 sPE participants, 34% (17/50)
had early-onset preeclampsia. The median (IQR) of sFlt-1/PIGF in the early-
and late-onset preeclampsia groups were 313.52 (502.25), and 166.59(195.37)
respectively, p = 0.006. From postpartum days zero to
three, 48% (24/50) of sPE received ≥ 3 slow- and/or a rapid-acting
antihypertensive drug. However, the daily administration of ≥ 3 slow- and/or
a rapid-acting antihypertensive drug in sPE were pre-delivery 26% (13/50),
postpartum day zero 18% (9/50), postpartum day one 34% (17/50), postpartum
day two 24% (12/50) and postpartum day three 20% (10/50). In sPE, the
pre-delivery sFlt-1/PIGF ratio was predictive of administration of ≥3 slow-
and/or a rapid-acting antihypertensive drug on postpartum days zero, one and
two with the optimal cut-off ratio being ≥315.0, ≥181.5 and ≥ 267.8
respectively (sensitivity 72.7–75.0%, specificity 64.7–78.6%, positive
predictive value 40.0–50.0% and negative predictive value 84.6% - 94.3%).
The predictive performance of sFlt-1/PIG ratio on postpartum day 3 among the
sPE was not statistically significant (area under receiver operating
characteristic curve, 0.6; 95% CI, 0.3–0.8). Conclusion A pre-delivery sFlt-1/PIGF ratio (< 181.5) is a promising predictor for
excluding the need for ≥3 slow- and/or a rapid-acting antihypertensive drug
therapy in the immediate postpartum period in sPE.
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Affiliation(s)
- Nnabuike Chibuoke Ngene
- Department of Obstetrics and Gynaecology, University of KwaZulu-Natal,
South Africa
- * E-mail:
| | - Jagidesa Moodley
- Women’s Health and HIV Research Group, Department of Obstetrics and
Gynaecology, University of KwaZulu-Natal, South Africa
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Wang Y, Liu C, He X, Li Y, Zou Y. Effects of metoprolol, methyldopa, and nifedipine on endothelial progenitor cells in patients with gestational hypertension and preeclampsia. Clin Exp Pharmacol Physiol 2019; 46:302-312. [PMID: 30614608 DOI: 10.1111/1440-1681.13063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/25/2018] [Accepted: 01/04/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Yangui Wang
- Department of General Practice Hunan Provincial People’s Hospital/The First Affiliated Hospital of Hunan Normal University Changsha China
| | - Cuizhong Liu
- Department of General Practice Hunan Provincial People’s Hospital/The First Affiliated Hospital of Hunan Normal University Changsha China
| | - Xin He
- Department of Obstetrics and GynaecologyHunan Provincial People’s Hospital/The First Affiliated Hospital of Hunan Normal University Changsha China
| | - Yingzhao Li
- Department of General Practice Hunan Provincial People’s Hospital/The First Affiliated Hospital of Hunan Normal University Changsha China
| | - Yan Zou
- Department of General Practice Hunan Provincial People’s Hospital/The First Affiliated Hospital of Hunan Normal University Changsha China
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DONG G, TIAN Y, LI X. Adiponectin Participates in Preeclampsia by Regulating the Biological Function of Placental Trophoblasts through P38 MAPK-STAT5 Pathway. IRANIAN JOURNAL OF PUBLIC HEALTH 2018; 47:1838-1844. [PMID: 30788298 PMCID: PMC6379621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND We aimed to investigate the participation of adiponectin in preeclampsia, and to explore the possible mechanism. METHODS A total of 52 patients with preeclampsia and 30 normal women with full-term pregnancy were enrolled. Immunohistochemistry was used to detect the localization of MAPK and STAT5. RT-PCR was used to detect the expression of adiponectin mRNA in placental tissue of patients with preeclampsia and normal pregnant women. Western blot was used to detect the expression of adiponectin protein, MAPK, p-MAPK, STAT5 and p-STAT5 in placental tissue of patients with preeclampsia and normal pregnant women. RESULTS p-p38 was highly expressed in placental trophoblasts of patients with preeclampsia, while p-STAT5 was less expressed. Expression level of p-p38 and p-STAT5 in patients with preeclampsia were significantly different from those in normal pregnant women (P<0.01). Expression level of adiponectin mRNA was significantly lower in patients with preeclampsia than in normal pregnant women (P<0.05). Level of p-p38 expression was negatively correlated with levels of adiponectin expression (r=-0.413, P<0.05). Expression level of p-STAT5 was positively correlated with expression level of adiponectin (r=0.526, P<0.01). CONCLUSION Adiponectin participates in preeclampsia by regulating the biological function of placental tropho-blasts through p38 MAPK-STAT5 pathway.
