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Alkhodier AA, Alsaif AS, Alqntash NH, Alanazi RB, Alotaibi G, Alrashid A. Pregnancy and Inflammatory Rheumatological Diseases: A Single-Center Retrospective Cohort Study. Cureus 2023; 15:e47277. [PMID: 38021813 PMCID: PMC10659568 DOI: 10.7759/cureus.47277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2023] [Indexed: 12/01/2023] Open
Abstract
Background Rheumatic diseases pose risks to pregnant women, leading to complications like preterm birth, congenital heart block, and pregnancy loss. These diseases are expected to deteriorate during pregnancy and further in the postpartum period. The impact of these diseases on the pregnancy will add further burden on the patient, fetus, physician, and healthcare system. Advances in diagnosis and treatment have improved outcomes making them similar to that of healthy women, but close follow-up in a multidisciplinary clinic is essential. The objective of this study is to study the outcome of pregnancy in women with rheumatological disease and the behavior of the disease during pregnancy. Methods A retrospective cohort study was conducted in King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia, to compare the outcomes of pregnancy across three rheumatological diseases: Sjogren syndrome (SS), systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA) from 2016 to 2021. A total of 128 pregnancies in 107 women with rheumatological diseases were included in this study. Pregnancy measures and outcomes were investigated by assessing maternal health, fetal health, and pregnancy complications, specifically maternal disease activity, medications to control the disease, infection, preterm birth, birth weight, abortions/stillbirths, mode of delivery, bleeding, preeclampsia, congenital heart block, and neonatal lupus. Results There were 55 patients with RA (63 RA pregnancies), 44 with SLE (54 SLE pregnancies), and eight with primary SS (11 SS pregnancies). In most of the pregnancies (n= 108; 95.58%), the patients were in clinical remission before pregnancy. Lupus nephritis, which was in remission before pregnancy, has been reported in nine (16.67%) out of 54 SLE pregnancies. Vaginal delivery was the most common mode of delivery (n=87; 67.97%). On the other hand, there were 38 cesarean sections (29.69%). Rheumatological disease flares occurred in 10 pregnancies (7.87%). One hundred and twenty-two live births were delivered. Preterm infants were born in 25 pregnancies (20.16%), and 16 (13.22%) of the newborns needed neonatal intensive care unit (NICU) care. Interestingly, congenital heart block (CHB) was found in five (12.2%) neonates out of 41 anti-SS-related antigen A (anti-SSA) positive mothers; one of those five died from heart block. Eleven neonates were delivered with positive serology, and five were diagnosed with neonatal lupus. Conclusion The outcome of pregnancy in patients with rheumatological disease is favorable. A multidisciplinary team approach and close clinical follow-up are the cornerstone for such success. A small dose of prednisolone (5 mg or less) is safe and will not have a negative impact on maternal or fetal health. CHB is a concern for pregnant women with positive anti-SSA.
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Affiliation(s)
- Abeer A Alkhodier
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, SAU
| | - Abdurhman S Alsaif
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Norah H Alqntash
- Clinical Sciences, Princess Nourah bint Abdulrahman University College of Medicine, Riyadh, SAU
| | - Rakan B Alanazi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Ghaida Alotaibi
- Pathology, King Khalid University Hospital, King Saud University, Riyadh, SAU
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Conklin J, Golpanian M, Engel A, Izmirly P, Belmont HM, Dervieux T, Buyon JP, Alexander RV. Erythrocyte complement receptor 1 (ECR1) and erythrocyte-bound C4d (EC4d) in the prediction of poor pregnancy outcomes in systemic lupus erythematosus (SLE). Lupus Sci Med 2022; 9:9/1/e000754. [PMID: 36755365 PMCID: PMC9445792 DOI: 10.1136/lupus-2022-000754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/19/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Complement activation has been associated with adverse pregnancy outcomes (APO) in SLE. Pregnant women with SLE were studied to evaluate whether complement dysregulation within the first two pregnancy trimesters predicts APO. METHODS Pregnant women fulfilled classification criteria for SLE. APO included neonatal death, preterm delivery before 36 weeks and small for gestational age newborn. Pre-eclampsia was also evaluated. Erythrocyte complement receptor 1 (ECR1) and erythrocyte-bound C4d (EC4d) were measured by flow cytometry. Complement proteins C3 and C4 were measured by immunoturbidimetry and anti-double-stranded DNA by ELISA in serum. Statistical analysis consisted of t-test, confusion matrix-derived diagnostic analysis, and multivariate logistic regression. RESULTS Fifty-one women had 57 pregnancies and 169 visits during the study. Baseline visits occurred mainly in the first (n=32) and second trimester (n=21). Fourteen (24.6%) pregnancies resulted in 21 APO with preterm delivery being the most common (n=10). ECR1 <5.5 net mean fluorescence intensity in the first trimester predicted APO with a diagnostic OR (DOR) of 18.33 (95% CI: 2.39 to 140.4; t-test p=0.04). Other individual biomarkers did not reach statistical significance. To estimate the likelihood of APO, we developed an algorithm that included the week of pregnancy, ECR1 and EC4d. From this algorithm, a Pregnancy Adversity Index (PAI) was calculated, and a PAI >0 indicated an elevated likelihood of pregnancy complications (DOR: 20.0 (95% CI: 3.64 to 109.97)). CONCLUSIONS Low levels of ECR1 in early or mid-pregnancy are predictive of an APO. Incorporating the weeks of gestation and both ECR1 and EC4d generated a PAI, which further predicted serious pregnancy complications.
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Affiliation(s)
| | - Michael Golpanian
- Division of Rheumatology, New York University School of Medicine, New York, New York, USA
| | - Alexis Engel
- Division of Rheumatology, New York University School of Medicine, New York, New York, USA
| | - Peter Izmirly
- Division of Rheumatology, New York University School of Medicine, New York, New York, USA
| | - H Michael Belmont
- Division of Rheumatology, New York University School of Medicine, New York, New York, USA
| | - Thierry Dervieux
- Research and Development, Prometheus Laboratories, San Diego, California, USA
| | - Jill P Buyon
- Division of Rheumatology, New York University School of Medicine, New York, New York, USA
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Tan Y, Yang S, Liu Q, Li Z, Mu R, Qiao J, Cui L. Pregnancy-related complications in systemic lupus erythematosus. J Autoimmun 2022; 132:102864. [PMID: 35872104 DOI: 10.1016/j.jaut.2022.102864] [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: 06/28/2022] [Accepted: 07/02/2022] [Indexed: 10/17/2022]
Abstract
Systemic lupus erythematosus (SLE) is a systemic autoimmune inflammatory disease that predominantly affects women of childbearing age and results in various adverse pregnancy outcomes (APOs). Pregnancy was formerly discouraged in patients with SLE because of unstable disease activity during the gestation period, increased thrombosis risk, severe organ damage, and inevitable side effects of immunosuppressive agents. Currently, most patients with SLE have successful pregnancies due to preconception counselling, strict monitoring, and improved therapy with minimised complications for both the mother and foetus. Hydroxychloroquine (HCQ) is extensively used and is beneficial for improving pregnancy outcomes. However, pregnant women with SLE have a high-risk of APOs, such as disease flare, preterm birth, intrauterine growth restriction (IUGR), preeclampsia, and pregnancy loss. Better understanding of the changes in maternal immunity and serum biomarkers, as well as their relationships with SLE-related APOs progression, would facilitate the investigation of molecular mechanisms for triggering and ameliorating APOs. Furthermore, it would enable us to explore and develop novel and effective therapeutic strategies to prevent disease activation. Therefore, this review briefly introduces the interaction between pregnancy outcomes and SLE, elucidates pathophysiological and immunological changes during SLE pregnancy. Furthermore, this review systematically expounds on the effective predictors of APOs and the molecular mechanisms underlying the SLE-related APOs to provide a solid foundation for the advanced management of lupus pregnancy.
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Affiliation(s)
- Yuan Tan
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, 100191, China; Core Unit of National Clinical Research Center for Laboratory Medicine, Peking University Third Hospital, Beijing, 100191, China; Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, China
| | - Shuo Yang
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, 100191, China; Core Unit of National Clinical Research Center for Laboratory Medicine, Peking University Third Hospital, Beijing, 100191, China
| | - Qi Liu
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, 100191, China; Core Unit of National Clinical Research Center for Laboratory Medicine, Peking University Third Hospital, Beijing, 100191, China; Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, China
| | - Zhongxin Li
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, 100191, China; Core Unit of National Clinical Research Center for Laboratory Medicine, Peking University Third Hospital, Beijing, 100191, China
| | - Rong Mu
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, 100191, China.
| | - Jie Qiao
- National Clinical Research Center for Obstetrical and Gynecological Diseases, Beijing, 100191, China; Ministry of Education Key Laboratory of Assisted Reproduction, Center for Reproductive Medicine, Beijing, 100191, China; Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.
| | - Liyan Cui
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, 100191, China; Core Unit of National Clinical Research Center for Laboratory Medicine, Peking University Third Hospital, Beijing, 100191, China.
