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Cerdeira AS, Karumanchi SA. Serial placental growth factor-based testing in pre-eclampsia. Lancet 2024; 403:588-589. [PMID: 38342125 DOI: 10.1016/s0140-6736(23)02578-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/16/2023] [Indexed: 02/13/2024]
Affiliation(s)
- Ana Sofia Cerdeira
- Fetal Maternal Medicine Unit, Queen Charlotte's and Chelsea Hospital, London, UK; Nuffield Department of Women's Health and Reproductive Research, University of Oxford, Oxford OX3 9DU, UK.
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Thadhani R, Cerdeira AS, Karumanchi SA. Translation of mechanistic advances in preeclampsia to the clinic: Long and winding road. FASEB J 2024; 38:e23441. [PMID: 38300220 DOI: 10.1096/fj.202301808r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/30/2023] [Accepted: 01/09/2024] [Indexed: 02/02/2024]
Abstract
As one of the leading causes of premature birth and maternal and infant mortality worldwide, preeclampsia remains a major unmet public health challenge. Preeclampsia and related hypertensive disorders of pregnancy are estimated to cause >75 000 maternal and 500 000 infant deaths globally each year. Because of rising rates of risk factors such as obesity, in vitro fertilization and advanced maternal age, the incidence of preeclampsia is going up with rates ranging from 5% to 10% of all pregnancies worldwide. A major discovery in the field was the realization that the clinical phenotypes related to preeclampsia, such as hypertension, proteinuria, and other adverse maternal/fetal events, are due to excess circulating soluble fms-like tyrosine kinase-1 (sFlt-1, also referred to as sVEGFR-1). sFlt-1 is an endogenous anti-angiogenic protein that is made by the placenta and acts by neutralizing the pro-angiogenic proteins vascular endothelial growth factor (VEGF) and placental growth factor (PlGF). During the last decade, this work has spawned a new era of molecular diagnostics for early detection of this condition. Antagonizing sFlt-1 either by reducing production or blocking its actions has shown salutary effects in animal models. Further, in early-stage human studies, the therapeutic removal of sFlt-1 from maternal circulation has shown promise in delaying disease progression and improving outcomes. Recently, the FDA approved the first molecular test for preterm preeclampsia (sFlt-1/PlGF ratio) for clinical use in the United States. Measuring serum sFlt-1/PlGF ratio in the acute hospital setting may aid short-term management, particularly regarding step-up or step-down of care, decision to transfer to settings better equipped to manage both the mother and the preterm neonate, appropriate timing of administration of steroids and magnesium sulfate, and in expectant management decisions. The test itself has the potential to save lives. Furthermore, the availability of a molecular test that correlates with adverse outcomes has set the stage for interventional clinical trials testing treatments for this disorder. In this review, we will discuss the role of circulating sFlt-1 and related factors in the pathogenesis of preeclampsia and specifically how this discovery is leading to concrete advances in the care of women with preeclampsia.
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Affiliation(s)
- Ravi Thadhani
- Woodruff Health Sciences Center, Emory University School of Medicine, Atlanta, Georgia, USA
- Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ana Sofia Cerdeira
- Nuffield Department of Women's Health and Reproductive Research, University of Oxford, Oxford, UK
- Fetal Maternal Medicine Unit, Queen Charlotte's and Chelsea Hospital, London, UK
| | - S Ananth Karumanchi
- Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Awoyemi T, Zhang W, Rahbar M, Cribbs A, Logenthiran P, Jiang S, Collett G, Cerdeira AS, Vatish M. A cross-sectional analysis of syncytiotrophoblast membrane extracellular vesicles-derived transcriptomic biomarkers in early-onset preeclampsia. Front Cardiovasc Med 2023; 10:1291642. [PMID: 38099221 PMCID: PMC10720444 DOI: 10.3389/fcvm.2023.1291642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/14/2023] [Indexed: 12/17/2023] Open
Abstract
Background Preeclampsia (PE) is a pregnancy-specific hypertensive disorder affecting 2%-8% of pregnancies worldwide. Biomarker(s) for the disorder exists, but while these have excellent negative predictive value, their positive predictive value is poor. Extracellular vesicles released by the placenta into the maternal circulation, syncytiotrophoblast membrane extracellular vesicles (STB-EVs), have been identified as being involved in PE with the potential to act as liquid biopsies. Objective The objective of this study was to identify the difference in the transcriptome of placenta and STB-EVs between preeclampsia and normal pregnancy (NP) and mechanistic pathways. Methods/study design We performed RNA-sequencing on placental tissue, medium/large and small STB-EVs from PE (n = 6) and NP (n = 6), followed by bioinformatic analysis to identify targets that could be used in the future for EV-based diagnostic tests for preeclampsia. Some of the identified biomarkers were validated with real-time polymerase chain reactions. Results Our analysis identified a difference in the transcriptomic STB-EV cargo between PE and NP. We then identified and verified the differential expression of FLNB, COL17A1, SLC45A4, LEP, HTRA4, PAPP-A2, EBI3, HSD17B1, FSTL3, INHBA, SIGLEC6, and CGB3. Our analysis also identified interesting mechanistic processes via an in silico prediction of STB-EV-based mechanistic pathways. Conclusions In this study, using comprehensive profiling of differentially expressed/carried genes of three linked sample subtypes in PE, we identified potential biomarkers and mechanistic gene pathways that may be important in the pathophysiology of PE and could be further explored in future studies.
