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Kacerovsky M, Hornychova H, Holeckova M, Pavlikova L, Rezabkova Chloubova J, Jacobsson B, Musilova I. Predictive Value of the sFlt-1/PlGF Ratio and Interleukin-6 for the Presence of Placental Lesions in Spontaneous Preterm Labor with Intact Membranes with Delivery within 7 Days. Fetal Diagn Ther 2024:1-11. [PMID: 38964308 DOI: 10.1159/000540203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/30/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION The aim of the study was to identify predictive values of the soluble fms-like tyrosine kinase/placental growth factor (sFlt-1/PlGF) ratio and interleukin (IL)-6, assessed with a clinically available method in a large-volume biochemistry laboratory, in maternal blood, amniotic fluid, and umbilical cord blood for the presence of the placental lesions consistent with maternal vascular malperfusion (MVM) and acute histological chorioamnionitis (HCA), respectively. METHODS This retrospective study included 92 women with preterm labor with intact membranes (PTL) delivered within 7 days of admission with gestational ages between 22+0 and 34+6 weeks. The sFlt-1/PlGF ratio and IL-6 were assessed in stored samples of maternal serum, amniotic fluid, and umbilical cord serum using Elecsys® sFlt-1, PlGF, and IL-6 immunoassays. RESULTS Women with MVM had a higher sFlt-1/PlGF ratio in the maternal serum, compared to those without MVM (19.9 vs. 4.6; p < 0.0001), but not in the amniotic fluid or umbilical cord blood. A cut-off value of 8 for the sFlt-1/PlGF ratio in maternal serum was identified as optimal for predicting MVM in patients with PTL. Women with HCA had higher concentrations of IL-6 in maternal serum, compared to those without HCA (11.1 pg/mL vs. 8.4 pg/mL; p = 0.03), amniotic fluid (9,216 pg/mL vs. 1,423 pg/mL; p < 0.0001), and umbilical cord blood (20.7 pg/mL vs. 10.7 pg/mL, p = 0.002). Amniotic-fluid IL-6 showed the highest predictive value. A cut-off value of IL-6 concentration in the amniotic fluid of 5,000 pg/mL was found to be optimal for predicting HCA in PTL. CONCLUSION Maternal serum sFlt-1/PlGF and amniotic fluid IL-6 concentrations can be used for liquid biopsy to predict placental lesions in women with PTL who deliver within 7 days.
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Affiliation(s)
- Marian Kacerovsky
- Biomedical Research Center, University Hospital Hradec Kralove, Hradec Kralove, Czechia
- Department of Obstetrics and Gynecology, Hospital Most, Krajska zdravotni a.s., Most, Czechia
| | - Helena Hornychova
- Fingerland's Department of Pathology, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czechia
| | - Magdalena Holeckova
- Institute of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czechia
| | - Ladislava Pavlikova
- Institute of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czechia
| | | | - Bo Jacobsson
- Institute of Clinical Biochemistry and Diagnostics, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czechia
- Region Västra Götaland, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Genetics and Bioinformatics, Domain of Health Data and Digitalization, Institute of Public Health, Oslo, Norway
| | - Ivana Musilova
- Biomedical Research Center, University Hospital Hradec Kralove, Hradec Kralove, Czechia
- Department of Obstetrics and Gynecology, Hospital Most, Krajska zdravotni a.s., Most, Czechia
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Kontovazainitis CG, Gialamprinou D, Theodoridis T, Mitsiakos G. Hemostasis in Pre-Eclamptic Women and Their Offspring: Current Knowledge and Hemostasis Assessment with Viscoelastic Tests. Diagnostics (Basel) 2024; 14:347. [PMID: 38337863 PMCID: PMC10855316 DOI: 10.3390/diagnostics14030347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/22/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Pre-eclampsia (PE) is a placenta-mediated disease and remains a major cause of maternal and neonatal mortality and morbidity. As PE develops, normal pregnancy's hypercoagulable balance is disrupted, leading to platelet hyperactivation, excessive pathological hypercoagulability, and perturbed fibrinolysis. This narrative review aims to summarize the current knowledge regarding hemostasis in PE compared with healthy gestation and the potential effects of maternal PE on neonatal hemostasis. Finally, it aims to discuss hemostasis assessments for normal pregnancies and PE, emphasizing the role of viscoelastic tests, namely, thromboelastography (TEG) and thromboelastometry (ROTEM), for monitoring PE-associated hemostatic alterations. The use of TEG/ROTEM for assessing the hemostatic profile of PE women has been little considered, even though conventional coagulation tests (CCTs) have not helped to monitor hemostasis in this population. Compared with normal pregnancy, TEG/ROTEM in PE reveals an excessive hypercoagulability analogous with the severity of the disease, characterized by higher-stability fibrin clots. The TEG/ROTEM parameters can reflect PE severity and may be used for monitoring and as predictive markers for the disease.
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Affiliation(s)
- Christos-Georgios Kontovazainitis
- 2nd Neonatal Department and Neonatal Intensive Care Unit (NICU), “Papageorgiou” University Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (C.-G.K.); (D.G.)
| | - Dimitra Gialamprinou
- 2nd Neonatal Department and Neonatal Intensive Care Unit (NICU), “Papageorgiou” University Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (C.-G.K.); (D.G.)
| | - Theodoros Theodoridis
- 1st Department of Obstetrics and Gynecology, “Papageorgiou” University Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece;
| | - Georgios Mitsiakos
- 2nd Neonatal Department and Neonatal Intensive Care Unit (NICU), “Papageorgiou” University Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (C.-G.K.); (D.G.)