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Chen Z, Gan J, Zhang M, Du Y, Zhao H. Ferroptosis and Its Emerging Role in Pre-Eclampsia. Antioxidants (Basel) 2022; 11:1282. [PMID: 35883776 PMCID: PMC9312356 DOI: 10.3390/antiox11071282] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/25/2022] [Accepted: 06/25/2022] [Indexed: 11/27/2022] Open
Abstract
Iron is essential for cell survival, and iron deficiency is a known risk factor for many reproductive diseases. Paradoxically, such disorders are also more common in cases of iron overload. Here, we evaluated the role of ferroptosis in women's health, particularly focusing on pre-eclampsia (PE). PE is a multisystem disorder and is one of the leading causes of maternal and perinatal morbidity and mortality, especially when the condition is of early onset. Nevertheless, the exact etiological mechanism of PE remains unclear. Interestingly, ferroptosis, as a regulated iron-dependent cell death pathway, involves a lethal accumulation of lipid peroxides and shares some characteristics with PE pathophysiology. In this review, we comprehensively reviewed and summarized recent studies investigating the molecular mechanisms involved in the regulation and execution of ferroptosis, as well as ferroptosis mechanisms in the pathology of PE. We propose that ferroptosis not only plays an important role in PE, but may also become a novel therapeutic target for PE.
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Affiliation(s)
- Zhixian Chen
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China; (Z.C.); (J.G.); (M.Z.)
- Department of Obstetrics and Gynecology of Shanghai Medical School, Fudan University, Shanghai 200032, China
| | - Jianfeng Gan
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China; (Z.C.); (J.G.); (M.Z.)
- Department of Obstetrics and Gynecology of Shanghai Medical School, Fudan University, Shanghai 200032, China
| | - Mo Zhang
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China; (Z.C.); (J.G.); (M.Z.)
- Department of Obstetrics and Gynecology of Shanghai Medical School, Fudan University, Shanghai 200032, China
| | - Yan Du
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China; (Z.C.); (J.G.); (M.Z.)
- Department of Obstetrics and Gynecology of Shanghai Medical School, Fudan University, Shanghai 200032, China
| | - Hongbo Zhao
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China; (Z.C.); (J.G.); (M.Z.)
- Department of Obstetrics and Gynecology of Shanghai Medical School, Fudan University, Shanghai 200032, China
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Mimura K, Tomimatsu T, Endo M, Kimura T. Atypical preeclampsia without underlying disease and elevated sFlt-1/PlGF ratio. J Obstet Gynaecol Res 2021; 48:471-476. [PMID: 34852396 DOI: 10.1111/jog.15117] [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: 05/18/2021] [Revised: 09/29/2021] [Accepted: 11/22/2021] [Indexed: 11/27/2022]
Abstract
Atypical preeclampsia before 20 weeks of gestation without an underlying disease is very rare; however, the soluble Fms-like tyrosine kinase 1/placental growth factor (sFlt-1/PlGF) ratios remain unknown. Four pregnant women with no underlying disease, except for a history of childhood IgA vasculitis, developed preeclampsia at 13, 14, 17, and 18 weeks of gestation with sFlt-1/PlGF ratios of 1589, 1183, 500, and 1460 pg/mL, respectively. Their pregnancies were terminated, and they delivered within 2 weeks. All previously abnormal clinical findings normalized within 3 months. The sFlt-1/PlGF ratios were elevated in the four patients with atypical preeclampsia without underlying disease before 20 weeks of gestation. A high sFlt-1/PlGF ratio may be indicative of preeclampsia when no underlying disease is present in pregnancies of less than 20 weeks of gestation.
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Affiliation(s)
- Kazuya Mimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takuji Tomimatsu
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masayuki Endo
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan
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Mimura K, Tomimatsu T, Endo M, Kimura T. Atypical preeclampsia with systemic lupus erythematosus and elevated soluble fms-like tyrosine kinase 1/placental growth factor ratio. J Obstet Gynaecol Res 2021; 47:4461-4466. [PMID: 34605122 DOI: 10.1111/jog.15055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/31/2021] [Accepted: 09/25/2021] [Indexed: 11/30/2022]
Abstract
While systemic lupus erythematosus is often complicated by preeclampsia, it is difficult to differentiate between its exacerbation and preeclampsia. The soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio is unknown in systemic lupus erythematosus with preeclampsia before 20 weeks of gestation. Three nulliparous women with systemic lupus erythematosus developed preeclampsia at 13, 13, and 17 weeks of gestation with sFlt-1/PlGF ratios of 427, 865, and 525, respectively. Two patients terminated their pregnancies and delivered within 2 weeks, while one experienced intrauterine fetal death 4 weeks after the measurements. Their symptoms gradually improved, and all patients were discharged within 3 months. The sFlt-1/PlGF ratio may be used in the differential diagnosis of preeclampsia and systemic lupus erythematosus exacerbation before 20 weeks of gestation.
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Affiliation(s)
- Kazuya Mimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takuji Tomimatsu
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masayuki Endo
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
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de Jesús GR, Lacerda MI, Rodrigues BC, Dos Santos FC, do Nascimento AP, Cristóvão Porto L, de Jesús NR, Levy RA, Klumb EM. Soluble Flt-1, Placental Growth Factor, and Vascular Endothelial Growth Factor Serum Levels to Differentiate Between Active Lupus Nephritis During Pregnancy and Preeclampsia. Arthritis Care Res (Hoboken) 2021; 73:717-721. [PMID: 32583963 DOI: 10.1002/acr.24360] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/13/2020] [Accepted: 06/16/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate mean serum levels of vascular endothelial growth factor (VEGF), placental growth factor (PlGF), and soluble Flt-1 (sFlt-1) in pregnant patients with systemic lupus erythematosus (SLE) with inactive disease, active lupus nephritis, and preeclampsia for differential diagnosis between these conditions. METHODS Pregnant women with SLE, with singleton pregnancies and no other autoimmune diseases, were classified according to disease activity (inactive SLE and active lupus nephritis) and the presence of preeclampsia. Serum samples were collected within 3 weeks of delivery and frozen for subsequent blinded analysis through the enzyme-linked immunosorbent assay method. RESULTS A total of 71 women were included, with 41 classified as having inactive SLE (group 1; Systemic Lupus Erythematosus Pregnancy Disease Activity Index [SLEPDAI] score <4), 15 with a diagnosis of active lupus nephritis (group 2, SLEPDAI score ≥4, including renal criteria), and 15 with a diagnosis of preeclampsia (group 3). Patients in group 3 had higher mean levels of sFlt-1 and lower mean levels of PlGF compared to groups 1 and 2, both findings with statistical significance. The sFlt-1:PlGF ratio was also significantly higher in patients with preeclampsia, while mean VEGF levels were higher in pregnant woman with active lupus nephritis compared to patients with preeclampsia or inactive SLE. CONCLUSION Evaluation of serum VEGF, PlGF, and sFlt-1 levels can differentiate between preeclampsia, inactive SLE, and active lupus nephritis during pregnancy.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Evandro M Klumb
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Bajpai D. Preeclampsia for the Nephrologist: Current Understanding in Diagnosis, Management, and Long-term Outcomes. Adv Chronic Kidney Dis 2020; 27:540-550. [PMID: 33328071 DOI: 10.1053/j.ackd.2020.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 11/11/2022]
Abstract
Preeclampsia is a multisystem progressive disorder of pregnancy that can be potentially catastrophic for the mother and the fetus. It involves complex perturbations of the kidney and systemic physiology, along with long-term effects on vascular and kidney health. Thus, the nephrologist plays a key role in the peripartum and long-term management of preeclampsia. Recent translational research has improved our understanding of its pathophysiology, and there is hope for novel therapies. In this review, we discuss the evolution of diagnostic criteria and dilemmas in the diagnosis of hypertensive disorders in pregnancy. We summarize the advances in the pathogenesis and prediction of preeclampsia. We describe the management and prevention of preeclampsia focusing specially on the forthcoming strategies from the nephrologist's perspective. We address the evidence regarding long-term outcomes for the mother and the child. We end with exploring areas warranting future research.