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Affiliation(s)
- Toluwalase Awoyemi
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Wei Zhang
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Maryam Rahbar
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Adam Cribbs
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Prasanna Logenthiran
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Shuhan Jiang
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Gavin Collett
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Ana Sofia Cerdeira
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Manu Vatish
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
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Vatish M, Powys VR, Cerdeira AS. Novel therapeutic and diagnostic approaches for preeclampsia. Curr Opin Nephrol Hypertens 2023; 32:124-133. [PMID: 36683536 DOI: 10.1097/mnh.0000000000000870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW This review will summarize recent findings relating to the diagnostic approach to preeclampsia and current avenues of research aimed at modifying the underlying disease process. RECENT FINDINGS Growing international consensus supports a broad preeclampsia definition that incorporates maternal end-organ and uteroplacental dysfunction. Recent evidence demonstrates that this definition better identifies women and babies at risk of adverse outcomes compared to the traditional definition of hypertension and proteinuria. Multiple studies have demonstrated the usefulness and cost-effectiveness of angiogenic biomarkers such as soluble fms-like tyrosine kinase-1 and placental growth factor as a clinical adjunct to diagnose and predict severity of preeclampsia associated outcomes. Current novel therapeutic approaches to preeclampsia target pathogenic pathways (e.g. antiangiogenesis) or downstream effects such as oxidative stress and nitric oxide. Recent findings relating to these promising candidates are discussed. Multicenter clinical trials are needed to evaluate their effectiveness and ability to improve fetal and maternal outcomes. SUMMARY We provide an updated framework of the current approaches to define and diagnose preeclampsia. Disease modifying therapies (in particular, targeting the angiogenic pathway) are being developed for the first time and promise to revolutionize the way we manage preeclampsia.
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Affiliation(s)
- Manu Vatish
- Nuffield Department of Women's Health and Reproductive Research, University of Oxford, Oxford
| | | | - Ana Sofia Cerdeira
- Nuffield Department of Women's Health and Reproductive Research, University of Oxford, Oxford
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Kifle MM, Dahal P, Vatish M, Cerdeira AS, Ohuma EO. The prognostic utility of soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PIGF) biomarkers for predicting preeclampsia: a secondary analysis of data from the INSPIRE trial. BMC Pregnancy Childbirth 2022; 22:520. [PMID: 35761268 PMCID: PMC9238141 DOI: 10.1186/s12884-022-04817-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 06/07/2022] [Indexed: 11/10/2022] Open
Abstract
Objective To compare the prognostic performance of biomarkers soluble fms-like tyrosine kinase-1 (sFlt-1), Placental Growth Factor (PIGF), and sFlt-1/PIGF ratio as continuous values or as a binary cut-off of 38 for predicting preeclampsia (PE) within 7 days. Design Secondary analysis of a randomised clinical trial. Setting Oxford University Hospitals, Oxford, United Kingdom (UK). Population Pregnant women between 24+0 to 37+0 weeks of gestation with a clinical suspicion of preeclampsia. Main outcome Onset of preeclampsia within 7 days of the initial biomarker test. Methods Logistic regression model for onset of preeclampsia using: (i) sFlt-1 (ii) PIGF, (iii) sFlt-1/PIGF ratio (continuous), and (iv) sFlt-1/PIGF ratio as a cut-off above or below 38. Results Of the total 370 women, 42 (11.3%) developed PE within 7 days of screening. Models with sFlt-1 and sFlt-1/PIGF ratio (continuous) had greater overall performance than models with PIGF or with sFlt-1/PIGF ratio as a cut-off at 38 (R2: sFlt-1 = 55%, PIGF = 38%, sFlt-1/PIGF ratio = 57%, sFlt-1/PIGF ratio as cut-off at 38 model = 46%). The discrimination performance was the highest in sFlt-1 and sFlt-1/PIGF ratio (continuous) (c-statistic, sFlt-1 = 0.94, sFlt-1/PIGF ratio (continuous) = 0.94) models compared to PIGF or sFlt-1/PIGF cut-off models (c-statistic, PIGF = 0.87, sFlt-1/PIGF cut-off = 0.89). Conclusion Models using continuous values of sFlt-1 only or sFlt-1/PIGF ratio had better predictive performance compared to a PIGF only or the model with sFlt-1/PIGF ratio as a cut-off at 38. Further studies based on a larger sample size are warranted to substantiate this finding.
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Affiliation(s)
- Meron M Kifle
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Prabin Dahal
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Manu Vatish
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Ana Sofia Cerdeira
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Eric O Ohuma
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK. .,Maternal, Adolescent, Reproductive and Child Health Centre, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
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Affiliation(s)
| | | | - Elena Plesca
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rebecca S Black
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Charlotte Frise
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Manu Vatish
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Ana Sofia Cerdeira
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.
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Cerdeira AS, O’Sullivan J, Ohuma EO, James T, Papageorghiou AT, Knight M, Vatish M. Ruling out preeclampsia in the next 4 weeks using a soluble fms-like tyrosine kinase 1/placental growth factor ratio ≤38: secondary analysis of the Interventional Study on Prediction of Preeclampsia/Eclampsia in Women With Suspected Preeclampsia. Am J Obstet Gynecol 2022; 226:443-445. [PMID: 34785177 DOI: 10.1016/j.ajog.2021.11.1345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/29/2021] [Accepted: 11/09/2021] [Indexed: 11/27/2022]
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Cerdeira AS, Ismail L, Moore N, George B, Majd HS. Retroperitoneal leiomyomatosis: a benign outcome of power morcellation with potentially serious consequences. Lancet 2022; 399:554. [PMID: 35123695 DOI: 10.1016/s0140-6736(22)00005-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/03/2021] [Accepted: 12/23/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Ana Sofia Cerdeira
- Department of Obstetrics and Gynaecology, Churchill Cancer Centre, Oxford University Hospital, NHS Foundation Trust, Oxford, UK; Nuffield Department of Women's and Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - Lamiese Ismail
- Department of Obstetrics and Gynaecology, Churchill Cancer Centre, Oxford University Hospital, NHS Foundation Trust, Oxford, UK
| | - Niall Moore
- Department of Radiology, Churchill Cancer Centre, Oxford University Hospital, NHS Foundation Trust, Oxford, UK
| | - Bruce George
- John Radcliffe Hospital, Department of Colorectal Surgery, Churchill Cancer Centre, Oxford University Hospital, NHS Foundation Trust, Oxford, UK
| | - Hooman Soleymani Majd
- Department of Gynaecological Oncology, Churchill Cancer Centre, Oxford University Hospital, NHS Foundation Trust, Oxford, UK; Nuffield Department of Women's and Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK.