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Troncoso F, Sandoval H, Ibañez B, López-Espíndola D, Bustos F, Tapia JC, Sandaña P, Escudero-Guevara E, Nualart F, Ramírez E, Powers R, Vatish M, Mistry HD, Kurlak LO, Acurio J, Escudero C. Reduced Brain Cortex Angiogenesis in the Offspring of the Preeclampsia-Like Syndrome. Hypertension 2023; 80:2559-2571. [PMID: 37767691 DOI: 10.1161/hypertensionaha.123.21756] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Children from pregnancies affected by preeclampsia have an increased risk of cognitive and behavioral alterations via unknown pathophysiology. We tested the hypothesis that preeclampsia generated reduced brain cortex angiogenesis in the offspring. METHODS The preeclampsia-like syndrome (PELS) mouse model was generated by administering the nitric oxide inhibitor NG-nitroarginine methyl ester hydrochloride. Confirmatory experiments were done using 2 additional PELS models. While in vitro analysis used mice and human brain endothelial cells exposed to serum of postnatal day 5 pups or umbilical plasma from preeclamptic pregnancies, respectively. RESULTS We report significant reduction in the area occupied by blood vessels in the motor and somatosensory brain cortex of offspring (postnatal day 5) from PELS compared with uncomplicated control offspring. These data were confirmed using 2 additional PELS models. Furthermore, circulating levels of critical proangiogenic factors, VEGF (vascular endothelial growth factor), and PlGF (placental growth factor) were lower in postnatal day 5 PELS. Also we found lower VEGF receptor 2 (KDR [kinase insert domain-containing receptor]) levels in mice and human endothelial cells exposed to the serum of postnatal day 5 PELS or fetal plasma of preeclamptic pregnancies, respectively. These changes were associated with lower in vitro angiogenic capacity, diminished cell migration, larger F-actin filaments, lower number of filopodia, and lower protein levels of F-actin polymerization regulators in brain endothelial cells exposed to serum or fetal plasma of offspring from preeclampsia. CONCLUSIONS Offspring from preeclampsia exhibited diminished brain cortex angiogenesis, associated with lower circulating VEGF/PlGF/KDR protein levels, impaired brain endothelial migration, and dysfunctional assembly of F-actin filaments. These alterations may predispose to structural and functional alterations in long-term brain development.
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Affiliation(s)
- Felipe Troncoso
- Vascular Physiology Laboratory, Department of Basic Sciences, Universidad del Bío-Bío, Chillán, Chile (F.T., H.S., B.I., E.E.-G., J.A., C.E.)
| | - Hermes Sandoval
- Vascular Physiology Laboratory, Department of Basic Sciences, Universidad del Bío-Bío, Chillán, Chile (F.T., H.S., B.I., E.E.-G., J.A., C.E.)
| | - Belén Ibañez
- Vascular Physiology Laboratory, Department of Basic Sciences, Universidad del Bío-Bío, Chillán, Chile (F.T., H.S., B.I., E.E.-G., J.A., C.E.)
| | - Daniela López-Espíndola
- Escuela de Tecnología Médica, Facultad de Medicina, Universidad de Valparaíso, Chile (D.L.-E., F.B.)
- Group of Research and Innovation in Vascular Health, Chillan, Chile (D.L.-E., C.E.)
| | - Francisca Bustos
- Escuela de Tecnología Médica, Facultad de Medicina, Universidad de Valparaíso, Chile (D.L.-E., F.B.)
| | - Juan Carlos Tapia
- Stem Cells and Neuroscience Center, School of Medicine, University of Talca, Chile (J.C.T.)
| | - Pedro Sandaña
- Anatomopatholy Unit, Hospital Clinico Herminda Martin, Chillan, Chile (P.S.)
| | - Esthefanny Escudero-Guevara
- Vascular Physiology Laboratory, Department of Basic Sciences, Universidad del Bío-Bío, Chillán, Chile (F.T., H.S., B.I., E.E.-G., J.A., C.E.)
| | - Francisco Nualart
- Laboratory of Neurobiology and Stem Cells NeuroCellT, Department of Cellular Biology, Center for Advanced Microscopy CMA Bio-Bio, Faculty of Biological Sciences, University of Concepcion, Chile (F.N., E.R.)
- Departamento de Biología Celular, Facultad de Ciencias Biológicas, Universidad de Concepción, Chile (F.N.)
| | - Eder Ramírez
- Laboratory of Neurobiology and Stem Cells NeuroCellT, Department of Cellular Biology, Center for Advanced Microscopy CMA Bio-Bio, Faculty of Biological Sciences, University of Concepcion, Chile (F.N., E.R.)
| | - Robert Powers
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, PA (R.P.)
| | - Manu Vatish
- Nuffield Department of Women's Health and Reproductive Research, University of Oxford, England (M.V.)
| | - Hiten D Mistry
- Division of Women and Children's Health, School of Life Course and Population Sciences, King's College London, United Kingdom (H.D.M.)
| | - Lesia O Kurlak
- Stroke Trials Unit, School of Medicine, University of Nottingham, United Kingdom (L.O.K.)
| | - Jesenia Acurio
- Vascular Physiology Laboratory, Department of Basic Sciences, Universidad del Bío-Bío, Chillán, Chile (F.T., H.S., B.I., E.E.-G., J.A., C.E.)
| | - Carlos Escudero
- Vascular Physiology Laboratory, Department of Basic Sciences, Universidad del Bío-Bío, Chillán, Chile (F.T., H.S., B.I., E.E.-G., J.A., C.E.)