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Sun M, Liu S, Gao J, Meng T, Xing X, Chen C, Chen H, Luo Y. Cyclin G2 Is Involved in the Proliferation of Placental Trophoblast Cells and Their Interactions with Endothelial Cells. Med Sci Monit 2020; 26:e926414. [PMID: 32941407 PMCID: PMC7521070 DOI: 10.12659/msm.926414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Remodeling of maternal spiral arteries after embryo implantation relies on well-regulated trophoblast functions. Although cyclin G2 (CCNG2) is thought to be involved in placental development and function, its role in trophoblasts and the mechanisms underlying placental development and function remain unclear. The present study investigated the potential role of CCNG2 in trophoblast cell proliferation and their interactions with endothelial cells. Material/Methods CCNG2 levels were modified by stable infection of HTR8/SVneo cells with lentiviruses overexpressing and silencing CCNG2. Cell proliferation was measured using CCK-8 assays. Network formation assays were performed using trophoblasts alone and co-cultured trophoblasts and endothelial cells to measure angiogenesis of trophoblasts and trophoblast-endothelial interactions. Levels of angiogenic factors (VEGF and sFlt-1) in the supernatant were measured by ELISA, and the expression of cell cycle regulatory (cyclin D1) and invasive (MMP2, MMP3, MMP9) markers implicated in artery remodeling were measured by western blotting. Results Ectopic expression of CCNG2 blocked the proliferation of HTR8/SVneo cells, as well as their abilities to form networks and integrate into human umbilical vein endothelial cells, whereas CCNG2 inhibition had the opposite effects. CCNG2 upregulation significantly reduced the expression of VEGF, cyclin D1, MMP2, MMP3, and MMP9, but enhanced the expression of sFlt-1. In contrast, CCNG2 downregulation had the opposite effects. Conclusions CCNG2 plays a critical role in trophoblast proliferation and trophoblast-endothelial cell interactions by significant affecting cell cycle, angiogenic, and invasive markers. CCNG2 may thus be a novel marker for the treatment of placental disorders.
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Affiliation(s)
- Manni Sun
- The Research Center for Medical Genomics, Key Laboratory of Medical Cell Biology, Ministry of Education, School of Life Science, China Medical University, Shenyang, Liaoning, China (mainland)
| | - Shenghuan Liu
- The Research Center for Medical Genomics, Key Laboratory of Medical Cell Biology, Ministry of Education, School of Life Science, China Medical University, Shenyang, Liaoning, China (mainland)
| | - Jinlan Gao
- The Research Center for Medical Genomics, Key Laboratory of Medical Cell Biology, Ministry of Education, School of Life Science, China Medical University, Shenyang, Liaoning, China (mainland)
| | - Tao Meng
- Department of Obstetrics, The First Affiliated Hospital of China Medical University, China Medical University, Shenyang, Liaoning, China (mainland)
| | - Xuesha Xing
- The Research Center for Medical Genomics, Key Laboratory of Medical Cell Biology, Ministry of Education, School of Life Science, China Medical University, Shenyang, Liaoning, China (mainland)
| | - Chen Chen
- The Research Center for Medical Genomics, Key Laboratory of Medical Cell Biology, Ministry of Education, School of Life Science, China Medical University, Shenyang, Liaoning, China (mainland)
| | - Haiying Chen
- Department of Obstetrics, The First Affiliated Hospital of China Medical University, China Medical University, Shenyang, Liaoning, China (mainland)
| | - Yang Luo
- The Research Center for Medical Genomics, Key Laboratory of Medical Cell Biology, Ministry of Education, School of Life Science, China Medical University, Shenyang, Liaoning, China (mainland)
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Leaños-Miranda A, Graciela Nolasco-Leaños A, Ismael Carrillo-Juárez R, José Molina-Pérez C, Janet Sillas-Pardo L, Manuel Jiménez-Trejo L, Isordia-Salas I, Leticia Ramírez-Valenzuela K. Usefulness of the sFlt-1/PlGF (Soluble fms-Like Tyrosine Kinase-1/Placental Growth Factor) Ratio in Diagnosis or Misdiagnosis in Women With Clinical Diagnosis of Preeclampsia. Hypertension 2020; 76:892-900. [PMID: 32713272 DOI: 10.1161/hypertensionaha.120.15552] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Preeclampsia is characterized by angiogenic imbalance (AI), sFlt-1 (soluble fms-like tyrosine kinase-1)/PlGF (placental growth factor) is useful for its diagnosis and prediction of adverse outcomes, but the relationship among the degrees of AI as assessed by this ratio with the correct diagnosis, clinical characteristics, and outcomes in women with clinical diagnosis of preeclampsia are unclear. We studied 810 women with clinical diagnosis of preeclampsia. Patients were divided into 3 groups based on their degree of AI, evaluated by the sFlt-1/PlGF ratio: no AI (≤38), mild AI (>38-<85), and severe AI (≥85). Patients with no AI were more likely to have comorbidities and false significant proteinuria compared with patients with mild and severe AI (P<0.001). The rates of preterm delivery, delivery within 14 days, and small-for-gestational-age infant were higher among patients with severe AI than in patients with no and mild AI (P<0.001) and in patients with mild AI that in those with no AI (P≤0.01). The occurrence of any adverse maternal outcome (HELLP syndrome, elevated liver enzymes, thrombocytopenia, placental abruption, acute kidney injury) was only present in patients with severe AI. Interestingly, the frequency of misdiagnosis of preeclampsia was progressively lower as the degrees of AI increased (no AI: 100%, mild AI: 88.2%, and severe AI: 15.6%). We concluded that in women with clinical diagnosis of preeclampsia, severe AI is characterized by high frequency of true preeclampsia and preeclampsia-related adverse outcomes, in contrast, no and mild AI, are characterized by unnecessary early deliveries, often due to misdiagnosis.
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Affiliation(s)
- Alfredo Leaños-Miranda
- From the Medical Research Unit in Reproductive Medicine (A.L.-M., A.G.N.-L., R.I.C.-J., C.J.M.-P.), UMAE-Hospital de Ginecología y Obstetricia "Luis Castelazo Ayala", Instituto Mexicano del Seguro Social (IMSS), Ciudad de México; Research Unit in Thrombosis, Hemostasia and Atherogenesis, HGR No.1 "Dr. Carlos Mac Gregor", IMSS
| | - Ana Graciela Nolasco-Leaños
- From the Medical Research Unit in Reproductive Medicine (A.L.-M., A.G.N.-L., R.I.C.-J., C.J.M.-P.), UMAE-Hospital de Ginecología y Obstetricia "Luis Castelazo Ayala", Instituto Mexicano del Seguro Social (IMSS), Ciudad de México; Research Unit in Thrombosis, Hemostasia and Atherogenesis, HGR No.1 "Dr. Carlos Mac Gregor", IMSS.,Posgrado e Investigación Biomedicina y Biotecnología Molecular, Instituto Politécnico Nacional, Ciudad de México (A.G.N.-L.)