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Affiliation(s)
- Gaoxia DONG
- Dept. of Obstetrics, The Second People’s Hospital of Liaocheng, Liaocheng 252600, China
| | - Ying TIAN
- Dept. of Obstetrics, Zhangqiu Maternity and Child Care Hospital, Jinan 250000, China
| | - Xinqin LI
- Dept. of Obstetrics, Jining First People’s Hospital, Jining 272011, China,Corresponding Author:
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Minhas R, Young D, Naseem R, Mueller A, Chinthala S, Perdigao JL, Yeo KTJ, Chan SL, Tung A, White JB, Shahul S, Rana S. Association of antepartum blood pressure levels and angiogenic profile among women with chronic hypertension. Pregnancy Hypertens 2018; 14:110-114. [PMID: 30527096 DOI: 10.1016/j.preghy.2018.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/25/2018] [Accepted: 09/04/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Angiogenic factors have been implicated in the pathogenesis of preeclampsia. This pilot study explored the association between antenatal blood pressure levels and angiogenic biomarkers (sFlt1 and PlGF) among women with chronic hypertension (cHTN). METHODS Blood samples were collected from women with cHTN (with/without superimposed preeclampsia) within 96 h prior to delivery. Subjects were stratified by mean outpatient BP as controlled (cBP < 140/90) or uncontrolled (uBP ≥ 140/90). Descriptive statistics were generated and assessed as appropriate. Logistic regression was employed to assess for adverse pregnancy outcomes between groups. RESULTS Data from seventy-eight women were analyzed, of which 58 (74.4%) were African American. Fifty-six (71.8%) had cBP and 22 (28.2%) had uBP. Use of antepartum outpatient antihypertensive medications was more frequent in patients with uBP (46.4% vs. 13.6%, p = 0.01). Compared to women with cBP, women with uBP had higher levels of pre-delivery sFlt1 and sFlt1/PlGF ratio (sFlt: 4218.5 vs. 3056.0 pg/ml, p = 0.046; sFlt/PlGF: 62.5 vs. 25.0, p = 0.04). Additionally, more uBP patients had superimposed preeclampsia with severe features (54.6% vs. 25.0%; p = 0.01) and preterm delivery (defined as a gestational age <35 weeks (40.9% vs. 10.7%; p = 0.002)) than cBP patients. In the multivariable model, women with uBP had greater odds of preterm delivery (OR 6.78; p = 0.01), superimposed preeclampsia (OR 3.20; p = 0.03) and preeclampsia with severe features (OR 3.27; p = 0.04) than women with cBP. CONCLUSION In women with cHTN, elevated antepartum BP is associated with worsened outcomes and may be associated with abnormal angiogenic profile at delivery. Larger studies are needed to confirm these findings.
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Affiliation(s)
- Ruby Minhas
- Section of Maternal Fetal Medicine/Department of Obstetrics & Gynecology, University of Chicago, Chicago, IL, USA
| | - Danielle Young
- Section of Maternal Fetal Medicine/Department of Obstetrics & Gynecology, University of Chicago, Chicago, IL, USA
| | - Rabab Naseem
- Section of Maternal Fetal Medicine/Department of Obstetrics & Gynecology, University of Chicago, Chicago, IL, USA
| | - Ariel Mueller
- Section of Maternal Fetal Medicine/Department of Obstetrics & Gynecology, University of Chicago, Chicago, IL, USA; Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sireesha Chinthala
- Section of Maternal Fetal Medicine/Department of Obstetrics & Gynecology, University of Chicago, Chicago, IL, USA
| | - Joana Lopes Perdigao
- Section of Maternal Fetal Medicine/Department of Obstetrics & Gynecology, University of Chicago, Chicago, IL, USA
| | - Kiang-Teck J Yeo
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Siaw Li Chan
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Avery Tung
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL, USA
| | - Julia Bregand White
- Section of Maternal Fetal Medicine/Department of Obstetrics & Gynecology, University of Chicago, Chicago, IL, USA
| | - Sajid Shahul
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL, USA
| | - Sarosh Rana
- Section of Maternal Fetal Medicine/Department of Obstetrics & Gynecology, University of Chicago, Chicago, IL, USA.