- Group of Research and Innovation in Vascular Health, Chillan, Chile (D.L.-E., C.E.)
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Şalk S, Yurtcu N, Çetin A. Predictive and diagnostic value of serum sVEGFR-1 level in women with preeclampsia: A prospective controlled study. Turk J Obstet Gynecol 2022; 19:268-274. [DOI: 10.4274/tjod.galenos.2022.38932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Cumsille P, Lara E, Verdugo-Hernández P, Acurio J, Escudero C. A robust quantitative approach for laser speckle contrast imaging perfusion analysis revealed anomalies in the brain blood flow in offspring mice of preeclampsia. Microvasc Res 2022; 144:104418. [PMID: 35931124 DOI: 10.1016/j.mvr.2022.104418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/27/2022] [Accepted: 07/31/2022] [Indexed: 02/01/2023]
Abstract
Microcirculation analysis of the brain cortex is challenging because surface perfusion varies rapidly in small space-time regions and is bone protected. The laser speckle contrast imaging (LSCI) technique allows analyzing in vivo brain vascular perfusion generating a large amount of data that requires sophisticated data analytics, making researchers invest much effort in processing. Our research question was whether the reduced placental perfusion model (RUPP) of preeclampsia (PE) was associated with impaired blood perfusion in the offspring's brains. We aimed to develop a robust numerical approach that mainly consisted of applying a signal-processing tool for calculating optimal segmentation and piece-wise fits of the offspring's brain perfusion signals obtained from the LSCI technique. We combined this tool with the usual statistical analysis, implementing both in Matlab software. We performed brain perfusion measurements from offspring (five days postnatal, P5) of control pregnant dams (sham, n = 13) and of RUPP dams (RUPP, n = 7) using the Pericam® PSI-HR system at a basal condition and after thermal stimuli (warm and cold). We found that pups of RUPP mice exhibited significant differences in perfusion and vascular response to thermal stimuli compared to the sham mice. These differences were associated with high data variability in the Sham group, while in the RUPP group, perfusion looks "stiffer." Data also suggest sex-dimorphism in the vascular response since female pups in the Sham group but not male pups showed statistically significant differences in response to the warm stimulus. Again, this sex-related difference was absent in pups of RUPP mice. In conclusion, we present a robust quantitative approach for LSCI measurements that revealed anomalies in the brain blood flow in offspring of the RUPP model of PE.
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Affiliation(s)
- Patricio Cumsille
- Vascular Physiology Laboratory, Department of Basic Sciences, Universidad del Bío-Bío, Campus Fernando May, Av. Andrés Bello 720, Casilla 447, Chillán, Chile; Centre for Biotechnology and Bioengineering (CeBiB), University of Chile, Santiago, Chile.
| | - Evelyn Lara
- Vascular Physiology Laboratory, Department of Basic Sciences, Universidad del Bío-Bío, Campus Fernando May, Av. Andrés Bello 720, Casilla 447, Chillán, Chile; Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillán, Chile
| | - Paula Verdugo-Hernández
- Escuela de Pedagogía en Ciencias Naturales y Exactas, Facultad de Ciencias de la Educación, Universidad de Talca, Chile
| | - Jesenia Acurio
- Vascular Physiology Laboratory, Department of Basic Sciences, Universidad del Bío-Bío, Campus Fernando May, Av. Andrés Bello 720, Casilla 447, Chillán, Chile; Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillán, Chile
| | - Carlos Escudero
- Vascular Physiology Laboratory, Department of Basic Sciences, Universidad del Bío-Bío, Campus Fernando May, Av. Andrés Bello 720, Casilla 447, Chillán, Chile; Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillán, Chile.
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Association of Maternal Preeclampsia with Neonatal Respiratory Distress Syndrome in Very-Low-Birth-Weight Infants. Sci Rep 2019; 9:13212. [PMID: 31519996 PMCID: PMC6744454 DOI: 10.1038/s41598-019-49561-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 08/27/2019] [Indexed: 12/22/2022] Open
Abstract
Preeclampsia is a common cause of preterm birth and neonatal morbidity, but its relationship with neonatal respiratory distress syndrome (RDS) remains controversial. We conducted a retrospective cohort study with data from very-low-birth-weight (VLBW) infants born in 1997–2014 from the database of the Premature Baby Foundation of Taiwan to evaluate the relationship between maternal preeclampsia and neonatal RDS. In total, 13,490 VLBW infants were enrolled, including 2200 (16.3%) infants born to preeclamptic mothers. The mean (standard deviation) gestational ages were 30.7 (2.5) weeks in the preeclamptic group and 28.6 (2.9) weeks in the control (non-preeclamptic) group. Severe RDS was defined according to the surfactant therapy requirement. The incidence of severe RDS was lower in infants exposed to maternal preeclampsia than in controls [28.9% vs. 44%; odds ratio (OR), 0.52; 95% confidence interval (CI), 0.47–0.57]. However, after adjustment for confounders, the OR for severe RDS development in the preeclampsia group was 1.16 (95% CI, 1.02–1.31). Other factors, such as gestational age, birth weight, female sex, and antenatal receipt of two or more steroid doses were significantly protective against RDS in multivariate regression analysis. This study revealed that maternal preeclampsia slightly increases the risk of severe RDS in VLBW infants.