| | - Reyes Ismael Carrillo-Juárez
- From the Medical Research Unit in Reproductive Medicine (A.L.-M., A.G.N.-L., R.I.C.-J., C.J.M.-P.), UMAE-Hospital de Ginecología y Obstetricia "Luis Castelazo Ayala", Instituto Mexicano del Seguro Social (IMSS), Ciudad de México; Research Unit in Thrombosis, Hemostasia and Atherogenesis, HGR No.1 "Dr. Carlos Mac Gregor", IMSS
| | - Carlos José Molina-Pérez
- From the Medical Research Unit in Reproductive Medicine (A.L.-M., A.G.N.-L., R.I.C.-J., C.J.M.-P.), UMAE-Hospital de Ginecología y Obstetricia "Luis Castelazo Ayala", Instituto Mexicano del Seguro Social (IMSS), Ciudad de México; Research Unit in Thrombosis, Hemostasia and Atherogenesis, HGR No.1 "Dr. Carlos Mac Gregor", IMSS
| | - Liliana Janet Sillas-Pardo
- Division of Maternal-Fetal Medicine (L.J.S.-P., K.L.R.-V.), UMAE-Hospital de Ginecología y Obstetricia "Luis Castelazo Ayala", Instituto Mexicano del Seguro Social (IMSS), Ciudad de México; Research Unit in Thrombosis, Hemostasia and Atherogenesis, HGR No.1 "Dr. Carlos Mac Gregor", IMSS
| | - Luis Manuel Jiménez-Trejo
- Intensive Care Unit (L.M.J.-T.), UMAE-Hospital de Ginecología y Obstetricia "Luis Castelazo Ayala", Instituto Mexicano del Seguro Social (IMSS), Ciudad de México; Research Unit in Thrombosis, Hemostasia and Atherogenesis, HGR No.1 "Dr. Carlos Mac Gregor", IMSS
| | | | - Karla Leticia Ramírez-Valenzuela
- Division of Maternal-Fetal Medicine (L.J.S.-P., K.L.R.-V.), UMAE-Hospital de Ginecología y Obstetricia "Luis Castelazo Ayala", Instituto Mexicano del Seguro Social (IMSS), Ciudad de México; Research Unit in Thrombosis, Hemostasia and Atherogenesis, HGR No.1 "Dr. Carlos Mac Gregor", IMSS
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Limaye MA, Buyon JP, Cuneo BF, Mehta-Lee SS. A review of fetal and neonatal consequences of maternal systemic lupus erythematosus. Prenat Diagn 2020; 40:1066-1076. [PMID: 32282083 DOI: 10.1002/pd.5709] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 03/20/2020] [Accepted: 04/06/2020] [Indexed: 12/14/2022]
Abstract
Systemic lupus erythematosus (SLE) primarily affects women of childbearing age and is commonly seen in pregnancy. The physiologic and immunologic changes of pregnancy may alter the course of SLE and impact maternal, fetal, and neonatal health. Multidisciplinary counseling before and during pregnancy from rheumatology, maternal fetal medicine, obstetrics, and pediatric cardiology is critical. Transplacental passage of autoantibodies, present in about 40% of women with SLE, can result in neonatal lupus (NL). NL can consist of usually permanent cardiac manifestations, including conduction system and myocardial disease, as well as transient cutaneous, hematologic, and hepatic manifestations. Additionally, women with SLE are more likely to develop adverse pregnancy outcomes such as preeclampsia, fetal growth restriction, and preterm birth, perhaps due to an underlying effect on placentation. This review describes the impact of SLE on maternal and fetal health by trimester, beginning with prepregnancy optimization of maternal health. This is followed by a discussion of NL and the current understanding of the epidemiology and pathophysiology of anti-Ro/La mediated cardiac disease, as well as screening, treatment, and methods for prevention. Finally discussed is the known increase in preeclampsia and fetal growth issues in women with SLE that can lead to iatrogenic preterm delivery.
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Affiliation(s)
- Meghana A Limaye
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, NYU Langone Medical Center, New York, New York, USA
| | - Jill P Buyon
- Division of Rheumatology, Department of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - Bettina F Cuneo
- Division of Cardiology, Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Shilpi S Mehta-Lee
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, NYU Langone Medical Center, New York, New York, USA
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12
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Saavedra MÁ, Miranda‐Hernández D, Lara‐Mejía A, Sánchez A, Morales S, Cruz‐Reyes C, Cruz‐Domínguez P, Medina G, Jara LJ. Use of antimalarial drugs is associated with a lower risk of preeclampsia in lupus pregnancy: A prospective cohort study. Int J Rheum Dis 2020; 23:633-640. [DOI: 10.1111/1756-185x.13830] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 03/06/2020] [Accepted: 03/07/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Miguel Ángel Saavedra
- Rheumatology Department Hospital de Especialidades Dr. Antonio Fraga Mouret Centro Médico Nacional La Raza Instituto Mexicano del Seguro Social Mexico City Mexico
| | - Dafhne Miranda‐Hernández
- Rheumatology Department Hospital de Especialidades Dr. Antonio Fraga Mouret Centro Médico Nacional La Raza Instituto Mexicano del Seguro Social Mexico City Mexico
| | - Alejandra Lara‐Mejía
- Rheumatology Department Hospital de Especialidades Dr. Antonio Fraga Mouret Centro Médico Nacional La Raza Instituto Mexicano del Seguro Social Mexico City Mexico
| | - Antonio Sánchez
- Rheumatology Department Hospital de Especialidades Dr. Antonio Fraga Mouret Centro Médico Nacional La Raza Instituto Mexicano del Seguro Social Mexico City Mexico
| | - Sara Morales
- Perinatology Department Hospital de Gineco‐Obstetricia No. 3 Centro Médico Nacional La Raza Instituto Mexicano del Seguro Social Mexico City Mexico
| | - Claudia Cruz‐Reyes
- Rheumatology Department Hospital de Especialidades Dr. Antonio Fraga Mouret Centro Médico Nacional La Raza Instituto Mexicano del Seguro Social Mexico City Mexico
| | - Pilar Cruz‐Domínguez
- Division of Investigation Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza Instituto Mexicano del Seguro Social Mexico City Mexico
| | - Gabriela Medina
- Research Unit in Traslational Medicine in Hemato‐Oncological Diseases Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza Instituto Mexicano del Seguro Social Mexico City Mexico
| | - Luis Javier Jara
- Direction of Education and Research Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza Instituto Mexicano del Seguro Social Mexico City Mexico
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13
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Genetic hypothesis for the developmental origins of health and disease theory. JOURNAL OF BIO-X RESEARCH 2020. [DOI: 10.1097/jbr.0000000000000056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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14
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Elevated levels of the secreted wingless agonist R-spondin 3 in preeclamptic pregnancies. J Hypertens 2020; 38:1347-1354. [DOI: 10.1097/hjh.0000000000002362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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15
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Eastwood KA, Hunter AJ, Patterson CC, Mc Cance DR, Young IS, Holmes VA. The role of biomarkers in predicting pre-eclampsia in high-risk women. Ann Clin Biochem 2019; 57:128-137. [PMID: 31757167 DOI: 10.1177/0004563219894022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background There are limited data on performance of biomarkers to predict pre-eclampsia (PE) in high-risk women. This study investigated the ability of FABP4, PAPP-A, PlGF, sFlt-1 and sEng to predict PE in a high-risk group. Methods Non-fasting samples were analysed at 11 + 0–13 + 6 (V1) and 19 + 0–21 + 6 weeks (V2) ( n = 195). Logistic regression models were determined. Area under (AUC) the receiver operating characteristic (ROC) curve analysis was performed. The added value of biomarkers to clinical characteristics for PE prediction was quantified using integrated discrimination improvement (IDI) and net reclassification improvement (NRI) indices. Results Prevalence of PE was 12%. Lower concentrations of sFlt-1:PlGF (V1) and PlGF and PlGF:sEng (V2) were seen in women who developed PE. Controlling for baseline characteristics (V1), a doubling of sFlt-1 (pg/mL) (median 896.0, IQR 725.5–1097.0) and sFlt-1:PlGF (median 21.2, IQR 14.7–32.3) was associated with reduction in odds of PE (OR 0.20, 95% CI 0.06–0.65, P = 0.007 and OR 0.48, 95% CI 0.25–0.92, P = 0.04). Addition of sFlt-1 and sFlt-1:PlGF to baseline characteristics non-significantly improved AUC (0.74) (AUC 0.77, P = 0.40 and 0.76, P = 0.39). NRI and IDI analyses confirmed added clinical utility of sFlt-1 (NRI = 0.539, P = 0.01 and IDI = 0.052, P = 0.03). In V2, doubling of PlGF:sEng (median 71.9, IQR 47.0–102.8) was associated with reduction in the risk of PE (OR 0.56, 95% CI 0.35–0.98, P = 0.04). The addition of PlGF:sEng to baseline characteristics non-significantly improved AUC from 0.78 to 0.82 ( P = 0.25) and improved reclassification of cases (NRI = 0.682, P = 0.002). Conclusions Screening tests incorporating first trimester sFlt-1 and second trimester PlGF:sEng have potential to aid PE prediction in high-risk pregnancies.
