Renin, angiotensin II, aldosterone, catecholamines, prostaglandins and vasopressin. The importance of pressor and depressor factors for hypertension in pregnancy

Association Study Between the Human Renin Gene and Preeclampsia

OBJECTIVE

We recently reported on a missense mutation in exon 9 of the human renin gene (G1051A) that may affect the functioning of this enzyme, and is associated with essential hypertension. The aim of the present study is to assess the association between the genotypes of this missense mutation in the renin gene and preeclampsia (PE) via a case-control study.

METHODS

DNA was extracted from peripheral blood leukocytes, and genotyping of G1051A was performed in 117 PE patients and in 171 non-PE controls.

RESULTS

The frequency of genotypes for G1051A was not significantly different between the two groups. The frequency of the A1051 allele was also not significantly different between PE patients (52.6%) and non-PE controls (50.6%).

CONCLUSIONS

The missense mutation G1051A in the human renin gene is not associated with PE.

Abnormal vasopressin and aldosterone response to furosemide in essential hypertension

Plasma concentrations of arginine vasopressin (AVP), angiotensin II (AII), aldosterone (Aldo), urinary output (V), osmolar clearance (Cosm), free water clearance (CH2O), fractional excretions of sodium (FENa) and potassium (FEK), urinary sodium excretion rate (U-Na) and serum potassium (S-K) were determined in 9 patients with essential hypertension (group I) and 13 normotensive healthy control subjects (group II) before and three times during the first 4 hours after an intravenous injection of 40 mg of furosemide. AVP, AII, Aldo, V, Cosm, FENa, FEK and U-Na increased in both groups. However, the elevation in AVP was significantly more pronounced and the rate of increase in Aldo was significantly slower in group I than in group II. There were no significant differences in AII, V, Cosm, CH2O, FENa, FEK and U-Na between the groups. S-K was significantly reduced only in group I. AVP and AII were not significantly correlated to each other or to blood pressure. It is suggested that the responsiveness of the renal tubules to AVP is reduced in essential hypertension and that the larger increase in AVP might be a compensatory phenomenon. The slower increase in Aldo in essential hypertension could be attributed to the reduction in S-K.

Autoantibody from women with preeclampsia induces soluble Fms-like tyrosine kinase-1 production via angiotensin type 1 receptor and calcineurin/nuclear factor of activated T-cells signaling

Preeclampsia is a pregnancy-specific hypertensive syndrome that causes substantial maternal and fetal morbidity and mortality. Recent evidence indicates that maternal endothelial dysfunction in preeclampsia results from increased soluble Fms-like tyrosine kinase-1 (sFlt-1), a circulating antiangiogenic protein. Factors responsible for excessive production of sFlt-1 in preeclampsia have not been identified. We tested the hypothesis that angiotensin II type 1 (AT(1)) receptor activating autoantibodies, which occur in women with preeclampsia, contribute to increased production of sFlt-1. IgG from women with preeclampsia stimulates the synthesis and secretion of sFlt-1 via AT(1) receptor activation in pregnant mice, human placental villous explants, and human trophoblast cells. Using FK506 or short-interfering RNA targeted to the calcineurin catalytic subunit mRNA, we determined that calcineurin/nuclear factor of activated T-cells signaling functions downstream of the AT(1) receptor to induce sFlt-1 synthesis and secretion by AT(1)-receptor activating autoantibodies. AT(1)-receptor activating autoantibody-induced sFlt-1 secretion resulted in inhibition of endothelial cell migration and capillary tube formation in vitro. Overall, our studies demonstrate that an autoantibody from women with preeclampsia induces sFlt-1 production via angiotensin receptor activation and downstream calcineurin/nuclear factor of activated T-cells signaling. These autoantibodies represent potentially important targets for diagnosis and therapeutic intervention.