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Mouna K, Doddagowda SM, Junjegowda K, Krishnamurthy L. Changes in Haematological Parameters in Newborns Born to Preeclamptic Mothers - A Case Control Study in a Rural Hospital. J Clin Diagn Res 2017; 11:EC26-EC29. [PMID: 28892906 PMCID: PMC5583780 DOI: 10.7860/jcdr/2017/29137.10303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 05/31/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Pregnancy is a physiological phenomenon. However, some women develop problems during pregnancy period, which puts both the mother's and the foetus health at risk. Hypertensive disorders of pregnancy are the type of the maternal diseases that can cause the most detrimental effects to the mother and foetus. AIMS To determine the haematological parameters in neonates born to preeclamptic mothers. MATERIALS AND METHODS It was a prospective case control study carried out on neonates born to preeclamptic mothers in our institute from March 2016 to November 2016. All the haematological parameters of the neonates were recorded and analyzed using SPSS 22.0 version software. Mean, Standard deviation, minimum and maximum values were calculated for continuous variables. The difference between the two groups was compared using independent student 't' test. The p-value <0.05 was considered as statistically significant. RESULTS About 120 mothers were included in the study out of which 60 were of study group and 60 of control group. Mean hemoglobin, PCV, red cell count, Mean Corpuscular Volume (MCV), reticulocyte count and nRBC were significantly increased p<0.001, whereas total leucocyte count, mean neutrophil count, absolute neutrophil count, lymphocyte count, platelet count were significantly decreased p<0.001 in babies born to preeclamptic mothers. No difference was found between the two groups in the Mean Corpuscular Haemoglobin (MCH) and Mean Corpuscular Haemoglobin Concentration (MCHC) value p(>0.05). CONCLUSION The babies born to preeclamptic mothers are more prone for development of prematurity, low birth weight, Intrauterine Growth Retardation (IUGR), sepsis, neutropenia, leucopenia, thrombocytopenia, increased RBC count, nRBC and reticulocyte count. Early haematological screening helps to decrease morbidity, improve growth, development and survival of the baby.
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Affiliation(s)
- Kalavakuru Mouna
- Student, Department of Pathology, Sri Devaraj Urs Medical College, Kolar, Karnataka, India
| | | | - Krishnappa Junjegowda
- Professor, Department of Pediatrics, Sri Devaraj Urs Medical College, Kolar, Karnataka, India
| | - Latha Krishnamurthy
- Assistant Professor, Department of Community Medicine, Sri Devaraj Urs Medical College, Kolar, Karnataka, India
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Lecuyer M, Laquerrière A, Bekri S, Lesueur C, Ramdani Y, Jégou S, Uguen A, Marcorelles P, Marret S, Gonzalez BJ. PLGF, a placental marker of fetal brain defects after in utero alcohol exposure. Acta Neuropathol Commun 2017; 5:44. [PMID: 28587682 PMCID: PMC5461764 DOI: 10.1186/s40478-017-0444-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 05/20/2017] [Indexed: 01/13/2023] Open
Abstract
Most children with in utero alcohol exposure do not exhibit all features of fetal alcohol syndrome (FAS), and a challenge for clinicians is to make an early diagnosis of fetal alcohol spectrum disorders (FASD) to avoid lost opportunities for care. In brain, correct neurodevelopment requires proper angiogenesis. Since alcohol alters brain angiogenesis and the placenta is a major source of angiogenic factors, we hypothesized that it is involved in alcohol-induced brain vascular defects. In mouse, using in vivo repression and overexpression of PLGF, we investigated the contribution of placenta on fetal brain angiogenesis. In human, we performed a comparative molecular and morphological analysis of brain/placenta angiogenesis in alcohol-exposed fetuses. Results showed that prenatal alcohol exposure impairs placental angiogenesis, reduces PLGF levels and consequently alters fetal brain vasculature. Placental repression of PLGF altered brain VEGF-R1 expression and mimicked alcohol-induced vascular defects in the cortex. Over-expression of placental PGF rescued alcohol effects on fetal brain vessels. In human, alcohol exposure disrupted both placental and brain angiogenesis. PLGF expression was strongly decreased and angiogenesis defects observed in the fetal brain markedly correlated with placental vascular impairments. Placental PGF disruption impairs brain angiogenesis and likely predicts brain disabilities after in utero alcohol exposure. PLGF assay at birth could contribute to the early diagnosis of FASD.
