Is there evidence of separate inflammatory or metabolic forms of preeclampsia?

Deep Sequencing Identified Dysregulated Circulating MicroRNAs in Late Onset Preeclampsia

BACKGROUND/AIM

To characterize global microRNA (miRNA) expression profile in the first trimester maternal plasma of women who subsequently develop late-onset preeclampsia (LOPE) compared to uncomplicated pregnancies.

MATERIALS AND METHODS

Five first trimester plasma samples from women who developed LOPE and 5 controls were analyzed using next generation sequencing technology (NGS) followed by target prediction, Gene Ontology analysis and pathway identification. Quantitative real-time polymerase chain reaction (qRT-PCR) was performed for confirmation in an independent cohort of 12 LOPE cases and 12 controls.

RESULTS

miR-23b-5p and miR-99b-5p were down-regulated by >1.5 fold in LOPE complicated pregnancies (p value <0.05) compared to controls. Target prediction showed that the major targets of these miRNAs are associated with glycometabolism and immune response.

CONCLUSION

miR-23b-5p and miR-99b-5p are possibly implicated in the pathogenic mechanisms leading to the induction of LOPE and may serve as candidate non-invasive biomarkers for early prediction and prevention.

Maternal ABO Blood Type and Factors Associated With Preeclampsia Subtype

BACKGROUND

The pathophysiology of preeclampsia remains unclear. The disorder is heterogeneous, and the pathophysiology may vary by subtype. Identification of relevant biomarkers will help to better elucidate the pathophysiologic basis of each preeclampsia subtype. Blood type may be a biomarker that allows risk identification for preeclampsia.

OBJECTIVE

The purpose of this study was to investigate the associations among maternal ABO blood type and preeclampsia subtype and fetal growth restriction (FGR).

METHOD

Medical records of 126 women with early-onset preeclampsia (≤33 6/7 weeks' gestation), 126 women with late-onset preeclampsia (≥34 0/7 weeks' gestation), and 259 controls who gave birth between January 2012 and June 2016 were retrospectively abstracted from a large suburban tertiary referral center in South Central Pennsylvania for this hospital-based case-control study.

RESULTS

Women with AB blood type had >3 times the odds of late-onset preeclampsia (odds ratio [ OR] = 3.35, 95% confidence interval (CI) = [1.02, 11.05]) compared to those with O blood type. Among women with early-onset preeclampsia, those with B blood type had 5 times the odds of having a growth-restricted fetus than did women with O blood type ( OR = 5.44, 95% CI [1.65, 17.94]).

DISCUSSION

Our findings suggest that AB blood type may be an important risk factor for late-onset preeclampsia and that among women with early-onset preeclampsia, those with B blood type have increased odds of FGR. These findings warrant further study in women and their offspring to identify the pathophysiologic processes that may link ABO blood type, preeclampsia subtype, and FGR.

Afamin: an early predictor of preeclampsia

Purpose

Oxidative stress is involved in the pathogenesis of hypertensive disorders such as preeclampsia (PE) and associated with the human vitamin E-binding protein afamin. The aim of this study was, therefore, to analyse afamin in the first trimester of patients developing PE later in pregnancy and in control subjects without pregnancy complications.

Methods

In this retrospective study, 137 serum samples from the first trimester of pregnancy were analysed in a case–control study design. 39 patients developed PE (10 patients with early-onset and 29 patients with late onset disease) and 98 women had an uncomplicated pregnancy. Mann–Whitney U test, t test, logistic regression and ROC analyses were performed for statistical evaluation.

Results

Pregnant women developing PE presented with higher afamin concentrations in the first trimester [median 101.81 mg/L; interquartile range (IQR) 88.94–113.26] compared to subjects with uncomplicated pregnancy (median 86.40; IQR 75.26–96.92; p < 0.001). After adjusting for confounders, the odds ratio per afamin standard deviation was 1.60 (95% CI: 1.04–2.58; p = 0.04). An afamin threshold concentration of 87.8 mg/L exhibited the best sensitivity (79.5%) and specificity (57.1%) in predicting PE. Subgroup analysis of early- and late-onset disease resulted in substantially higher afamin concentrations in women with developing late-onset PE compared to controls (p < 0.001) with an odds ratio per afamin standard deviation of 1.62 (95% CI: 0.98–2.70; p = 0.06).

Conclusions

Serum afamin concentrations are elevated in the first trimester among patients developing PE compared to controls. Substantial differences were observed mainly among patients with late-onset PE.

Increased maternal C1q/TNF-related protein-1 (CTRP-1) serum levels in pregnancies with preeclampsia

Objective: Metabolic changes and inflammation are involved in the pathogenesis of preeclampsia. Complement C1q tumor necrosis factor-related protein-1 (CTRP-1) is a pleiotropic molecule that possesses insulin-sensitizing effects and is also involved in lipid metabolism and inflammatory responses. The aim of the study was to investigate CTRP-1 levels in pregnancies with preeclampsia.Material and methods: Serum concentrations of CTRP-1 were measured in 29 pregnant women with early-onset preeclampsia (EOPE), 24 pregnant women with late-onset preeclampsia (LOPE), and 26 women with uncomplicated pregnancies using an enzyme-linked immunosorbent assay method.Results: Patients with both EOPE and LOPE had significantly higher serum concentrations of CTRP-1 compared to the healthy controls (p < .001). However, no significant difference was found between the EOPE and LOPE groups regarding CTRP-1 levels (p = 1.000). Correlation analysis showed that CTRP-1 levels were positively correlated with systolic blood pressure (p < .001), diastolic blood pressure (p < .001), and mean UtA PI (p < .001) but negatively correlated with gestational age at delivery (p = .001) and birth weight (p < .001).Conclusions: Serum CTRP-1 levels were significantly higher in patients with both EOPE and LOPE than in healthy pregnant women.