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Affiliation(s)
- Kelly-Ann Eastwood
- Centre for Public Health, Institute of Clinical Sciences, Royal Victoria Hospital, Queen's University Belfast, Belfast, UK.,Royal Jubilee Maternity Hospital, Belfast, UK
| | - Alyson J Hunter
- Centre for Public Health, Institute of Clinical Sciences, Royal Victoria Hospital, Queen's University Belfast, Belfast, UK.,Royal Jubilee Maternity Hospital, Belfast, UK
| | - Christopher C Patterson
- Centre for Public Health, Institute of Clinical Sciences, Royal Victoria Hospital, Queen's University Belfast, Belfast, UK
| | - David R Mc Cance
- Centre for Public Health, Institute of Clinical Sciences, Royal Victoria Hospital, Queen's University Belfast, Belfast, UK.,Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - Ian S Young
- Centre for Public Health, Institute of Clinical Sciences, Royal Victoria Hospital, Queen's University Belfast, Belfast, UK
| | - Valerie A Holmes
- Centre for Public Health, Institute of Clinical Sciences, Royal Victoria Hospital, Queen's University Belfast, Belfast, UK
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16
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Changes of platelet count throughout pregnancy in women with antiphospholipid syndrome. J Reprod Immunol 2019; 136:102612. [PMID: 31542513 DOI: 10.1016/j.jri.2019.102612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 08/22/2019] [Accepted: 09/09/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Antiphospholipid antibodies (aPL) activate several cell types, such as endothelial cells, monocytes, neutrophils, fibroblasts, trophoblasts and platelets, thus leading to thrombosis and obstetric complications in patients with antiphospholipid syndrome (APS). The aim of the present study was the longitudinal investigation of platelet count in women with APS. Additionally, platelet count in women with APS who developed preeclampsia during pregnancy were compared to women with APS and uncomplicated pregnancy for potential early detection of preeclampsia. MATERIAL AND METHODS This longitudinal study included 65 women with APS, 38 women with preeclampsia and 84 women with normal pregnancies, where platelet count was determined every four weeks, starting in early pregnancy. RESULTS Platelet count was significantly lower in women with APS compared to women who developed preeclampsia and normal pregnancies starting at 12 weeks of gestation. The areas under the curve (AUC) for platelet count were 0.765 at 12 weeks of gestation (95% of CI of 0.634-0.896), 0.747 at 20 weeks (95% of CI of 0.600-0.894), 0.719 at 24 weeks (95% of CI of 0.555-0.882), respectively. The cut off points for platelets were 216 at 12-14 weeks of gestation, 226.5 at 20 weeks of gestation, and 163.5 at 24 weeks of gestation, respectively. DISCUSSION We demonstrated a significant lower platelet count in women with APS throughout gestation. Additionally, platelet count is significantly decreased in women with APS who developed preeclampsia. According to our results, platelet count seems to have a predictive value for the development of preeclampsia in these women.
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Tomimatsu T, Mimura K, Matsuzaki S, Endo M, Kumasawa K, Kimura T. Preeclampsia: Maternal Systemic Vascular Disorder Caused by Generalized Endothelial Dysfunction Due to Placental Antiangiogenic Factors. Int J Mol Sci 2019; 20:E4246. [PMID: 31480243 PMCID: PMC6747625 DOI: 10.3390/ijms20174246] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/20/2019] [Accepted: 08/28/2019] [Indexed: 12/13/2022] Open
Abstract
Preeclampsia, a systemic vascular disorder characterized by new-onset hypertension and proteinuria after 20 weeks of gestation, is the leading cause of maternal and perinatal morbidity and mortality. Maternal endothelial dysfunction caused by placental factors has long been accepted with respect to the pathophysiology of preeclampsia. Over the past decade, increased production of placental antiangiogenic factors has been identified as a placental factor leading to maternal endothelial dysfunction and systemic vascular dysfunction. This review summarizes the recent advances in understanding the molecular mechanisms of endothelial dysfunction caused by placental antiangiogenic factors, and the novel clinical strategies based on these discoveries.
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Affiliation(s)
- Takuji Tomimatsu
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan.
| | - Kazuya Mimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Shinya Matsuzaki
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Masayuki Endo
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Keiichi Kumasawa
- Department of Obstetrics and Gynecology, Tokyo University Graduate School of Medicine, Tokyo 113-0033, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
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18
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Phipps EA, Thadhani R, Benzing T, Karumanchi SA. Pre-eclampsia: pathogenesis, novel diagnostics and therapies. Nat Rev Nephrol 2019; 15:275-289. [PMID: 30792480 PMCID: PMC6472952 DOI: 10.1038/s41581-019-0119-6] [Citation(s) in RCA: 551] [Impact Index Per Article: 110.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pre-eclampsia is a complication of pregnancy that is associated with substantial maternal and fetal morbidity and mortality. The disease presents with new-onset hypertension and often proteinuria in the mother, which can progress to multi-organ dysfunction, including hepatic, renal and cerebral disease, if the fetus and placenta are not delivered. Maternal endothelial dysfunction due to circulating factors of fetal origin from the placenta is a hallmark of pre-eclampsia. Risk factors for the disease include maternal comorbidities, such as chronic kidney disease, hypertension and obesity; a family history of pre-eclampsia, nulliparity or multiple pregnancies; and previous pre-eclampsia or intrauterine fetal growth restriction. In the past decade, the discovery and characterization of novel antiangiogenic pathways have been particularly impactful both in increasing understanding of the disease pathophysiology and in directing predictive and therapeutic efforts. In this Review, we discuss the pathogenic role of antiangiogenic proteins released by the placenta in the development of pre-eclampsia and review novel therapeutic strategies directed at restoring the angiogenic imbalance observed during pre-eclampsia. We also highlight other notable advances in the field, including the identification of long-term maternal and fetal risks conferred by pre-eclampsia.
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Affiliation(s)
- Elizabeth A Phipps
- Nephrology Division, Brigham and Women's Hospital, Boston, MA, USA
- Nephrology Division, Massachusetts General Hospital, Boston, MA, USA
| | - Ravi Thadhani
- Nephrology Division, Massachusetts General Hospital, Boston, MA, USA
- Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Thomas Benzing
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - S Ananth Karumanchi
- Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Nephrology Division, Departments of Medicine, Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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19
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Shahid S, Khalid E, Fatima SS, Khan GM. Evaluation of soluble TNF-like weak inducer of apoptosis (sTWEAK) levels to predict preeclampsia in early weeks of pregnancy. Eur J Obstet Gynecol Reprod Biol 2019; 234:165-170. [PMID: 30708268 DOI: 10.1016/j.ejogrb.2019.01.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/02/2019] [Accepted: 01/14/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) is linked to endothelial dysfunction; a key factor in pre-eclamptic pathogenesis. This study aimed to compare sTWEAK levels during pregnancy to assess for its prognostic ability. MATERIALS AND METHODS Sixty three high risk pregnant women were followed up from 12 weeks of gestation till term. Serum levels of sTWEAK and platelet derived growth factor (PlGF), blood pressure, serum glucose, uric acid, urea/creatinine and liver function tests were measured. Subjects were stratified according to the ACOG criteria as women who developed PE, or PIH or remained normotensive at term. A negative control group of normotensive healthy pregnant women (n = 17) was also recruited for comparison. RESULTS Baseline sTWEAK levels were lower (4.03 ± 0.37 ng/dl) in HR cohort that developed PE and further reduced at term (1.93 ± 0.23 ng/dl) as compared to HR subjects who remained normotensive and negative control group (30.53 ± 0.79 ng/dl; p < 0.01). Likewise PlGF levels were significantly lower (74.22 ± 10.11 pg/ml) in HR cohort that developed PE (p = 0.013). At term 39.68% (n = 22) HR subjects with low sTWEAK developed PIH and 34.92% (n = 24) developed PE. In terms of high risk characteristics observed in the HR group; 73% of the subjects were multiparous, whereas 26.98% reported to have developed PE in previous pregnancies. CONCLUSION sTWEAK levels at early pregnancy weeks were found to be low in high risk females who developed PE at follow up versus normotensive pregnant women. Baseline TWEAK might serve as an independent variable for prediction of pre-eclampsia; however longitudinal studies with larger sample size are required to ascertain the causal relation.
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Affiliation(s)
- Sana Shahid
- Department of Physiology, Sir Syed College of Medical Sciences for Girls, Karachi, Pakistan
| | - Erum Khalid
- Department of Obstetrics and Gynecology, Taj Medical Complex, Hamdard University, Pakistan
| | - Syeda Sadia Fatima
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan.
| | - Ghulam Mustafa Khan
- Department of Physiology, Basic Medical Science Institute, Karachi, Pakistan
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20
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Clinical usefulness of serum levels of soluble fms-like tyrosine kinase 1/placental growth factor ratio to rule out preeclampsia in women with new-onset lupus nephritis during pregnancy. CEN Case Rep 2018; 8:95-100. [PMID: 30565047 DOI: 10.1007/s13730-018-0373-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/07/2018] [Indexed: 12/20/2022] Open
Abstract
Measurement of the soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio may be clinically useful to discriminate systemic lupus erythematosus (SLE) from preeclampsia. Here, we present a pregnant woman with new-onset SLE with hypertension, with the measurement of the sFlt-1/PlGF ratio during pregnancy. A 31-year-old Japanese nulliparous woman, who had been diagnosed with idiopathic thrombocytopenic purpura at 10 years, had a systolic blood pressure of 120 mmHg and was negative for proteinuria at 12+1 weeks. Since her blood pressure increased to 159/86 mmHg with 3+ proteinuria at 25+4 weeks, preeclampsia was suspected. Deterioration of the kidney function (creatinine: 0.58 mg/dL at 24+6 weeks to 0.83 mg/dL at 33+6 weeks) necessitated cesarean section at 33+6 weeks. After delivery, she still showed increased creatinine and proteinuria. Therefore, she was transferred to a nephrology specialist in a tertiary center and was finally diagnosed with SLE with lupus nephritis class IV-G(A) (diffuse lupus nephritis). The serum levels of sFlt-1 and the sFlt-1/PlGF ratio, which are usually elevated in preeclampsia, were within normal reference ranges at 27+6, 28+1, and 28+6 weeks of gestation, although the serum levels of PlGF were slightly lower than the normal reference range. In conclusion, measurement of the sFlt-1/PlGF ratio may be clinically useful to discriminate lupus nephritis from preeclampsia.