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Strong inhibitory effect of pre-eclampsia serum on angiogenesis detected in vitro by human cell-based angiogenesis tests. Pregnancy Hypertens 2016; 6:367-373. [DOI: 10.1016/j.preghy.2016.08.239] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/26/2016] [Indexed: 11/21/2022]
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Zubor P, Dokus K, Zigo I, Skerenova M, Pullmann R, Danko J. TNF α G308A gene polymorphism has an impact on renal function, microvascular permeability, organ involvement and severity of preeclampsia. Gynecol Obstet Invest 2014; 78:150-61. [PMID: 25059926 DOI: 10.1159/000364865] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 05/27/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Preeclampsia (PE) is a life-threatening complication of pregnancy that is associated with a high rate of maternal and perinatal morbidity and/or mortality worldwide. If untreated, it can progress to eclampsia, which can result in the death of the mother, the fetus or both. The etiology of PE is still uncertain; however, recently the role of the immune system has gained in importance. The role of tumor necrosis factor-α (TNF-α), a cytokine involved in inflammation processes, has been widely investigated in obstetric disorders. The aims of the present study were to investigate the effect of TNF-α gene G308A (rs1800629) polymorphism on disease risk, renal function, microvascular permeability, endothelial cell dysfunction and organ involvement in women with PE. METHODS Initially, 102 3rd-trimester pregnant women (preeclamptic cases and healthy controls) with singleton pregnancy were invited for participation, of which 76 were genotyped for TNF-α G308A polymorphism and evaluated for plasma levels of soluble vascular cell adhesion molecule-1 (sVCAM-1), fibronectin and TNF-α, which were tested for correlations with the profile of PE. The odds ratio (OR) and 95% confidence intervals obtained from unconditional logistic regression were used to test the association between the TNF-α polymorphism and PE risk. For continuous variables, we applied Student's t test and, for categorical variables, the Pearson χ(2) or Fisher's exact test. The two-way ANOVA test with Bonferroni correction was used in multivariate analyses. RESULTS The A allele was more frequent in cases than controls (22.4 vs. 13.2%), which increased disease risk (OR = 2.73). Maternal serum levels of TNF-α, sVCAM-1 and fibronectin were significantly increased in cases (855.8 ± 385.1 pg/ml, 1,243 ± 671 ng/ml, 0.308 ± 0.231 g/l, respectively) compared to controls (301.1 ± 156.1 pg/ml, 651 ± 250 ng/ml, 0.218 ± 0.101 g/l, respectively; p < 0.0001, p < 0.0001 and p = 0.031, respectively), and these levels showed an increasing trend with the mutant allele genotype. Moderate and severe proteinuria was higher in rs1800629 allele A subjects compared to G/G carriers (53.8 vs. 14.3% (p < 0.05) and 13.0 vs. 4.7% (p < 0.01), respectively). The adverse effect of rs1800629 allele A on renal function was confirmed by increased plasma creatine levels, urinary protein excretion and lower tubular resorption rate in preeclamptic patients. Moreover, rs1800629 allele A preeclamptic carriers showed higher serum levels of fibronectin and sVCAM-1 compared to G/G homozygotes. CONCLUSION This study reveals a possible association between clinical and laboratory manifestations of PE and the TNF-α gene G308A (rs1800629) polymorphism.
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Affiliation(s)
- Pavol Zubor
- Department of Obstetrics and Gynecology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovak Republic
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Sahay AS, Patil VV, Sundrani DP, Joshi AA, Wagh GN, Gupte SA, Joshi SR. A longitudinal study of circulating angiogenic and antiangiogenic factors and AT1-AA levels in preeclampsia. Hypertens Res 2014; 37:753-8. [DOI: 10.1038/hr.2014.71] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 12/26/2013] [Accepted: 01/21/2014] [Indexed: 11/09/2022]
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Olmos A, Díaz L, Avila E, Barrera D, López-Marure R, Biruete B, Larrea F, Halhali A. Associations between insulin-like growth factor I, vascular endothelial growth factor and its soluble receptor 1 in umbilical serum and endothelial cells obtained from normotensive and preeclamptic pregnancies. Growth Factors 2013; 31:123-9. [PMID: 23750889 DOI: 10.3109/08977194.2013.802692] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The aim of this study was to investigate the associations between insulin-like growth factor I (IGF-I) with vascular endothelial growth factor (VEGF) and its soluble receptor 1 (sFlt-1) in umbilical serum and to study the effects of IGF-I upon sFlt-1 synthesis in human umbilical vein endothelial cells (HUVEC) in normotensive (NT) and preeclamptic (PE) pregnancies. As compared with the NT group, umbilical serum IGF-I and VEGF levels were lower in the PE group, while sFlt-1 concentrations were higher. Levels of sFlt-1 correlated with IGF-I in the NT group and with VEGF in the PE group. Basal concentration of sFlt-1 in HUVEC culture media was higher in the PE group. IGF-I stimulated sFlt-1 synthesis only in the NT group. In summary, umbilical serum sFlt-1 is associated with IGF-I in normotensive pregnancy and with VEGF in preeclampsia. IGF-I stimulates sFlt-1 synthesis in endothelial cells in normotensive but not in PE pregnancies.