Preeclampsia: Syndrome or Disease?

The focus on disease mechanisms underlying the hypertension and proteinuria defining preeclampsia has increased knowledge of the pathophysiology yet we lack both therapy and predictors. We propose this is in part due to the fact that diagnostic findings identify a "preeclampsia syndrome" but do not necessarily indicate the most important pathophysiology nor if organs are involved as cause or consequence. The increased risk for later life cardiovascular disease in women who develop preeclampsia suggests the stress test of pregnancy exposes pre-existing subclinical vascular disease. The dogma that inadequate trophoblast invasion and ischemia/reperfusion injury to the placenta is "the" cause of preeclampsia is more relevant to early onset preeclampsia (<34 weeks). There is much less evidence for defective placentation in late onset preeclampsia where maternal constitutive factors or susceptibility to vascular damage is more relevant. The contribution of differing disease phenotypes to the syndrome may explain the inability of biomarker studies to identify all preeclampsia. Identification of phenotypes will require large amounts of prospective clinical data and biospecimens, collected in a harmonized manner with analysis in an unbiased discovery approach.

Developing Potential Candidates of Preclinical Preeclampsia

The potential for developing molecules of interest in preclinical preeclampsia from candidate genes that were discovered on gene expression microarray analysis has been challenged by limited access to additional first trimester trophoblast and decidual tissues. The question of whether these candidates encode secreted proteins that may be detected in maternal circulation early in pregnancy has been investigated using various proteomic methods. Pilot studies utilizing mass spectrometry based proteomic assays, along with enzyme linked immunosorbent assays (ELISAs), and Western immunoblotting in first trimester samples are reported. The novel targeted mass spectrometry methods led to robust multiple reaction monitoring assays. Despite detection of several candidates in early gestation, challenges persist. Future antibody-based studies may lead to a novel multiplex protein panel for screening or detection to prevent or mitigate preeclampsia.

Zinc supplementation and the effects on metabolic status in gestational diabetes: A randomized, double-blind, placebo-controlled trial

OBJECTIVE

To the best of our knowledge, no reports are available indicating the effects of zinc supplementation on metabolic status in women with gestational diabetes (GDM). This study was designed to determine the effects of zinc supplementation on glucose homeostasis parameters and lipid concentrations in GDM women.

METHODS

This randomized, double-blind, placebo-controlled trial was performed among 58 women diagnosed with GDM, primigravida and aged 18-40years old. Patients were randomly divided into two groups to receive 233mg zinc gluconate (containing 30mg zinc) supplements (n=29) or placebo (n=29) per day for 6weeks. Fasting blood samples were taken at the beginning and end of the trial to quantify glucose, insulin and lipid concentrations.

RESULTS

Patients who received zinc supplements had significantly higher serum zinc concentrations (+6.9±13.2 vs. -1.5±16.5mg/dL, P=0.03) than those received the placebo. In addition, zinc-supplemented patients had reduced fasting plasma glucose (FPG) (-6.6±11.2 vs. +0.6±6.7mg/dL, P=0.005), serum insulin levels (-1.3±6.6 vs. +6.6±12.2μIU/mL, P=0.003), homeostasis model of assessment-insulin resistance (HOMA-IR) (-0.5±1.6 vs. +1.5±2.7, P=0.001), homeostatic model assessment-Beta cell function (HOMA-B) (-0.7±25.0 vs. +26.5±49.5, P=0.01) and increased quantitative insulin sensitivity check index (QUICKI) (+0.01±0.01 vs. -0.01±0.02, P=0.004) compared with the placebo. Additionally, significant differences in serum triglycerides (+13.6±61.4 vs. +45.9±36.5mg/dL, P=0.01) and VLDL-cholesterol concentrations (+2.7±12.3 vs. +9.2±7.3mg/dL, P=0.01) were observed following the administration of zinc supplements compared with the placebo.We did not observe any significant effects of taking zinc supplements on other lipid profiles.

CONCLUSIONS

Taken together, 30mg zinc supplementation per day for 6weeks among GDM women had beneficial effects on metabolic profiles.

Endothelial dysfunction and metabolic syndrome in preeclampsia: an alternative viewpoint

Several clinical and basic science reports have elucidated partial aspects of the pathophysiology of preeclampsia and have led many authors to conclude that different "subtypes" of the disease exist. All these subtypes share the main clinical features of the disease and present additional characteristics that define different clinical phenotypes. Nevertheless, immunological alterations, endothelial dysfunction, and insulin resistance constantly characterize this syndrome. These aspects are intimately related at a molecular level; thus, we propose an alternative approach to explaining biologically the main intracellular processes that occur in preeclampsia and this may yield an insight into the pathogenesis.

Bridging global gene expression candidates in first trimester placentas with susceptibility loci from linkage studies of preeclampsia

Preeclampsia is as a leading cause of maternal and perinatal morbidity and mortality. Prevention, early identification, and individualized treatments may become feasible if reliable early biomarkers can be developed. Towards a systems biology framework, this review synthesizes prior linkage studies and genome scans of preeclampsia with candidates identified in a global gene expression microarray analysis of chorionic villus sampling (CVS) specimens from women who subsequently developed preeclampsia. Nearly 40% of these CVS candidate genes occurred in previously identified susceptibility loci for preeclampsia. Integration of genetic epidemiologic and functional gene expression data could help to elucidate preeclampsia as a complex disease resulting from multiple maternal and fetal/placental factors that each contributes a greater or lesser effect. These loci and related candidate genes are set to substantially improve insights into the first trimester pathogenesis of this pregnancy disorder.