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Cerdeira AS, James T, Vatish M. The diagnostic value of angiogenic and antiangiogenic factors in differential diagnosis of preeclampsia. Am J Obstet Gynecol 2022; 226:156. [PMID: 34481777 DOI: 10.1016/j.ajog.2021.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/29/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Ana Sofia Cerdeira
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Level 3, Women's Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, United Kingdom; Department of Obstetrics and Gynecology, Women's Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
| | - Tim James
- Department of Biochemistry, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Manu Vatish
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Level 3, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom; Department of Obstetrics and Gynecology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Cerdeira AS, Rana S, Karumanchi SA. Is Prolonging Gestation in Preeclampsia For Better or Worse in Preventing Cardiovascular Disease? Hypertension 2021; 78:1395-1397. [PMID: 34644174 DOI: 10.1161/hypertensionaha.121.18013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ana Sofia Cerdeira
- Department of Obstetrics and Gynecology, John Radcliffe Hospital, United Kingdom (A.S.C.).,Nuffield Department of Women's & Reproductive Health, University of Oxford, United Kingdom (A.S.C.)
| | - Sarosh Rana
- Division of Maternal-Fetal Medicine and Department of Obstetrics and Gynecology, University of Chicago, IL (S.R.)
| | - S Ananth Karumanchi
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (S.A.K.)
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Cooke W, Jiang P, Ji L, Jones G, Zhang W, Kandzija N, Cerdeira AS, Lo D, Redman C, Vatish M. 5’-tRNA-halves: circulating syncytiotrophoblast RNA signals in early-onset preeclampsia. Placenta 2021. [DOI: 10.1016/j.placenta.2021.07.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cerdeira AS, O'Sullivan J, Ohuma EO, James T, Papageorghiou AT, Knight M, Vatish M. Performance of soluble fms-like tyrosine kinase-1-to-placental growth factor ratio of ≥85 for ruling in preeclampsia within 4 weeks. Am J Obstet Gynecol 2021; 224:322-323. [PMID: 33207235 DOI: 10.1016/j.ajog.2020.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 11/05/2020] [Accepted: 11/10/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Ana Sofia Cerdeira
- Nuffield Department of Women's Health and Reproductive Research, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Joe O'Sullivan
- Merton College, University of Oxford, Oxford, United Kingdom
| | - Eric O Ohuma
- Centre for Statistics in Medicine, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Tim James
- Department of Clinical Biochemistry, Oxford University Hospitals, National Health Service Foundation Trust, Oxford, United Kingdom
| | - Aris T Papageorghiou
- Fetal Medicine Unit, St. George's Hospital, St. George's, University of London, London, United Kingdom
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Manu Vatish
- Nuffield Department of Women's Health and Reproductive Research, University of Oxford, Level 3, Women's Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, United Kingdom.
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Yamazaki T, Cerdeira AS, Agrawal S, Koh I, Sugimoto J, Vatish M, Kudo Y. Predictive Accuracy of Soluble FMS-Like Tyrosine Kinase-1/Placental Growth Factor Ratio for Preeclampsia in Japan: A Systematic Review. Hypertens Res Pregnancy 2021. [DOI: 10.14390/jsshp.hrp2020-012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tomomi Yamazaki
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Hiroshima University
- equal contribution
| | - Ana Sofia Cerdeira
- Nuffield Department of Women’s Health and Reproductive Research, University of Oxford, Level 3, Women’s Center, John Radcliffe Oxford University Hospital Oxford
- equal contribution
| | - Swati Agrawal
- Department of Maternal-Fetal Medicine, University of Toronto
| | - Iemasa Koh
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Hiroshima University
| | - Jun Sugimoto
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Hiroshima University
| | - Manu Vatish
- Nuffield Department of Women’s Health and Reproductive Research, University of Oxford, Level 3, Women’s Center, John Radcliffe Oxford University Hospital Oxford
- equal contribution
| | - Yoshiki Kudo
- Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Hiroshima University
- equal contribution
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Cerdeira AS, Vatish M, Lecarpentier E. One Step Closer to a Cure for Preeclampsia?: Boosting the Natural Affinity of VEGF (Vascular Endothelial Growth Factor) to sFlt (Soluble fms-Like Tyrosine Kinase)-1. Hypertension 2020; 76:1081-1083. [PMID: 32903106 DOI: 10.1161/hypertensionaha.120.15112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ana Sofia Cerdeira
- From the Nuffield Department of Women's & Reproductive Health University of Oxford, United Kingdom (A.S.C., M.V.)
| | - Manu Vatish
- From the Nuffield Department of Women's & Reproductive Health University of Oxford, United Kingdom (A.S.C., M.V.)
| | - Edouard Lecarpentier
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal de Creteil, University Paris Est Créteil, France (E.L.)