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Affiliation(s)
- Andrea Olmos
- Department of Reproductive Biology Carlos Gual Castro, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, DF México
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Staff AC, Benton SJ, von Dadelszen P, Roberts JM, Taylor RN, Powers RW, Charnock-Jones DS, Redman CWG. Redefining preeclampsia using placenta-derived biomarkers. Hypertension 2013; 61:932-42. [PMID: 23460278 DOI: 10.1161/hypertensionaha.111.00250] [Citation(s) in RCA: 259] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Kalay S, Cakcak B, Oztekin O, Tezel G, Tosun O, Akcakus M, Oygur N. The role of VEGF and its soluble receptor VEGFR-1 in preterm newborns of preeclamptic mothers with RDS. J Matern Fetal Neonatal Med 2013; 26:978-83. [PMID: 23339636 DOI: 10.3109/14767058.2013.766692] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We measured vascular endothelial growth factor (VEGF) and soluble VEGF receptor 1(sVEGFR-1) concentrations in cord blood and tracheal aspirate fluid (TAF) in order to investigate the role of them in lung maturation and the severity of respiratory distress syndrome (RDS) in preterm newborns, born to preeclamptic mothers. METHODS Newborns were divided into two groups as preterms born to preeclamptic mothers and preterms born to healthy mothers. They were also divided into two groups as severe RDS (sRDS) and mild RDS (mRDS) according to the need of surfactant and extent or type of ventilatory support. The concentrations of VEGF and sVEGFR-1 in cord blood and TAF (only in preterms with sRDS) were assayed by standardized enzyme-linked immunosorbent assay. RESULTS When the patients were evaluated as sRDS and mRDS, cord blood VEGF and VEGF/sVEGFR-1 concentrations of preterms with sRDS were significantly lower than the concentrations of preterms with mRDS. Conversely, cord blood sVEGFR-1 concentrations of preterms with sRDS were significantly higher than the concentrations of preterms with mRDS. VEGF and sVEGFR-1 concentrations in TAF could be compared only between sRDS preterms, born to preeclampsia (+) and (-) mothers. No statistical significance was detected between the two groups when sVEGFR-1, VEGF and VEGF/sVEGFR-1 concentrations in TAF were compared. CONCLUSION Preeclampsia seems not to have an important effect on VEGF and sVEGFR-1 concentrations of preterm newborns both in cord blood and in TAF. Low VEGF and high sVEGFR-1 concentrations seem to be associated with the severity of RDS irrespective of preeclampsia, suggesting that VEGF may be one of the main components of lung maturation.
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Affiliation(s)
- Salih Kalay
- Department of Pediatrics, Akdeniz University Medical School, Antalya, Turkey
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van den Hooven EH, Pierik FH, de Kluizenaar Y, Hofman A, van Ratingen SW, Zandveld PYJ, Russcher H, Lindemans J, Miedema HME, Steegers EAP, Jaddoe VWV. Air pollution exposure and markers of placental growth and function: the generation R study. ENVIRONMENTAL HEALTH PERSPECTIVES 2012; 120:1753-9. [PMID: 22922820 PMCID: PMC3548279 DOI: 10.1289/ehp.1204918] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 08/24/2012] [Indexed: 05/20/2023]
Abstract
BACKGROUND Air pollution exposure during pregnancy might affect placental growth and function, perhaps leading to pregnancy complications. OBJECTIVE We prospectively evaluated the associations of maternal air pollution exposure with markers of placental growth and function among 7,801 pregnant women in the Netherlands. METHODS We estimated levels of particulate matter ≤ 10 µm in aerodynamic diameter (PM10) and nitrogen dioxide (NO2) at the home address for different periods during pregnancy using dispersion modeling techniques. Pro- and anti-angiogenic factors [placental growth factor (PlGF) and soluble fms-like tyrosine kinase 1 (sFlt-1), respectively] were measured in first- and second-trimester maternal blood and in fetal cord blood samples at delivery. Pulsatility index of the uterine and umbilical arteries was measured by Doppler ultrasound in second and third trimester, and notching was assessed in third trimester. Placenta weight and birth weight were obtained from medical records. RESULTS Higher PM10 and NO2 exposure levels were associated with lower second-trimester maternal sFlt-1 and PlGF levels. PM10 and NO2 exposures averaged over total pregnancy were associated with higher sFlt-1 and lower PlGF levels in fetal cord blood, consistent with an anti-angiogenic state. PM10 and NO2 exposures were not consistently associated with second- or third-trimester placental resistance indices. NO2 exposure was associated with third-trimester notching (odds ratio 1.33; 95% CI: 0.99, 1.78 per 10-µg/m3 increase in the prior 2 months). PM10 and NO2 exposures were associated with lower placenta weight (-11.8 g; 95% CI: -20.9, -2.7, and -10.7 g; 95% CI: -19.0, -2.4, respectively, per 10-µg/m3 increase in the prior 2 months), but not with placenta to birth weight ratio. CONCLUSIONS Our results suggest that maternal air pollution exposure may influence markers of placental growth and function. Future studies are needed to confirm these findings and explore the maternal and fetal consequences.
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Sezer SD, Küçük M, Yenisey C, Yüksel H, Odabaşı AR, Türkmen MK, Çetinkaya Çakmak B, Ömürlü IK. Comparison of angiogenic and anti-angiogenic factors in maternal and umbilical cord blood in early- and late-onset pre-eclampsia. Gynecol Endocrinol 2012; 28:628-32. [PMID: 22429154 DOI: 10.3109/09513590.2011.650759] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The aim of this study was to compare maternal and umbilical cord serum levels of the angiogenic and anti-angiogenic factors in early- and late-onset pre-eclamptic pregnancies as well as in normal pregnancies, which might have significant importance in the etiology of pre-eclampsia. MATERIALS AND METHODS This prospective case-control study was carried out with pre-eclamptic (early-onset, ≤ 34 weeks and late-onset, >34 weeks) and normal pregnant women. VEGF, PIGF, sFlt-1 and sEng levels in maternal and umbilical cord serum were measured before delivery and the findings were compared. RESULTS The study was conducted with 15 early- and 15 late-onset pre-eclampsia patients, and 17 patients with normal pregnancies. It was found that sEng levels were higher in the umbilical cord serum in the early-onset and in the maternal serum in the late-onset pre-eclampsia group than the control group (p < 0.05). No significant difference in any factor was observed between the early- and late-onset pre-eclampsia groups. CONCLUSION In this study, the results showed that angiogenic and anti-angiogenic factor levels in maternal serum and umbilical cord serum may not be related to the time of onset of pre-eclampsia.