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Abstract
Importance We have performed a systematic search to summarize the role of statins for preventing and treating severe preeclampsia. Objective The aim of this study was to examine whether pravastatin is a useful and safe alternative for treating preeclampsia during pregnancy. Evidence Acquisition A systematic MEDLINE (PubMed) search was performed (1979 to June 2017), which was restricted to articles published in English, using the relevant key words of "statins," "pregnancy," "preeclampsia," "obstetrical antiphospholipid syndrome," and "teratogenicity." Results The initial search provided 296 articles. Finally, 146 articles were related to the use of statins during pregnancy, regarding their effect on the fetus and the treatment of preeclampsia. Ten studies were related to in vitro studies, 25 in animals, and 24 in humans (13 case report series and 11 cohort studies). We found 84 studies on reviews of such guidelines on cardiovascular disease (35 studies), use of statins in the antiphospholipid syndrome (25 studies), statin's specific use during pregnancy (13 studies), or preeclampsia treatment (11 studies). Conclusions Although the studies are of poor quality, the rate of major congenital abnormalities in the newborn exposed to statins during pregnancy is no higher than the expected when compared with overall risk population. The review shows a potential beneficial role of statins in preventing and treating severe preeclampsia that needs to be evaluated through well-designed clinical trials. Relevance This update could influence positively the clinical practice, giving an alternative therapy for clinicians who treat preeclampsia, particularly in severe cases.
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11
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Yang MY, Diao ZY, Wang ZY, Yan GJ, Zhao GF, Zheng MM, Dai AY, Dai YM, Hu YL. Pravastatin alleviates lipopolysaccharide-induced placental TLR4 over-activation and promotes uterine arteriole remodeling without impairing rat fetal development. J Biomed Res 2018; 32:288-297. [PMID: 30008464 PMCID: PMC6117606 DOI: 10.7555/jbr.32.20180039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Preeclampsia is associated with over-activation of the innate immune system in the placenta, in which toll-like receptor 4 (TLR4) plays an essential part. With their potent anti-inflammatory effects, statins have been suggested as potential prevention or treatment of preeclampsia, although evidence remains inadequate. Herewith, we investigated whether pravastatin could ameliorate preeclampsia-like phenotypes in a previously established lipopolysaccharide (LPS)-induced rat preeclampsia model, through targeting the TLR4/NF-κB pathway. The results showed that pravastatin reduced the blood pressure [maximum decline on gestational day (GD) 12, (101.33±2.49) mmHg vs. (118.3±1.37) mmHg, P<0.05] and urine protein level [maximum decline on GD9, (3,726.23±1,572.86)μg vs. (1,991.03±609.37)μg, P<0.05], which were elevated following LPS administration. Pravastatin also significantly reduced the rate of fetal growth restriction in LPS-treated rats (34.10% vs. 8.99%, P<0.05). Further pathological analyses suggested a restoration of normal spiral artery remodeling in preeclampsia rats by pravastatin treatment. These effects of pravastatin were associated with decreased TLR4/NF-κB protein levels in the placenta and IL-6/MCP-1 levels in serum. Additionally, no obvious abnormalities in fetal liver, brain, and kidney were found after administration of pravastatin. These results provide supportive evidence for use of pravastatin in preventing preeclampsia.