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Smith I, Cerdeira AS, Thomas C, Vatish M, James TJ. Specimen Requirements for Preeclampsia Markers. J Appl Lab Med 2020; 5:605-607. [PMID: 32445352 DOI: 10.1093/jalm/jfaa010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ian Smith
- Department of Clinical Biochemistry, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ana Sofia Cerdeira
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Claire Thomas
- Department of Clinical Biochemistry, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Manu Vatish
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Tim J James
- Department of Clinical Biochemistry, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Cerdeira AS, Kandzija N, Pargmae P, Tome M, Zhang W, Cooke WR, Agrawal S, James T, Redman C, Vatish M. In vivo evidence of significant placental growth factor release by normal pregnancy placentas. Sci Rep 2020; 10:132. [PMID: 31924819 PMCID: PMC6954247 DOI: 10.1038/s41598-019-56906-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/26/2019] [Indexed: 12/23/2022] Open
Abstract
Placental growth factor (PlGF) is an angiogenic factor identified in the maternal circulation, and a key biomarker for the diagnosis and management of placental disorders. Furthermore, enhancing the PlGF pathway is regarded as a promising therapy for preeclampsia. The source of PlGF is still controversial with some believing it to be placental in origin while others refute this. To explore the source of PlGF, we undertook a prospective study enrolling normal pregnant women undergoing elective caesarean section. The level of PlGF was estimated in 17 paired serum samples from the uterine vein (ipsilateral or contralateral to the placental insertion) during caesarean section and from a peripheral vein on the same day and second day post-partum. PlGF levels were higher in the uterine than in the peripheral vein with a median difference of 52.2 (IQR 20.1-85.8) pg/mL p = 0.0006. The difference when the sampled uterine vein was ipsilateral to the placenta was 54.8 (IQR 37.1-88.4) pg/mL (n = 11) and 23.7 (IQR -11; 70.5) pg/mL (n = 6) when the sample was contralateral. Moreover, PlGF levels fell by 83% on day 1-2 post-partum. Our findings strongly support the primary source of PlGF to be placental. These findings will be of value in designing target therapies such as PlGF overexpression, to cure placental disorders during pregnancy.
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Affiliation(s)
- Ana Sofia Cerdeira
- Nuffield Department of Women's Health and Reproductive Research, University of Oxford, Level 3, Women's Center, John Radcliffe Oxford University Hospital, Oxford, OX3 9DU, United Kingdom.,Department of Obstetrics and Gynecology, Women's Center, John Radcliffe Oxford University Hospital, Oxford, OX3 9DU, United Kingdom
| | - Neva Kandzija
- Nuffield Department of Women's Health and Reproductive Research, University of Oxford, Level 3, Women's Center, John Radcliffe Oxford University Hospital, Oxford, OX3 9DU, United Kingdom
| | - Pille Pargmae
- Department of Obstetrics and Gynecology, Women's Center, John Radcliffe Oxford University Hospital, Oxford, OX3 9DU, United Kingdom
| | - Mariana Tome
- Department of Obstetrics and Gynecology, Women's Center, John Radcliffe Oxford University Hospital, Oxford, OX3 9DU, United Kingdom
| | - Wei Zhang
- Nuffield Department of Women's Health and Reproductive Research, University of Oxford, Level 3, Women's Center, John Radcliffe Oxford University Hospital, Oxford, OX3 9DU, United Kingdom
| | - William R Cooke
- Nuffield Department of Women's Health and Reproductive Research, University of Oxford, Level 3, Women's Center, John Radcliffe Oxford University Hospital, Oxford, OX3 9DU, United Kingdom.,Department of Obstetrics and Gynecology, Women's Center, John Radcliffe Oxford University Hospital, Oxford, OX3 9DU, United Kingdom
| | | | - Tim James
- Department of Biochemistry, John Radcliffe Oxford University Hospital, Oxford, OX3 9DU, United Kingdom
| | - Christopher Redman
- Nuffield Department of Women's Health and Reproductive Research, University of Oxford, Level 3, Women's Center, John Radcliffe Oxford University Hospital, Oxford, OX3 9DU, United Kingdom
| | - Manu Vatish
- Nuffield Department of Women's Health and Reproductive Research, University of Oxford, Level 3, Women's Center, John Radcliffe Oxford University Hospital, Oxford, OX3 9DU, United Kingdom. .,Department of Obstetrics and Gynecology, Women's Center, John Radcliffe Oxford University Hospital, Oxford, OX3 9DU, United Kingdom.
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Cerdeira AS, Tome M, Moore N, Lim L. Seeing red degeneration in uterine fibroids in pregnancy: proceed with caution. Lancet 2019; 394:e37. [PMID: 31777390 DOI: 10.1016/s0140-6736(19)32322-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/08/2019] [Accepted: 10/04/2019] [Indexed: 11/23/2022]
Affiliation(s)
- Ana Sofia Cerdeira
- Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford University Hospital, NHS Foundation Trust, Oxford, UK; Nuffield Department of Women's Health and Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK.
| | - Mariana Tome
- Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford University Hospital, NHS Foundation Trust, Oxford, UK
| | - Niall Moore
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospital, NHS Foundation Trust, Oxford, UK
| | - Lee Lim
- Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford University Hospital, NHS Foundation Trust, Oxford, UK
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18
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Gill M, Motta-Mejia C, Kandzija N, Cooke W, Zhang W, Cerdeira AS, Bastie C, Redman C, Vatish M. Placental Syncytiotrophoblast-Derived Extracellular Vesicles Carry Active NEP (Neprilysin) and Are Increased in Preeclampsia. Hypertension 2019; 73:1112-1119. [PMID: 30929513 DOI: 10.1161/hypertensionaha.119.12707] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
NEP (neprilysin) is a widely expressed membrane-bound metalloprotease, which binds and cleaves a variety of peptides including vasodilators, natriuretics, and diuretics. Higher levels of NEP result in hypertension-a cardinal feature of the placental disease preeclampsia. Syncytiotrophoblast-derived extracellular vesicles (EVs), comprising microvesicles and exosomes, are released into the peripheral circulation in pregnancy and are postulated as a key mechanism coupling placental dysfunction and maternal phenotype in preeclampsia. We aimed to determine whether higher levels of active NEP are found in syncytiotrophoblast-derived EVs in preeclampsia compared with normal pregnancy. Using immunostaining and Western blotting, we first demonstrated that NEP levels are greater not only in preeclampsia placental tissue but also in syncytiotrophoblast-derived microvesicles and exosomes isolated from preeclampsia placentas ( P<0.05, n=5). We confirmed placental origin using antibody-coated magnetic beads to isolate NEP-bound vesicles, finding that they stain for placental alkaline phosphatase. NEP on syncytiotrophoblast-derived EVs is active and inhibited by thiorphan ( P<0.01, n=3; specific inhibitor). Syncytiotrophoblast-derived microvesicles, isolated from peripheral plasma, demonstrated higher NEP expression in preeclampsia using flow cytometry ( P<0.05, n=8). We isolated plasma exosomes using size-exclusion chromatography and showed greater NEP activity in preeclampsia ( P<0.05, n=8). These findings show that the placenta releases active NEP into the maternal circulation on syncytiotrophoblast-derived EVs, at significantly greater levels in preeclampsia. NEP has pathological roles in hypertension, heart failure, and amyloid deposition, all of which are features of preeclampsia. Circulating syncytiotrophoblast-derived EV-bound NEP thus may contribute to the pathogenesis of this disease.