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Affiliation(s)
- Selda Demircan Sezer
- Department of Obstetrics and Gynecology, Adnan Menderes University, Faculty of Medicine, Aydın, Turkey.
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Weed S, Bastek JA, Anton L, Elovitz MA, Parry S, Srinivas SK. Examining the correlation between placental and serum placenta growth factor in preeclampsia. Am J Obstet Gynecol 2012; 207:140.e1-6. [PMID: 22704767 DOI: 10.1016/j.ajog.2012.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 05/02/2012] [Accepted: 05/02/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Decreased levels of serum placenta growth factor (PlGF) are associated with preeclampsia. We sought to determine whether serum and placental levels of PlGF (sPlGF and pPlGF) are associated with preeclampsia and whether there is a correlation between serum and placental PlGF levels. STUDY DESIGN These analyses were part of a larger, prospective, case-control study. Cases were women with preeclampsia. Controls were women without preeclampsia who delivered at term. Analyses included nonparametric tests to compare medians, logistic regression to estimate odds, and calculation of correlation coefficients. RESULTS Twenty-four cases (10 preterm, 14 term) were compared with 14 controls. Median levels of PlGF were significantly lower in cases than controls (pPlGF: 232.6 vs 363.4 pg/mL, P = .02; sPlGF: 85.5 vs 274.4 pg/mL, P < .001). Serum and placental PlGF were correlated (overall: 39%, P = .006; cases with preterm preeclampsia and growth restriction: 87%, P = .02). CONCLUSION Serum and placental PlGF are independently associated with preeclampsia and correlated with each other.
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Lazdam M, Davis EF, Lewandowski AJ, Worton SA, Kenworthy Y, Kelly B, Leeson P. Prevention of vascular dysfunction after preeclampsia: a potential long-term outcome measure and an emerging goal for treatment. J Pregnancy 2011; 2012:704146. [PMID: 22175025 PMCID: PMC3235810 DOI: 10.1155/2012/704146] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 09/15/2011] [Indexed: 01/10/2023] Open
Abstract
Preeclampsia is increasingly being recognised as more than an isolated disease of pregnancy. In particular, preeclampsia has emerged as an independent risk factor for maternal cardiovascular disease and has recently been recognised as a risk factor for cardiovascular disease in children exposed in utero. Preeclampsia and cardiovascular disease may share important pathophysiological and molecular mechanisms and further investigation into these is likely to offer insight into the origins of both conditions. This paper considers the links between cardiovascular disease and preeclampsia and the implication of these findings for refinement of the management of patients whose care is complicated by preeclampsia.
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Affiliation(s)
- Merzaka Lazdam
- Department of Cardiovascular Medicine, Oxford Cardiovascular Clinical Research Facility, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Esther F. Davis
- Department of Cardiovascular Medicine, Oxford Cardiovascular Clinical Research Facility, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Adam J. Lewandowski
- Department of Cardiovascular Medicine, Oxford Cardiovascular Clinical Research Facility, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Stephanie A. Worton
- Department of Obstetrics and Gynaecology, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Yvonne Kenworthy
- Department of Cardiovascular Medicine, Oxford Cardiovascular Clinical Research Facility, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Brenda Kelly
- Department of Obstetrics and Gynaecology, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Paul Leeson
- Department of Cardiovascular Medicine, Oxford Cardiovascular Clinical Research Facility, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
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Woodham PC, Brittain JE, Baker AM, Long DL, Haeri S, Camargo CA, Boggess KA, Stuebe AM. Midgestation maternal serum 25-hydroxyvitamin D level and soluble fms-like tyrosine kinase 1/placental growth factor ratio as predictors of severe preeclampsia. Hypertension 2011; 58:1120-5. [PMID: 21986503 DOI: 10.1161/hypertensionaha.111.179069] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Recent studies have shown that low serum 25-hydroxyvitamin D (25[OH]D) level is a risk factor for preeclampsia. The clinical significance of in vitro findings that vitamin D regulates vascular endothelial growth factor production is unclear. We sought to determine whether there is an association between midgestation serum 25(OH)D levels and angiogenic factor activity and to compare their predictive value for the development of severe preeclampsia. We conducted a nested case-control study of women with severe preeclampsia (n=41) versus women with uncomplicated term birth (n=123) who had second trimester genetic screening (15-20 weeks). Using banked frozen serum, we measured levels of 25(OH)D, vascular endothelial growth factor, soluble fms-like tyrosine kinase 1, and placental growth factor and compared their correlations and predictive values. We found no correlation between serum 25(OH)D and angiogenic factors levels. 25(OH)D alone was comparable to vascular endothelial growth factor and soluble fms-like tyrosine kinase 1/placental growth factor ratio as a predictive marker for severe preeclampsia. A composite of both 25(OH)D level and soluble fms-like tyrosine kinase 1/placental growth factor ratio was more predictive than either alone (area under curve: 0.83 versus 0.74 and 0.67, respectively). In conclusion, combining midpregnancy 25(OH)D level with soluble fms-like tyrosine kinase 1/placental growth factor ratio provides a better prediction for the development of severe preeclampsia.