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Affiliation(s)
- Mu-Yi Yang
- Drum Tower Clinical Medical College, Nanjing Medical University, Nanjing, Jiangsu 210008, China
| | - Zhen-Yu Diao
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu 210008, China
| | - Zhi-Yin Wang
- Drum Tower Clinical Medical College, Nanjing Medical University, Nanjing, Jiangsu 210008, China
| | - Gui-Jun Yan
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu 210008, China
| | - Guang-Feng Zhao
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu 210008, China
| | - Ming-Ming Zheng
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu 210008, China
| | - An-Yi Dai
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu 210008, China
| | - Yi-Min Dai
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu 210008, China
| | - Ya-Li Hu
- Drum Tower Clinical Medical College, Nanjing Medical University, Nanjing, Jiangsu 210008, China
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Verheecke M, Hermans E, Tuyaerts S, Souche E, Van Bree R, Verbist G, Everaert T, Cortès-Calabuig A, Van Houdt J, Van Calsteren K, Amant F. Acute Drug Effects on the Human Placental Tissue: The Development of a Placental Murine Xenograft Model. Reprod Sci 2018; 25:1637-1648. [PMID: 29439620 DOI: 10.1177/1933719118756771] [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: 11/16/2022]
Abstract
OBJECTIVE A pilot study was conducted to establish a human placental xenograft, which could serve as a model to evaluate the effect of toxic exposures during pregnancy. STUDY DESIGN The protocol consisted of engraftment of third-trimester human placental tissue in immunocompromised mice, after induction of a pseudo-pregnancy state by ovariectomy and progesterone supplementation. To validate the model, the placental tissue before and after engraftment was examined by immunohistochemistry, fluorescence-activated cell sorting (FACS), single-nucleotide polymorphism (SNP) genotyping, and whole transcriptome sequencing (WTSS). The human chorion gonadotropin (hCG) production in serum and urine was examined by enzyme-linked immunosorbent assay. RESULTS Microscopic evaluation of the placental tissue before and after engraftment revealed a stable morphology and preserved histological structure of the human tissue. Viable trophoblast was present after engraftment and remained stable over time. Vascularization and hormonal secretion (hCG) were present till 3 weeks after engraftment. Thirty-one SNPs were equally present, and there was a stable expression level for 56 451 genes evaluated by whole transcriptome sequencing. CONCLUSION Although this human placental xenograft model cannot copy the unique uterine environment in which the placenta develops and interacts between the mother and the fetus, it could be a suitable tool to evaluate the acute impact and adaptive processes of the placental tissue to environmental changes.
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Affiliation(s)
- Magali Verheecke
- 1 Department of Oncology, KU Leuven, Leuven, Belgium.,2 Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Els Hermans
- 3 TRACE (the patient-derived human xenograft platform), Catholic University of Leuven, KU Leuven, Leuven, Belgium.,4 Center for Human Genetics, University Hospitals Leuven, Leuven, Belgium.,5 Genomics Core, KU Leuven, Leuven, Belgium
| | | | - Erika Souche
- 4 Center for Human Genetics, University Hospitals Leuven, Leuven, Belgium.,5 Genomics Core, KU Leuven, Leuven, Belgium
| | - Rita Van Bree
- 6 Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Godelieve Verbist
- 6 Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Tina Everaert
- 1 Department of Oncology, KU Leuven, Leuven, Belgium
| | - Alvaro Cortès-Calabuig
- 4 Center for Human Genetics, University Hospitals Leuven, Leuven, Belgium.,5 Genomics Core, KU Leuven, Leuven, Belgium
| | - Jeroen Van Houdt
- 4 Center for Human Genetics, University Hospitals Leuven, Leuven, Belgium.,5 Genomics Core, KU Leuven, Leuven, Belgium
| | - Kristel Van Calsteren
- 2 Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium.,6 Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Frederic Amant
- 1 Department of Oncology, KU Leuven, Leuven, Belgium.,7 Center for Gynecologic Oncology Amsterdam (CGOA), Netherlands Cancer Institute, (NKI), Amsterdam, the Netherlands
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Katsi V, Georgountzos G, Kallistratos MS, Zerdes I, Makris T, Manolis AJ, Nihoyannopoulos P, Tousoulis D. The Role of Statins in Prevention of Preeclampsia: A Promise for the Future? Front Pharmacol 2017; 8:247. [PMID: 28529486 PMCID: PMC5418337 DOI: 10.3389/fphar.2017.00247] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 04/19/2017] [Indexed: 11/13/2022] Open
Abstract
Preeclampsia has been linked to high morbidity and mortality during pregnancy. However, no efficient pharmacological options for the prevention of this condition are currently available. Preeclampsia is thought to share several pathophysiologic mechanisms with cardiovascular disease, which has led to investigations for the potential role of statins (HMG CoA reductase inhibitors) in its prevention and early management. Pravastatin seems to have a safer pharmacokinetic profile compared to other statins, however, the existing preclinical evidence for its effectiveness in preeclampsia treatment has been mostly restricted to animal models. This review aims to summarize the current data and delineate the potential future role of statins in the prevention and management of preeclampsia.