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Affiliation(s)
- Manjot Gill
- From the Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom (M.G., C.M.-M., N.K., W.C., W.Z., A.S.C., C.R., M.V.)
| | - Carolina Motta-Mejia
- From the Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom (M.G., C.M.-M., N.K., W.C., W.Z., A.S.C., C.R., M.V.)
| | - Neva Kandzija
- From the Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom (M.G., C.M.-M., N.K., W.C., W.Z., A.S.C., C.R., M.V.)
| | - William Cooke
- From the Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom (M.G., C.M.-M., N.K., W.C., W.Z., A.S.C., C.R., M.V.)
| | - Wei Zhang
- From the Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom (M.G., C.M.-M., N.K., W.C., W.Z., A.S.C., C.R., M.V.)
| | - Ana Sofia Cerdeira
- From the Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom (M.G., C.M.-M., N.K., W.C., W.Z., A.S.C., C.R., M.V.)
| | - Claire Bastie
- Department of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom (C.B.)
| | - Christopher Redman
- From the Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom (M.G., C.M.-M., N.K., W.C., W.Z., A.S.C., C.R., M.V.)
| | - Manu Vatish
- From the Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom (M.G., C.M.-M., N.K., W.C., W.Z., A.S.C., C.R., M.V.)
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Affiliation(s)
- Ana Sofia Cerdeira
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Manu Vatish
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
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20
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Agrawal S, Shinar S, Cerdeira AS, Redman C, Vatish M. Predictive Performance of PlGF (Placental Growth Factor) for Screening Preeclampsia in Asymptomatic Women: A Systematic Review and Meta-Analysis. Hypertension 2019; 74:1124-1135. [PMID: 31522621 DOI: 10.1161/hypertensionaha.119.13360] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Preeclampsia is a systemic syndrome that seems to originate from the placenta and is associated with an imbalance between angiogenic factors in the maternal circulation. One of the well-studied and widely used factors is PlGF (placental growth factor), the levels of which drop in women destined to develop preeclampsia. This drop is known to precede the development of actual signs and symptoms of preeclampsia, thus proving to be a useful screening tool in predicting the disease. The literature varies widely in terms of the clinical usefulness of the test. We conducted a meta-analysis to study the predictive accuracy of PlGF in asymptomatic women. Our analysis included 40 studies with 3189 cases of preeclampsia and 89 498 controls. The overall predictive odds ratio of the test was 9 (6-13). Subgroup analysis evaluating various PlGF thresholds demonstrated that the predictive values were highest for PlGF levels between 80 and 120 pg/mL with a high predictive odds ratio of 25 (7-88), a sensitivity of 0.78 (95% CI, 0.67-0.86), a specificity of 0.88 (95% CI, 0.75-0.95), a positive likelihood ratio of 6.3 (95% CI, 2.7-14.7), and a negative likelihood ratio of 0.26 (95% CI, 0.16-0.42). Additionally, the accuracy was higher when the test was performed after 14 weeks of gestation (OR, 10 [7-15]) and for prediction of early onset preeclampsia (OR, 18 [9-37]). We conclude that PlGF is a useful screening tool to predict preeclampsia. Nonetheless, its utility should be judged with caution and randomized controlled trials are warranted to explore if its implementation improves perinatal outcomes in asymptomatic women.
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Affiliation(s)
- Swati Agrawal
- From the Department of Maternal-Fetal Medicine, University of Toronto, Canada (S.A., S.S.)
| | - Shiri Shinar
- From the Department of Maternal-Fetal Medicine, University of Toronto, Canada (S.A., S.S.)
| | - Ana Sofia Cerdeira
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, United Kingdom (A.S.C., C.R., M.V.)
| | - Christopher Redman
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, United Kingdom (A.S.C., C.R., M.V.)
| | - Manu Vatish
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, United Kingdom (A.S.C., C.R., M.V.)
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Cerdeira AS, O'Sullivan J, Ohuma EO, Harrington D, Szafranski P, Black R, Mackillop L, Impey L, Greenwood C, James T, Smith I, Papageorghiou AT, Knight M, Vatish M. Randomized Interventional Study on Prediction of Preeclampsia/Eclampsia in Women With Suspected Preeclampsia: INSPIRE. Hypertension 2019; 74:983-990. [PMID: 31401877 PMCID: PMC6756298 DOI: 10.1161/hypertensionaha.119.12739] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Supplemental Digital Content is available in the text. The ratio of maternal serum sFlt-1 (soluble fms-like tyrosine kinase 1) to PlGF (placental growth factor) has been used retrospectively to rule out the occurrence of preeclampsia, a pregnancy hypertensive disorder, within 7 days in women presenting with clinical suspicion of preeclampsia. A prospective, interventional, parallel-group, randomized clinical trial evaluated the use of sFlt-1/PlGF ratio in women presenting with suspected preeclampsia. Women were assigned to reveal (sFlt-1/PlGF result known to clinicians) or nonreveal (result unknown) arms. A ratio cutoff of 38 was used to define low (≤38) and elevated risk (>38) of developing the condition in the subsequent week. The primary end point was hospitalization within 24 hours of the test. Secondary end points were development of preeclampsia and other adverse maternal-fetal outcomes. We recruited 370 women (186 reveal versus 184 nonreveal). Preeclampsia occurred in 85 women (23%). The number of admissions was not significantly different between groups (n=48 nonreveal versus n=60 reveal; P=0.192). The reveal trial arm admitted 100% of the cases that developed preeclampsia within 7 days, whereas the nonreveal admitted 83% (P=0.038). Use of the test yielded a sensitivity of 100% (95% CI, 85.8–100) and a negative predictive value of 100% (95% CI, 97.1–100) compared with a sensitivity of 83.3 (95% CI, 58.6–96.4) and negative predictive value of 97.8 (95% CI, 93.7–99.5) with clinical practice alone. Use of the sFlt-1/PlGF ratio significantly improved clinical precision without changing the admission rate.