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21
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Nguyen TH, Bui TC, Vo TM, Tran QM, Luu LTT, Nguyen TD. Predictive value of the sFlt-1 and PlGF in women at risk for preeclampsia in the south of Vietnam. Pregnancy Hypertens 2018; 14:37-42. [PMID: 30527116 DOI: 10.1016/j.preghy.2018.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/04/2018] [Accepted: 07/26/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND It has been suggested that soluble fms-like tyrosine kinase receptor-1 (sFlt-1) and placental growth factor (PlGF) play potential roles in preeclampsia diagnosis. Nevertheless, studies on the use of sFlt-1, PlGF, and sFlt-1/PlGF ratio in predicting preeclampsia have found contradictory results. Thus, more studies in different populations are needed. OBJECTIVES This study aims to (i) examine the associations between sFlt-1, PlGF, or sFlt-1/PlGF ratio at gestational ages of 24-28 weeks and subsequent preeclampsia, and (ii) estimate predictive values of these markers in southern Vietnamese women. METHODS We used a nested case-control design from a cohort of 490 pregnant women who were at risk of preeclampsia. The total sample size for statistical analysis consisted of 30 cases and 67controls. Levels of sFlt-1 and PlGF were quantified by using a fully automated electrochemiluminescence immunoassay platform (Elecsys®/Cobas®). RESULTS The median of sFlt-1 concentration was not statistically different between case and control groups. The median PlGF concentration was lower (349.7 pg/ml versus 534.6 pg/ml, P < .001) and the median sFlt-1/PlGF ratio was higher in the preeclampsia group (4.3 versus 1.9, P < .001). After adjusting for maternal age, gestational age, nullipara, and body mass index, the odds of preeclampsia in women with an sFlt-1/PlGF ratio in the fourth quartile were 10 times greater than in women with an sFlt-1/PlGF ratio in the other quartiles (95% confidence interval, 3.2-31.4; P < .001). CONCLUSIONS This study contributes to the literature that sFlt-1/PlGF ratio measured at gestational weeks 24-28 in southern Vietnamese women can separate preeclamptic from normotensive cases.
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Affiliation(s)
- Trung Huu Nguyen
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam.
| | - Thanh Cong Bui
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States.
| | - Tuan Minh Vo
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Quan Minh Tran
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Viet Nam
| | | | - Tai Duy Nguyen
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
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Serrano NC, Quintero-Lesmes DC, Becerra-Bayona S, Guio E, Beltran M, Paez MC, Ortiz R, Saldarriaga W, Diaz LA, Monterrosa Á, Miranda J, Mesa CM, Sanin JE, Monsalve G, Dudbridge F, Hingorani AD, Casas JP. Association of pre-eclampsia risk with maternal levels of folate, homocysteine and vitamin B12 in Colombia: A case-control study. PLoS One 2018; 13:e0208137. [PMID: 30521542 PMCID: PMC6283543 DOI: 10.1371/journal.pone.0208137] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/12/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Maternal serum concentrations of folate, homocysteine, and vitamin B12 have been associated with pre-eclampsia. Nevertheless, reported studies involve limited number of cases to reliably assess the nature of these associations. Our aim was to examine the relation of these three biomarkers with pre-eclampsia risk in a large Colombian population. MATERIALS AND METHODS Design: A case-control study. Setting: Cases of pre-eclampsia and healthy pregnant controls were recruited at the time of delivery from eight different Colombian cities between 2000 and 2012. Population or Sample: 2978 cases and 4096 controls were studied. Maternal serum concentrations of folate, homocysteine, and vitamin B12 were determined in 1148 (43.6%) cases and 1300 (31.7%) controls. Also, self-reported folic acid supplementation was recorded for 2563 (84%) cases and 3155 (84%) controls. Analysis: Adjusted odds ratios (OR) for pre-eclampsia were estimated for one standard deviation (1SD) increase in log-transformed biomarkers. Furthermore, we conducted analyses to compare women that reported taking folic acid supplementation for different periods during pregnancy. Main Outcomes Measures: Odds ratio for pre-eclampsia. RESULTS After adjusting for potential confounders in logistic regression models, the OR for pre-eclampsia was 0.80 (95% CI: 0.72, 0.90) for 1SD increase in log-folate, 1.16 (95%CI: 1.05, 1.27) for 1SD increase in log-homocysteine, and 1.10 (95%CI: 0.99, 1.22) for 1SD increase in log-vitamin B12. No interactions among the biomarkers were identified. Women who self-reported consumption of folic acid (1 mg/day) throughout their pregnancy had an adjusted OR for pre-eclampsia of 0.86 (95%CI: 0.67, 1.09) compared to women that reported no consumption of folic acid at any point during pregnancy. CONCLUSIONS Maternal serum concentrations of folate were associated as a protective factor for pre-eclampsia while concentrations of homocysteine were associated as a risk factor. No association between maternal vitamin B12 concentrations and preeclampsia was found.
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Affiliation(s)
- Norma C. Serrano
- Fundación Cardiovascular de Colombia, Floridablanca, Colombia
- Hospital Internacional de Colombia, Piedecuesta, Colombia
- Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | | | | | - Elizabeth Guio
- Fundación Cardiovascular de Colombia, Floridablanca, Colombia
| | - Mónica Beltran
- Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
- Universidad Industrial de Santander, Bucaramanga, Colombia
| | - María C. Paez
- Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Ricardo Ortiz
- Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Wilmar Saldarriaga
- Departamento de Ginecología y Obstetricia, Departamento de Morfología, Facultad de Salud, Universidad del Valle, Cali, Colombia
| | - Luis A. Diaz
- Universidad Industrial de Santander, Bucaramanga, Colombia
| | | | | | | | - José E. Sanin
- Universidad Pontificia Bolivariana, Bucaramanga, Colombia
| | | | - Frank Dudbridge
- Department of Health Sciences, Centre for Medicine, University of Leicester, Leicester, United Kingdom
| | - Aroon D. Hingorani
- Farr Institute of Health Informatics, University College London, London, United Kingdom
| | - Juan P. Casas
- Farr Institute of Health Informatics, University College London, London, United Kingdom
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23
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de Moreuil C, Fauchais AL, Merviel P, Tremouilhac C, Le Moigne E, Pasquier E, Pan-Petesch B, Lacut K. [Pre-eclampsia prevention in 2018 in general population and in lupic women: At the dawn of a personalized medicine?]. Rev Med Interne 2018; 39:935-941. [PMID: 29933972 DOI: 10.1016/j.revmed.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 05/27/2018] [Accepted: 06/03/2018] [Indexed: 11/17/2022]
Abstract
Pre-eclampsia prevention represents a major public health issue, as this vasculo-placental disorder generates a great burden of foeto-maternal morbi-mortality. Aspirin has proved its efficacy in primary and secondary pre-eclampsia prevention, especially when it is given at 150mg per day bedtime before 15 weeks of gestation to high-risk women. In the English trial ASPRE, high-risk women were identified by an algorithm taking into account angiogenic biomarkers ascertained at the end of first trimester of pregnancy. This article focuses on physiopathological mechanisms and risk factors of pre-eclampsia and on the interest of early angiogenic biomarkers dosing during pregnancy, for the assessment of pre-eclampsia risk. Unlike Great Britain or Israel, cost-effectiveness of this algorithm in general population has not been assessed in France. Finally, systemic lupus erythematous is at high risk of vasculo-placental disorders. Although few studies of angiogenic biomarkers dosing during lupus pregnancies identified a correlation between high sFlt1 levels at the end of first trimester and subsequent onset of severe vasculo-placental disorders, with a very good negative predictive value of sFtl1. Angiogenic biomarkers ascertainment for screening of vasculo-placental disorders in pregnant women with systemic lupus erythematous could allow targeting at best women needing an aspirin treatment and a closer monitoring.