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Affiliation(s)
- Vasiliki Katsi
- Department of Cardiology, Hippokration HospitalAthens, Greece
| | | | | | - Ioannis Zerdes
- Faculty of Medicine, School of Health Sciences, University of IoanninaIoannina, Greece
| | - Thomas Makris
- Department of Cardiology, Elena Venizelou HospitalAthens, Greece
| | | | - Petros Nihoyannopoulos
- First University Department of Cardiology, Hippokration Hospital, University of AthensAthens, Greece
| | - Dimitris Tousoulis
- First University Department of Cardiology, Hippokration Hospital, University of AthensAthens, Greece
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Brownfoot FC, Tong S, Hannan NJ, Binder NK, Walker SP, Cannon P, Hastie R, Onda K, Kaitu’u-Lino TJ. Effects of Pravastatin on Human Placenta, Endothelium, and Women With Severe Preeclampsia. Hypertension 2015. [DOI: 10.1161/hypertensionaha.115.05445] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Fiona C. Brownfoot
- From the Translational Obstetrics Group, Department of Obstetrics and Gynaecology (F.C.B., S.T., N.J.H., N.K.B., P.C., R.H., K.O., T.J.K.-L.), Department of Perinatal Medicine (S.P.W.), Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia; and Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, School of Pharmacy, Japan (K.O.)
| | - Stephen Tong
- From the Translational Obstetrics Group, Department of Obstetrics and Gynaecology (F.C.B., S.T., N.J.H., N.K.B., P.C., R.H., K.O., T.J.K.-L.), Department of Perinatal Medicine (S.P.W.), Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia; and Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, School of Pharmacy, Japan (K.O.)
| | - Natalie J. Hannan
- From the Translational Obstetrics Group, Department of Obstetrics and Gynaecology (F.C.B., S.T., N.J.H., N.K.B., P.C., R.H., K.O., T.J.K.-L.), Department of Perinatal Medicine (S.P.W.), Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia; and Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, School of Pharmacy, Japan (K.O.)
| | - Natalie K. Binder
- From the Translational Obstetrics Group, Department of Obstetrics and Gynaecology (F.C.B., S.T., N.J.H., N.K.B., P.C., R.H., K.O., T.J.K.-L.), Department of Perinatal Medicine (S.P.W.), Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia; and Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, School of Pharmacy, Japan (K.O.)
| | - Susan P. Walker
- From the Translational Obstetrics Group, Department of Obstetrics and Gynaecology (F.C.B., S.T., N.J.H., N.K.B., P.C., R.H., K.O., T.J.K.-L.), Department of Perinatal Medicine (S.P.W.), Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia; and Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, School of Pharmacy, Japan (K.O.)
| | - Ping Cannon
- From the Translational Obstetrics Group, Department of Obstetrics and Gynaecology (F.C.B., S.T., N.J.H., N.K.B., P.C., R.H., K.O., T.J.K.-L.), Department of Perinatal Medicine (S.P.W.), Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia; and Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, School of Pharmacy, Japan (K.O.)
| | - Roxanne Hastie
- From the Translational Obstetrics Group, Department of Obstetrics and Gynaecology (F.C.B., S.T., N.J.H., N.K.B., P.C., R.H., K.O., T.J.K.-L.), Department of Perinatal Medicine (S.P.W.), Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia; and Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, School of Pharmacy, Japan (K.O.)
| | - Kenji Onda
- From the Translational Obstetrics Group, Department of Obstetrics and Gynaecology (F.C.B., S.T., N.J.H., N.K.B., P.C., R.H., K.O., T.J.K.-L.), Department of Perinatal Medicine (S.P.W.), Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia; and Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, School of Pharmacy, Japan (K.O.)
| | - Tu’uhevaha J. Kaitu’u-Lino
- From the Translational Obstetrics Group, Department of Obstetrics and Gynaecology (F.C.B., S.T., N.J.H., N.K.B., P.C., R.H., K.O., T.J.K.-L.), Department of Perinatal Medicine (S.P.W.), Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia; and Department of Clinical Pharmacology, Tokyo University of Pharmacy and Life Sciences, School of Pharmacy, Japan (K.O.)
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