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Affiliation(s)
- Ana Sofia Cerdeira
- From the Nuffield Department of Women's Health and Reproductive Research (A.S.C., P.S., M.V.), University of Oxford, United Kingdom
| | - Joe O'Sullivan
- Merton College (J.O.), University of Oxford, United Kingdom
| | - Eric O Ohuma
- Centre for Statistics in Medicine, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (E.O.O.), University of Oxford, United Kingdom.,Department of Obstetrics and Gynaecology, University of Toronto, Canada (E.O.O.)
| | - Deborah Harrington
- Department of Obstetrics (D.H., R.B., L.M., L.I., C.G.), Oxford University Hospitals, NHS Foundation Trust, United Kingdom
| | - Pawel Szafranski
- From the Nuffield Department of Women's Health and Reproductive Research (A.S.C., P.S., M.V.), University of Oxford, United Kingdom
| | - Rebecca Black
- Department of Obstetrics (D.H., R.B., L.M., L.I., C.G.), Oxford University Hospitals, NHS Foundation Trust, United Kingdom
| | - Lucy Mackillop
- Department of Obstetrics (D.H., R.B., L.M., L.I., C.G.), Oxford University Hospitals, NHS Foundation Trust, United Kingdom
| | - Lawrence Impey
- Department of Obstetrics (D.H., R.B., L.M., L.I., C.G.), Oxford University Hospitals, NHS Foundation Trust, United Kingdom
| | - Catherine Greenwood
- Department of Obstetrics (D.H., R.B., L.M., L.I., C.G.), Oxford University Hospitals, NHS Foundation Trust, United Kingdom
| | - Tim James
- Department of Clinical Biochemistry (T.J., I.S.), Oxford University Hospitals, NHS Foundation Trust, United Kingdom
| | - Ian Smith
- Department of Clinical Biochemistry (T.J., I.S.), Oxford University Hospitals, NHS Foundation Trust, United Kingdom
| | - Aris T Papageorghiou
- Fetal Medicine Unit, St George's Hospital, St George's University of London, United Kingdom (A.T.P.)
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health (M.K.), University of Oxford, United Kingdom
| | - Manu Vatish
- From the Nuffield Department of Women's Health and Reproductive Research (A.S.C., P.S., M.V.), University of Oxford, United Kingdom
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22
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Cooke WR, Cribbs A, Zhang W, Kandzija N, Motta-Mejia C, Dombi E, Ri R, Cerdeira AS, Redman C, Vatish M. Maternal circulating syncytiotrophoblast-derived extracellular vesicles contain biologically active 5'-tRNA halves. Biochem Biophys Res Commun 2019; 518:107-113. [PMID: 31405560 DOI: 10.1016/j.bbrc.2019.08.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
The placenta releases syncytiotrophoblast-derived extracellular vesicles (STB-EV) into the maternal circulation throughout gestation. STB-EV dependent signalling is believed to contribute to the widespread maternal adaptive physiological changes seen in pregnancy. Transfer RNA (tRNA) halves have been identified in vesicles released from other human and murine organ systems, which alter gene expression in target cells. Here, we characterise tRNA-half expression in STB-EV and demonstrate biological activity of a highly abundant tRNA-half. Short RNA from ex-vivo, dual-lobe placental perfusion STB-EV was sequenced, showing that most (>95%) comprised tRNA species. Whole placental tissue contained <50% tRNA species, suggesting selective packaging and export of tRNA into STB-EV. Most tRNA within STB-EV were 5'-tRNA halves cleaved at 30-32 nucleotides. The pattern of tRNA expression differed depending on the size/origin of the STB-EV; this was confirmed by qPCR. Protein synthesis was suppressed in human fibroblasts when they were cultured with a 5'-tRNA half identified from STB-EV sequencing. This study is the first to evaluate tRNA species in STB-EV. The presence of biologically active 5'-tRNA halves, specific to a vesicular origin, suggests a novel mechanism for maternal-fetal signalling in normal pregnancy.
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Affiliation(s)
- William R Cooke
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - Adam Cribbs
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK
| | - Wei Zhang
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - Neva Kandzija
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - Carolina Motta-Mejia
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - Eszter Dombi
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - Rannya Ri
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - Ana Sofia Cerdeira
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - Christopher Redman
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - Manu Vatish
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK.
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Kandzija N, Zhang W, Motta-Mejia C, Mhlomi V, McGowan-Downey J, James T, Cerdeira AS, Tannetta D, Sargent I, Redman CW, Bastie CC, Vatish M. Placental extracellular vesicles express active dipeptidyl peptidase IV; levels are increased in gestational diabetes mellitus. J Extracell Vesicles 2019; 8:1617000. [PMID: 31164969 PMCID: PMC6534242 DOI: 10.1080/20013078.2019.1617000] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/30/2019] [Accepted: 05/02/2019] [Indexed: 01/09/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy and is characterized by insulin resistance and decreased circulating glucagon-like peptide-1 (GLP-1). GDM resolves rapidly after delivery implicating the placenta in the disease. This study examines the biological functions that cause this pathology. The placenta releases syncytiotrophoblast-derived extracellular vesicles (STB-EVs) into the maternal circulation, which is enhanced in GDM. Dipeptidyl peptidase IV (DPPIV) is known to play a role in type 2 diabetes by breaking down GLP-1, which in turn regulates glucose-dependent insulin secretion. STB-EVs from control and GDM women were analysed. We show that normal human placenta releases DPPIV-positive STB-EVs and that they are higher in uterine than paired peripheral blood, confirming placental origin. DPPIV-bound STB-EVs from normal perfused placentae are dose dependently inhibited with vildagliptin. DPPIV-bound STB-EVs from perfused placentae are able to breakdown GLP-1 in vitro. STB-EVs from GDM perfused placentae show greater DPPIV activity. Importantly, DPPIV-bound STB-EVs increase eightfold in the circulation of women with GDM. This is the first report of STB-EVs carrying a biologically active molecule that has the potential to regulate maternal insulin secretion.