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Affiliation(s)
- C de Moreuil
- Département de médecine interne et pneumologie, hôpital La Cavale Blanche, CHU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France; EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France.
| | - A-L Fauchais
- Département de médecine interne, CHU de Limoges, 29200 Limoges, France
| | - P Merviel
- EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France; Service de gynécologie et d'obstétrique, hôpital Morvan, CHU de Brest, 29200 Brest, France
| | - C Tremouilhac
- EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France; Service de gynécologie et d'obstétrique, hôpital Morvan, CHU de Brest, 29200 Brest, France
| | - E Le Moigne
- Département de médecine interne et pneumologie, hôpital La Cavale Blanche, CHU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France; EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France
| | - E Pasquier
- Département de médecine interne et pneumologie, hôpital La Cavale Blanche, CHU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France; EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France
| | - B Pan-Petesch
- EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France; Fédération de cancérologie et d'hématologie, hôpital Morvan, CHU de Brest, 29200 Brest, France
| | - K Lacut
- Département de médecine interne et pneumologie, hôpital La Cavale Blanche, CHU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France; EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France
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24
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Abstract
Pregnancy-related acute kidney injury (AKI) has declined in incidence in the last three decades, although it remains an important cause of maternal and fetal morbidity and mortality. Pregnancy-related causes of AKI such as preeclampsia, acute fatty liver of pregnancy, HELLP (Hemolysis, Elevated Liver function tests, Low Platelets) syndrome, and the thrombotic microangiopathies (thrombotic thrombocytopenic purpura, atypical hemolytic-uremic syndrome [HUS]) exhibit overlapping features and often present as diagnostic dilemmas. Differentiating among these conditions may be difficult or impossible based on clinical criteria only. In difficult and rare cases, a renal biopsy may need to be considered for the exact diagnosis and to facilitate appropriate treatment, but the risks and benefits need to be carefully weighed. The use of eculizumab for the treatment of atypical HUS has demonstrated efficacy in early case reports. Non-pregnancy related causes such as volume depletion and pyelonephritis require early and aggressive resuscitative as well as antibiotic measures respectively. We will discuss in this review the various etiologies of AKI in pregnancy, current diagnostic approaches, and the latest treatment strategies. Given the recent trends of increasing maternal age at the time of pregnancy, and the availability of modern reproductive methods increase the risks of AKI in pregnancy in the coming years.
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Affiliation(s)
- Belinda Jim
- ?>Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, NY
| | - Vesna D Garovic
- Division of Nephrology and Hypertension, and Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN.
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25
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Mayer-Pickel K, Stern C, Eberhard K, Lang U, Obermayer-Pietsch B, Cervar-Zivkovic M. Angiogenic factors in pregnancies of women with antiphospholipid syndrome and systemic lupus erythematosus. J Reprod Immunol 2018; 127:19-23. [PMID: 29689494 DOI: 10.1016/j.jri.2018.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 03/05/2018] [Accepted: 04/09/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES An imbalance of angiogenic placental factors such as endoglin, soluble fms-like tyrosine kinase 1(sFlt-1) and placental growth factor (PlGF) has been implicated in the pathophysiology of preeclampsia. This study aimed to evaluate serum levels of sFlt-1, PlGF and endoglin in women with primary and secondary antiphospholipid Syndrome (APS) and systemic lupus erythematosus (SLE) longitudinally through pregnancy. MATERIAL AND METHODS Serum levels of sFlt-1, PlGF and endoglin were measured prospectively at 4-week intervals (from gestational weeks 12-36) in 17 women with primary APS (PAPS), 18 women with secondary APS (SAPS), and 23 women with SLE. RESULTS 6/17 (35%) of women with PAPS, 3/18 (17%) of women with SAPS, and 2/23 (9%) of women with SLE developed early-onset preeclampsia. Women who developed preeclampsia had significantly higher mean sFlt-1 and endoglin levels, higher sFlt-1/PlGF ratios, and lower mean PlGF-levels than women who did not. These changes became statistically significant at 12 weeks for sFlt-1, PlGF and endoglin. DISCUSSION Endoglin, sFlt-1 and PlGF are potential early screening parameters for the development of preeclampsia in pregnant women with autoimmune diseases like APS and SLE.
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Affiliation(s)
- Karoline Mayer-Pickel
- Department of Obstetrics, Department of Internal Medicine and Endocrinology Lab Platform, Medical University Graz, Graz, Austria.
| | - Christina Stern
- Department of Obstetrics, Department of Internal Medicine and Endocrinology Lab Platform, Medical University Graz, Graz, Austria
| | - Katharina Eberhard
- Computational Bioanalytics, Center for Medical Research, Department of Internal Medicine and Endocrinology Lab Platform, Medical University Graz, Graz, Austria
| | - Uwe Lang
- Department of Obstetrics, Department of Internal Medicine and Endocrinology Lab Platform, Medical University Graz, Graz, Austria
| | - Barbara Obermayer-Pietsch
- Division of Endocrinology and Diabetology, Department of Internal Medicine and Endocrinology Lab Platform, Medical University Graz, Graz, Austria
| | - Mila Cervar-Zivkovic
- Department of Obstetrics, Department of Internal Medicine and Endocrinology Lab Platform, Medical University Graz, Graz, Austria
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26
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Xiao Z, Li S, Yu Y, Li M, Chen J, Wang F, Zhang J, Deng W, Yang Q, Fan X. VEGF-A regulates sFlt-1 production in trophoblasts through both Flt-1 and KDR receptors. Mol Cell Biochem 2018; 449:1-8. [PMID: 29497919 DOI: 10.1007/s11010-018-3337-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 02/17/2018] [Indexed: 11/25/2022]
Abstract
Studies have shown that sFlt-1 overproduction stimulated by excess VEGF of deciduous origin in trophoblasts can cause preeclampsia. However, the mechanism underlying how VEGF regulates sFtl-1 expression in trophoblasts remains unknown. To address this issue, JEG3 and HTR-8/SV neo (HTR8) trophoblast cell lines were used to investigate the signaling pathways involved in the regulation of sFlt-1 production via VEGF overexpression in vitro. JEG3 (VEGF-GFP-JEG3, V-J) and HTR8 (VEGF-GFP-HTR8, V-H) cells overexpressing VEGF165 were established by infecting the JEG3 and HTR8 cell lines with lentivirus expressing VEGF165. Both the mRNA and protein levels of VEGF and sFlt-1 were dramatically up-regulated in the V-J and V-H cells compared to the JEG3 and HTR8 cells, and they were significantly decreased after treatment with an Flt-1 receptor inhibitor (MK-2461), a KDR receptor inhibitor (XL-184), or an Flt-1 and KDR receptor inhibitor (ABT-869). The mRNA levels of sFlt-1, Flt-1, and KDR were increased in V-H cells after treatment, and the VEGF-A mRNA levels were also elevated. The migration and invasion abilities of JEG3 and HTR8 cells were decreased after VEGF overexpression, and this reduction could be reversed with VEGF receptor inhibitor treatment. In addition, after the different treatments, the cell migration rates of V-J cells were significantly increased compared with the control treatment. Taken together, these results indicate that sFlt-1 up-regulation by VEGF may be mediated by the VEGF/Flt-1 and/or VEGF/KDR signaling pathways. However, elucidating which pathway plays this key role requires further investigation.
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Affiliation(s)
- Zhonglin Xiao
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
- College of Veterinary Medicine, Hunan Agricultural University, Changsha, 410128, China
| | - Songjun Li
- Reproductive Center of Shenzhen Armed Police Hospital, Shenzhen, 518023, China
| | - Yan Yu
- Baoan Women's and Children's Hospital, Shenzhen, 518133, China
| | - Mengxia Li
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Jie Chen
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Feng Wang
- Reproductive Center of Shenzhen Armed Police Hospital, Shenzhen, 518023, China
| | - Jian Zhang
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Weifen Deng
- Reproductive Center of Shenzhen Armed Police Hospital, Shenzhen, 518023, China.
| | - Qing Yang
- College of Veterinary Medicine, Hunan Agricultural University, Changsha, 410128, China.
| | - Xiujun Fan
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China.