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Affiliation(s)
- Padmashree Chaudhury Woodham
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 3010 Old Clinic Building, CB#7516, Chapel Hill, NC 27599-7516, USA.
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Decreased PAPP-A is associated with preeclampsia, premature delivery and small for gestational age infants but not with placental abruption. Eur J Obstet Gynecol Reprod Biol 2011; 157:48-52. [DOI: 10.1016/j.ejogrb.2011.03.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 02/09/2011] [Accepted: 03/05/2011] [Indexed: 11/19/2022]
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Romani F, Lanzone A, Tropea A, Tiberi F, Catino S, Apa R. Nicotine and cotinine affect the release of vasoactive factors by trophoblast cells and human umbilical vein endothelial cells. Placenta 2010; 32:153-60. [PMID: 21145589 DOI: 10.1016/j.placenta.2010.11.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 11/10/2010] [Accepted: 11/10/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine nicotine (N) and cotinine (C) effects on trophoblast cells (TCs) and human umbilical vein endothelial cells (HUVEC) secretion of soluble fms-like tyrosine kinase (sFlt-1), soluble endoglin (sENG), placental growth factor (PlGF), transforming growth factor-beta (TGF-beta) and vascular endothelial growth factor (VEGF). STUDY DESIGN Human placentas and umbilical cords were collected from uncomplicated pregnancies at term from a total of 24 non-smoking women with a history of normal blood pressure. TCs and HUVEC were cultured for 24 h with C or N (from 10(-12) to 10(-7) M). MAIN OUTCOME MEASURES sFlt-1, sENG, PlGF, TGF-beta and VEGF release and messenger RNA (mRNA) expression were evaluated by ELISA and real-time polymerase chain reaction (PCR), respectively. RESULTS N and C reduced sFlt-1, sENG and PlGF release by TCs and TGF-beta release by HUVEC. Conversely, N and C increased PlGF secretion, while N alone increased sFlt-1 release by HUVEC. N and C were able to modulate VEGF mRNA expression in HUVEC. CONCLUSIONS Our results suggest that N and C affect the balance of some important vasoactive factors released by TCs and HUVEC. This might be one of the possible mechanism through which smoke reduces the risk of hypertensive disorders during pregnancy as well as contributes to the well known detrimental effects of smoking on fetal development.
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Affiliation(s)
- F Romani
- Cattedra di Fisiopatologia della Riproduzione Umana, Università Cattolica del Sacro Cuore (UCSC), Largo A. Gemelli 8, 00168 Roma, Italy.
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Bussen S, Bussen D. Influence of the vascular endothelial growth factor on the development of severe pre-eclampsia or HELLP syndrome. Arch Gynecol Obstet 2010; 284:551-7. [DOI: 10.1007/s00404-010-1704-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 09/22/2010] [Indexed: 12/25/2022]
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Zhao M, Chang C, Liu Z, Chen LM, Chen Q. The level of vascular endothelial cell growth factor, nitric oxide, and endothelin-1 was correlated with ovarian volume or antral follicle counts: a potential predictor of pregnancy outcome in IVF. Growth Factors 2010; 28:299-305. [PMID: 20370579 DOI: 10.3109/08977191003766866] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The objective of this study was to investigate the correlation between the concentrations of vascular endothelial cell growth factor (VEGF), nitric oxide (NO), or endothelin-1 (ET-1) in follicular fluid with antral follicle counts (AFCs) or ovarian volume in order to predict the outcome of in vitro fertilization (IVF). One hundred and thirty-one patients were enrolled in this study, and the pregnancy rate was 37.4%. The concentration of VEGF or NO was significantly increased, while the concentration of ET-1 in follicular fluid was decreased in the group who became pregnant (P < 0.05). The ovarian volume or AFC was significantly higher in groups that became pregnant (P < 0.05). In addition, the ovarian volume or AFC was positively correlated with the concentration of VEGF or NO and negatively correlated with the concentration of ET-1 in follicular fluid. Our data suggest that these correlations may be associated with the successful pregnancies through IVF.
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Affiliation(s)
- M Zhao
- Wuxi Maternity and Child Health Hospital, Nanjing Medical University, Nanjing, PR China
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Abstract
Preeclampsia is characterized by systemic maternal endothelial dysfunction that precedes the onset of clinical symptoms. Antiangiogenic factors are associated with preeclampsia. The aim of this study was to investigate the correlation between the levels of three antiangiogenic factors in preeclamptic pregnancies with/without fetal growth restriction (FGR), and to compare their level in early onset or late onset preeclampsia. Antiangiogenic factors, soluble endoglin (sEndoglin), sFlt-1, and placental growth factor (PIGF) were analyzed in healthy and preeclamptic women (including seven with FGR) at three different time points. sEndoglin or sFlt-1 but not PIGF levels were significantly higher in women with preeclampsia at admission. The level of sEndoglin was significantly higher in early onset, and higher in preeclamptic pregnancies with FGR compared to those without FGR. The level of sEndoglin was correlated with mean arterial pressure or 24-h urine protein in preeclampsia. Our data potentially suggest that Endoglin level correlates with the clinical symptoms of preeclampsia and preeclamptic pregnancies with FGR.
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Affiliation(s)
- Wenqiu Zhao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, PR China
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