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Affiliation(s)
- Neva Kandzija
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Wei Zhang
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Carolina Motta-Mejia
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.,College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - Vuyane Mhlomi
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | | | - Tim James
- Department of Clinical Biochemistry, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Ana Sofia Cerdeira
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Dionne Tannetta
- Department of Food and Nutritional Sciences, University of Reading, Reading, UK
| | - Ian Sargent
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Christopher W Redman
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Claire C Bastie
- Division of Biomedical Sciences, Warwick Medical School, Coventry, UK
| | - Manu Vatish
- Department of Clinical Biochemistry, Oxford University Hospitals NHS Trust, Oxford, UK
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24
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Cerdeira AS, Kandzija N, Pargmae P, Cooke W, James T, Redman C, Vatish M. Circulating soluble fms-like tyrosine kinase-1 is placentally derived in normal pregnancy: First in vivo evidence. Pregnancy Hypertens 2019; 16:145-147. [DOI: 10.1016/j.preghy.2019.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/27/2019] [Accepted: 03/29/2019] [Indexed: 10/27/2022]
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Cerdeira AS, Thadhani RI. Predicting the Future Is Not Difficult. Hypertension 2018; 73:47-48. [PMID: 30571566 DOI: 10.1161/hypertensionaha.118.11931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ana Sofia Cerdeira
- Nuffield Department of Women's Health and Reproductive Research, University of Oxford, United Kingdom (A.S.C.)
| | - Ravi I Thadhani
- Departments of Biomedical Science and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (R.I.T.)
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26
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Agrawal S, Cerdeira AS, Redman C, Vatish M. Meta-Analysis and Systematic Review to Assess the Role of Soluble FMS-Like Tyrosine Kinase-1 and Placenta Growth Factor Ratio in Prediction of Preeclampsia. Hypertension 2018; 71:306-316. [DOI: 10.1161/hypertensionaha.117.10182] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/11/2017] [Accepted: 11/13/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Swati Agrawal
- From the Nuffield Department of Obstetrics and Gynaecology, University of Oxford, United Kingdom
| | - Ana Sofia Cerdeira
- From the Nuffield Department of Obstetrics and Gynaecology, University of Oxford, United Kingdom
| | - Christopher Redman
- From the Nuffield Department of Obstetrics and Gynaecology, University of Oxford, United Kingdom
| | - Manu Vatish
- From the Nuffield Department of Obstetrics and Gynaecology, University of Oxford, United Kingdom
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Abstract
Pre‐eclampsia is a complex disease with significant maternal and fetal morbidity and mortality. Its syndromic nature makes diagnosis and management difficult. The field is rapidly evolving with the definition of pre‐eclampsia being challenged by some organisations, with proteinuria no longer being essential in the presence of other features. In the last decade, angiogenic factors, in particular soluble fms‐like tyrosine kinase 1 (sFlt‐1), have emerged as important molecules in the pathogenesis of pre‐eclampsia. Here we review the most recent evidence regarding the potential of these factors as biomarkers and therapeutic targets for pre‐eclampsia. Tweetable abstract A review of angiogenic factors, sFlt‐1 and PlGF, in the diagnosis, prediction and management of pre‐eclampsia. A review of angiogenic factors, sFlt‐1 and PlGF, in the diagnosis, prediction and management of pre‐eclampsia.
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Affiliation(s)
- A S Cerdeira
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
| | - S Agrawal
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
| | - A C Staff
- Division of Obstetrics and Gynaecology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - C W Redman
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
| | - M Vatish
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
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28
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Allan DSJ, Cerdeira AS, Ranjan A, Kirkham CL, Aguilar OA, Tanaka M, Childs RW, Dunbar CE, Strominger JL, Kopcow HD, Carlyle JR. Transcriptome analysis reveals similarities between human blood CD3 - CD56 bright cells and mouse CD127 + innate lymphoid cells. Sci Rep 2017; 7:3501. [PMID: 28615725 PMCID: PMC5471261 DOI: 10.1038/s41598-017-03256-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 04/05/2017] [Indexed: 12/14/2022] Open
Abstract
For many years, human peripheral blood natural killer (NK) cells have been divided into functionally distinct CD3− CD56bright CD16− and CD3− CD56dim CD16+ subsets. Recently, several groups of innate lymphoid cells (ILC), distinct from NK cells in development and function, have been defined in mouse. A signature of genes present in mouse ILC except NK cells, defined by Immunological Genome Project studies, is significantly over-represented in human CD56bright cells, by gene set enrichment analysis. Conversely, the signature genes of mouse NK cells are enriched in human CD56dim cells. Correlations are based upon large differences in expression of a few key genes. CD56bright cells show preferential expression of ILC-associated IL7R (CD127), TNFSF10 (TRAIL), KIT (CD117), IL2RA (CD25), CD27, CXCR3, DPP4 (CD26), GPR183, and MHC class II transcripts and proteins. This could indicate an ontological relationship between human CD56bright cells and mouse CD127+ ILC, or conserved networks of transcriptional regulation. In line with the latter hypothesis, among transcription factors known to impact ILC or NK cell development, GATA3, TCF7 (TCF-1), AHR, SOX4, RUNX2, and ZEB1 transcript levels are higher in CD56bright cells, while IKZF3 (AIOLOS), TBX21 (T-bet), NFIL3 (E4BP4), ZEB2, PRDM1 (BLIMP1), and RORA mRNA levels are higher in CD56dim cells.