Maternal serum of women with pre-eclampsia reduces trophoblast cell viability: evidence for an increased sensitivity to Fas-mediated apoptosis

OBJECTIVE

Pre-eclampsia or 'toxemia of pregnancy' has been attributed to the presence of a circulating 'toxin' which disappears from peripheral blood after delivery of the placenta. However, the presence, nature and effects of this toxin have eluded characterization. Increased trophoblast apoptosis has been observed in the placenta of women with pre-eclampsia, and it is possible that this biological phenomenon is important for the genesis of the disease and mediated through a soluble factor(s) present in maternal blood. This study was designed to test the hypothesis that serum from women with pre-eclampsia changes trophoblast viability. Moreover, we sought to examine whether this effect could be mediated through changes in sensitivity to Fas/Fas ligand-mediated apoptosis.

STUDY DESIGN

H8 trophoblast cells were cultured with serum obtained from normal pregnant women (n = 48) and patients with pre-eclampsia (n = 12). Cell viability was determined by the Cell Titer 96 assay. Fas sensitivity was determined by treating the cells with an agonist anti-Fas antibody or a blocking anti-Fas ligand antibody.

RESULTS

Serum from normal pregnant women did not affect trophoblast cell viability. In contrast, serum from pre-eclamptic women reduced trophoblast viability, and this was enhanced by treatment with an anti-Fas antibody. This effect was reversed by the treatment with a blocking anti-Fas ligand antibody.

CONCLUSION

Serum from women with pre-eclampsia induces the cytotoxicity of a first-trimester trophoblast cell line (H8). This effect appears to be related to changes in trophoblast sensitivity to Fas-mediated apoptosis. These findings suggest that a factor present in the maternal blood of patients with pre-eclampsia may have a role in the genesis of the syndrome.

Maternal and fetal angiotensinogen gene allele sharing in pre-eclampsia

OBJECTIVE

To compare the angiotensinogen genotypes in normotensive and pre-eclamptic pregnancies in maternal and fetal samples.

DESIGN

Prospective observational study.

SETTING

University Hospital, Queen's Medical Centre, Nottingham.

POPULATION

Forty-three women with pre-eclampsia and 84 normotensive pregnant women. Fetal samples were available for genotyping from 96% of the pregnancies.

METHODS

Maternal and fetal DNA was genotyped at angiotensinogen codon 235 and at a dinucleotide repeat polymorphism in the 3' flanking region of the gene. Angiotensinogen and renin concentrations were measured in maternal plasma by radioimmunoassay.

RESULTS

In contrast to earlier studies, no association was demonstrated between the angiotensinogen 235 Thr variant and pre-eclampsia. Normotensive pregnant women homozygous for this variant had significantly lower plasma angiotensinogen concentrations (median 2.2 ng AI/mL; IQR 1.8-3.0) than women homozygous for the 235 Met allele (3.6 ng AI/mL; IQR 2.5-4.1; P = 0.04). In pre-eclamptic pregnancies, 79% (11/14) of mothers heterozygous for the dinucleotide repeat allele designated A9 transmitted this allele to the fetus, more frequently than would be expected by chance (P = 0.02). The A9 allele was associated with low plasma angiotensinogen concentrations (P = 0.001) and high renin concentrations (P = 0.02) in normotensive women.

CONCLUSIONS

There is no evidence that the angiotensinogen 235 Thr allele is associated with pre-eclampsia in the Nottingham population. The angiotensinogen 235 Thr allele is associated with low plasma angiotensinogen concentrations in normotensive pregnant women, in contrast to the high levels associated with this variant in non-pregnant women, suggesting that regulation of angiotensinogen expression in normal pregnancy may differ significantly from that in the non-pregnant state. There is preliminary evidence that maternal-fetal transmission of an angiotensinogen allele associated with low plasma angiotensinogen concentrations is associated with pre-eclampsia. Impaired generation of angiotensin II at the maternal-fetal interface may be a factor in the pathogenesis of pre-eclampsia.