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27
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Rodríguez-Almaraz ME, Herraiz I, Gómez-Arriaga PI, Vallejo P, Gonzalo-Gil E, Usategui A, López-Jiménez EA, Galindo A, Galindo M. The role of angiogenic biomarkers and uterine artery Doppler in pregnant women with systemic lupus erythematosus or antiphospholipid syndrome. Pregnancy Hypertens 2018. [PMID: 29523283 DOI: 10.1016/j.preghy.2018.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To evaluate the usefulness of the uterine artery mean pulsatility index (mPI-UtA) and the sFlt-1/PlGF ratio in women with systemic lupus erythematosus (SLE) or antiphospholipid syndrome (APS) for the prediction of placental dysfunction-related adverse outcomes (AO), namely pre-eclampsia (PE) and intrauterine growth restriction (IUGR), and for differential diagnosis between PE and SLE flares. STUDY DESIGN Observational prospective cohort study of 57 pregnant women with SLE or APS. MAIN OUTCOME MEASURES mPI-UtA and sFlt-1/PlGF ratio in maternal serum were obtained at four gestational age periods (11-14, 19-22, 24-29 and 32-34 weeks). Comparisons among pregnancies with normal outcome, SLE flare and AO were performed. RESULTS Overall, we had 44 ongoing pregnancies (36 with SLE and 8 with APS) of which most (n = 35, 80%) were uncomplicated. The overall rate of AO was 9% (n = 4), that was diagnosed at a mean (SD) gestational age of 34.1 (7.5) weeks. Five SLE patients (14%) suffered a SLE flare. No differences for these markers were found between normal pregnancies and those affected by SLE flare. mUtA-PI values were significantly higher in the AO group when compared with normal and SLE flare groups, at 19-22 weeks (1.52, 0.95 and 0.76) and 32-34 weeks (1.13, 0.68 and 0.65), respectively. The sFlt-1/PlGF ratio was significantly higher in the AO group at 24-29 weeks (191.1, 3.1 and 9.2), respectively. CONCLUSION Our preliminary results indicate that mPI-UtA and sFlt1/PlGF ratio may be useful to predict AO in women with SLE, and to make the differential diagnosis with a lupus flare.
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Affiliation(s)
- M E Rodríguez-Almaraz
- Department of Rheumatology, Hospital Universitario 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Universidad Complutense, Madrid, Spain
| | - I Herraiz
- Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, Hospital Universitario 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Universidad Complutense, Madrid, Spain.
| | - P I Gómez-Arriaga
- Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, Hospital Universitario 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Universidad Complutense, Madrid, Spain
| | - P Vallejo
- Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, Hospital Universitario 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Universidad Complutense, Madrid, Spain
| | - E Gonzalo-Gil
- Department of Rheumatology, Hospital Universitario 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Universidad Complutense, Madrid, Spain
| | - A Usategui
- Department of Rheumatology, Hospital Universitario 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Universidad Complutense, Madrid, Spain
| | - E A López-Jiménez
- Department of Biochemistry, Hospital Universitario 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Universidad Complutense, Madrid, Spain
| | - A Galindo
- Fetal Medicine Unit-SAMID, Department of Obstetrics and Gynaecology, Hospital Universitario 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Universidad Complutense, Madrid, Spain
| | - M Galindo
- Department of Rheumatology, Hospital Universitario 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Universidad Complutense, Madrid, Spain
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28
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Soh MC, Nelson-Piercy C, Westgren M, McCowan L, Pasupathy D. Do adverse pregnancy outcomes contribute to accelerated cardiovascular events seen in young women with systemic lupus erythematosus? Lupus 2017; 26:1351-1367. [PMID: 28728509 DOI: 10.1177/0961203317719146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiovascular events (CVEs) are prevalent in patients with systemic lupus erythematosus (SLE), and it is the young women who are disproportionately at risk. The risk factors for accelerated cardiovascular disease remain unclear, with multiple studies producing conflicting results. In this paper, we aim to address both traditional and SLE-specific risk factors postulated to drive the accelerated vascular disease in this cohort. We also discuss the more recent hypothesis that adverse pregnancy outcomes in the form of maternal-placental syndrome and resultant preterm delivery could potentially contribute to the CVEs seen in young women with SLE who have fewer traditional cardiovascular risk factors. The pathophysiology of how placental-mediated vascular insufficiency and hypoxia (with the secretion of placenta-like growth factor (PlGF) and soluble fms-tyrosine-like kinase-1 (sFlt-1), soluble endoglin (sEng) and other placental factors) work synergistically to damage the vascular endothelium is discussed. Adverse pregnancy outcomes ultimately are a small contributing factor to the complex pathophysiological process of cardiovascular disease in patients with SLE. Future collaborative studies between cardiologists, obstetricians, obstetric physicians and rheumatologists may pave the way for a better understanding of a likely multifactorial aetiological process.
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Affiliation(s)
- M C Soh
- 1 Women's Health Academic Centre, King's College London, United Kingdom.,3 Faculty of Medical and Health Science, University of Auckland, New Zealand
| | - C Nelson-Piercy
- 1 Women's Health Academic Centre, King's College London, United Kingdom
| | - M Westgren
- 2 Department of Clinical Science, Karolinska Institutet, Sweden
| | - L McCowan
- 3 Faculty of Medical and Health Science, University of Auckland, New Zealand.,4 National Women's Health, South Auckland Clinical School of Medicine and Counties Manukau Health, Auckland, New Zealand
| | - D Pasupathy
- 1 Women's Health Academic Centre, King's College London, United Kingdom.,5 Biomedical Research Centre at Guy's & St Thomas's NHS Foundation Trust and King's College London, United Kingdom
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29
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Soh MC, Nelson-Piercy C. Biomarkers for Adverse Pregnancy Outcomes in Rheumatic Diseases. Rheum Dis Clin North Am 2017; 43:201-214. [PMID: 28390563 DOI: 10.1016/j.rdc.2016.12.008] [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] [Indexed: 10/20/2022]
Abstract
Pregnancy is a delicate balance of angiogenic factors. Adverse pregnancy outcomes in the form of placental insufficiency occur when antiangiogenic factors predominate, which manifests as maternal-placental syndrome (MPS). Women with rheumatic disease are at increased risk of MPS. Endothelial damage from circulating antiangiogenic factors and other inflammatory molecules in combination with preexisting maternal vascular risk factors is the likely underlying pathophysiological process for MPS. It is likely that these changes persist, and additional "insults" from ongoing inflammation, medications, and disease damage contribute to the development of accelerated cardiovascular disease seen in young women with rheumatic disease.
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Affiliation(s)
- May Ching Soh
- Silver Star High-Risk Pregnancy Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, UK; de Sweit Obstetric Medicine Department, Queen Charlotte's & Chelsea Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK; Women's Health Academic Centre, King's College London, St Thomas' Hospital, 10th Floor, North Wing, Westminster Bridge Road, London SE1 7EH, UK.
| | - Catherine Nelson-Piercy
- de Sweit Obstetric Medicine Department, Queen Charlotte's & Chelsea Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK; Women's Health Academic Centre, King's College London, St Thomas' Hospital, 10th Floor, North Wing, Westminster Bridge Road, London SE1 7EH, UK
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30
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Tomimatsu T, Mimura K, Endo M, Kumasawa K, Kimura T. Pathophysiology of preeclampsia: an angiogenic imbalance and long-lasting systemic vascular dysfunction. Hypertens Res 2016; 40:305-310. [PMID: 27829661 DOI: 10.1038/hr.2016.152] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 10/07/2016] [Accepted: 10/07/2016] [Indexed: 01/13/2023]
Abstract
Preeclampsia is a systemic vascular disorder characterized by new-onset hypertension and proteinuria after 20 weeks of gestation. This condition targets several organs, including the kidneys, liver and brain, and is the leading cause of maternal and perinatal morbidity and mortality. Furthermore, recent evidence has revealed preeclampsia as a significant risk factor for future cardiovascular diseases in these women. Over the past decade, increasing evidence has indicated that maternal angiogenic imbalances caused by placental antiangiogenic factors play a central role in the systemic vascular dysfunction underling preeclampsia. The severity of the maternal antiangiogenic state correlates closely with maternal and perinatal outcomes. Assessing angiogenic imbalance and several vascular function tests have also emerged as a way of detecting systemic vascular dysfunction during pregnancy. This review summarizes the current understanding of the pathophysiology of preeclampsia, its clinical applications and clinical evidence for future cardiovascular risks.
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Affiliation(s)
- Takuji Tomimatsu
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuya Mimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masayuki Endo
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Keiichi Kumasawa
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
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31
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Andersen LB, Dechend R, Jørgensen JS, Luef BM, Nielsen J, Barington T, Christesen HT. Prediction of preeclampsia with angiogenic biomarkers. Results from the prospective Odense Child Cohort. Hypertens Pregnancy 2016; 35:405-19. [DOI: 10.3109/10641955.2016.1167219] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Louise Bjørkholt Andersen
- HCA Research, Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Ralf Dechend
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
- Experimental and Clinical Research Center Max-Delbrueck Center and Charité Berlin, Berlin, Germany
- Department of Cardiology, Helios-Klinikum Berlin, Berlin, Germany
| | - Jan Stener Jørgensen
- Institute of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Birgitte Møller Luef
- HCA Research, Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Jan Nielsen
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | - Torben Barington
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
- Odense Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
- Odense Child Cohort, Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
| | - Henrik Thybo Christesen
- HCA Research, Hans Christian Andersen Children’s Hospital, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
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