Urinary excretion of 6-keto prostaglandin F1 alpha in pre-eclampsia

In order to investigate whether urinary excretion of prostaglandins (PG) is involved in the pathophysiology of pre-eclampsia, urinary immunoreactive 6-keto PGF1 alpha and TXB2 were measured in normal and pre-eclamptic women by radio-immunoassay after extraction with Bond Elut column. Urinary levels of 6-keto PGF1 alpha and TXB2 were expressed as ratio of urinary concentration of prostaglandin vs. creatinine (pg prostaglandin/mg creatinine; pg/mg cre.). Urinary excretion in normal pregnant and postpartum women were 211.2 +/- 33.8 and 160.1 +/- 9.1 pg/mg cre., respectively. In the pre-eclamptic group, urinary excretion of 6-keto PGF1 alpha was 105.3 +/- 28.2 pg/mg cre. in pregnancy and 99.0 +/- 12.5 pg/mg cre. in the postpartum period. Urinary excretion of 6-keto PGF1 alpha in the pre-eclamptic group was significantly lower (P less than 0.05) than in normal controls during pregnancy but not in the postpartum period. Urinary excretion of TXB2 was not significantly different between the two groups. The urinary excretion of 6-keto PGF1 alpha was measured before and after the onset of pre-eclampsia in four cases of edema and weight gain of more than 500 g/week (group e), one case of proteinuria of more than 200 mg/dl with edema (group ep) and three cases of pre-eclampsia (group eph). The urinary excretion of 6-keto PGF1 alpha in these eight patients before onset of pre-eclampsia was slightly lower than of normal controls but not significantly so. In group eph, urinary excretion of PG was decreased after the onset of pre-eclampsia. These results provide further evidence of the involvement of PG in the pathophysiology of pre-eclampsia.

Post-renal-transplant hypertension. Urine volume, free water clearance and plasma concentrations of arginine vasopressin, angiotensin II and aldosterone before and after oral water loading in hypertensive and normotensive renal transplant recipients

Urine volume (V), free water clearance (CH2O) and plasma concentrations of arginine vasopressin (AVP), angiotensin II (A II) and aldosterone (Aldo) were determined before and three times during the first 5 h after an oral water load of 20 ml/kg body wt in 19 patients with post-renal-transplant hypertension (group I), in 13 normotensive renal transplant recipients (group II) and in 20 control subjects (group III). Both V and CH2O increased significantly in all groups, but considerably less in groups I and II than in group III. When CH2O was related to glomerular filtration rate no differences existed between patients and control subjects. Basal AVP was the same in groups I (3.3 pmol/l, median) and II (3.0 pmol/l), but significantly (p less than 0.01) higher than in group III (1.9 pmol/l). Basal A II was significantly (p less than 0.01) elevated in group I (18 pmol/l) when compared to both groups II (10 pmol/l) and III (11 pmol/l), and the level was independent of the presence of native kidneys. Basal Aldo was the same in all groups. During loading, AVP was reduced in all groups, A II was almost unchanged, and Aldo was increased in groups I and II and reduced in group III depending on alterations in serum potassium. Thus urinary diluting ability is reduced in renal transplant recipients due to a reduced glomerular filtration rate. The enhanced A II in hypertensive renal transplant recipients gives further evidence for the point of view that hypertension is angiotensin-dependent in most of these patients.

Relationship between urinary concentrating ability, arginine vasopressin in plasma and blood pressure after renal transplantation

Arginine vasopressin (AVP) and serum osmolality (Sosm) were determined in plasma before and after a 24-h period of water deprivation in 19 patients with post-renal-transplant hypertension (group I), 14 patients with normal blood pressure after renal transplantation (group II), and 16 healthy control subjects (group III). Urine was collected in four periods of 6 h each for measurement of urine volume (V), urine osmolality (Uosm) and tubular capacity for reabsorption of water (Tc water). AVP and Sosm increased significantly in all groups. The AVP levels were the same in groups I and II, but higher in group I than III both before and after water deprivation. In group II, AVP was higher than in group III only after water deprivation; V was significantly reduced in all groups. In groups I and II, V, Tc water and Uosm were the same. In group III, V was significantly lower than in groups I and II in the last three 6-h periods, and in group III, Tc water was higher in the first 6-h period than in groups I and II. There was a significant positive correlation between AVP and Sosm in all groups. In conclusion, renal water excretion cannot be reduced as rapidly and to the same degree in renal transplant recipients as in control subjects because of a decreased renal capacity for reabsorption of water. The higher AVP level in the transplant recipients may be a compensatory phenomenon for the decreased responsiveness of the renal collecting ducts in the transplanted kidneys. The sensitivity of the osmoreceptors to changes in osmotic stimuli was normal.