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Affiliation(s)
- David S J Allan
- Department of Immunology, University of Toronto, and Sunnybrook Research Institute, Toronto, Ontario, Canada. .,Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
| | - Ana Sofia Cerdeira
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Oxford, UK
| | - Anuisa Ranjan
- Department of Immunology, University of Toronto, and Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Christina L Kirkham
- Department of Immunology, University of Toronto, and Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Oscar A Aguilar
- Department of Immunology, University of Toronto, and Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Miho Tanaka
- Department of Immunology, University of Toronto, and Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Richard W Childs
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Cynthia E Dunbar
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jack L Strominger
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Hernan D Kopcow
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - James R Carlyle
- Department of Immunology, University of Toronto, and Sunnybrook Research Institute, Toronto, Ontario, Canada.
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Motta-Mejia C, Kandzija N, Zhang W, Mhlomi V, Cerdeira AS, Burdujan A, Tannetta D, Dragovic R, Sargent IL, Redman CW, Kishore U, Vatish M. Placental Vesicles Carry Active Endothelial Nitric Oxide Synthase and Their Activity is Reduced in Preeclampsia. Hypertension 2017; 70:372-381. [PMID: 28607124 PMCID: PMC5507817 DOI: 10.1161/hypertensionaha.117.09321] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 03/14/2017] [Accepted: 05/22/2017] [Indexed: 12/21/2022]
Abstract
Supplemental Digital Content is available in the text. Preeclampsia, a multisystem hypertensive disorder of pregnancy, is associated with increased systemic vascular resistance. Placentae from patients with preeclampsia have reduced levels of endothelial nitric oxide synthase (eNOS) and, thus, less nitric oxide (NO). Syncytiotrophoblast extracellular vesicles (STBEV), comprising microvesicles (STBMV) and exosomes, carry signals from the syncytiotrophoblast to the mother. We hypothesized that STBEV-bound eNOS (STBEV-eNOS), capable of producing NO, are released into the maternal circulation. Dual-lobe ex vivo placental perfusion and differential centrifugation was used to isolate STBEV from preeclampsia (n=8) and normal pregnancies (NP; n=11). Plasma samples of gestational age–matched preeclampsia and NP (n=6) were used to isolate circulating STBMV. STBEV expressed placental alkaline phosphatase, confirming placental origin. STBEV coexpressed eNOS, but not inducible nitric oxide synthase, confirmed using Western blot, flow cytometry, and immunodepletion. STBEV-eNOS produced NO, which was significantly inhibited by N G-nitro-l-arginine methyl ester (eNOS inhibitor; P<0.05) but not by N-(3-(aminomethyl) bezyl) acetamidine) (inducible nitric oxide synthase inhibitor). STBEV-eNOS catalytic activity was confirmed by visualizing eNOS dimerization. STBEV-eNOS was more abundant in uterine vein compared with peripheral blood, indicating placental origin. STBEV isolated from preeclampsia-perfused placentae had lower levels of STBEV-eNOS (STBMV; P<0.05) and overall lower NO activity (STBMV, not significant; syncytiotrophoblast extracellular exosomes, P<0.05) compared with those from NP. Circulating plasma STBMV from preeclampsia women had lower STBEV-eNOS expression compared with that from NP women (P<0.01). This is the first observation of functional eNOS expressed on STBEV from NP and preeclampsia placentae, as well as in plasma. The lower STBEV-eNOS NO production seen in preeclampsia may contribute to the decreased NO bioavailability in this disease.
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Affiliation(s)
- Carolina Motta-Mejia
- From the Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, United Kingdom (C.M.-M., N.K., W.Z., V.M., A.S.C., A.B., R.D., I.L.S., C.W.R., M.V.); Biosciences, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom (C.M.-M., U.K.); and Department of Food and Nutritional Sciences, University of Reading, United Kingdom (D.T.)
| | - Neva Kandzija
- From the Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, United Kingdom (C.M.-M., N.K., W.Z., V.M., A.S.C., A.B., R.D., I.L.S., C.W.R., M.V.); Biosciences, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom (C.M.-M., U.K.); and Department of Food and Nutritional Sciences, University of Reading, United Kingdom (D.T.)
| | - Wei Zhang
- From the Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, United Kingdom (C.M.-M., N.K., W.Z., V.M., A.S.C., A.B., R.D., I.L.S., C.W.R., M.V.); Biosciences, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom (C.M.-M., U.K.); and Department of Food and Nutritional Sciences, University of Reading, United Kingdom (D.T.)
| | - Vuyane Mhlomi
- From the Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, United Kingdom (C.M.-M., N.K., W.Z., V.M., A.S.C., A.B., R.D., I.L.S., C.W.R., M.V.); Biosciences, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom (C.M.-M., U.K.); and Department of Food and Nutritional Sciences, University of Reading, United Kingdom (D.T.)
| | - Ana Sofia Cerdeira
- From the Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, United Kingdom (C.M.-M., N.K., W.Z., V.M., A.S.C., A.B., R.D., I.L.S., C.W.R., M.V.); Biosciences, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom (C.M.-M., U.K.); and Department of Food and Nutritional Sciences, University of Reading, United Kingdom (D.T.)
| | - Alexandra Burdujan
- From the Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, United Kingdom (C.M.-M., N.K., W.Z., V.M., A.S.C., A.B., R.D., I.L.S., C.W.R., M.V.); Biosciences, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom (C.M.-M., U.K.); and Department of Food and Nutritional Sciences, University of Reading, United Kingdom (D.T.)
| | - Dionne Tannetta
- From the Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, United Kingdom (C.M.-M., N.K., W.Z., V.M., A.S.C., A.B., R.D., I.L.S., C.W.R., M.V.); Biosciences, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom (C.M.-M., U.K.); and Department of Food and Nutritional Sciences, University of Reading, United Kingdom (D.T.)
| | - Rebecca Dragovic
- From the Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, United Kingdom (C.M.-M., N.K., W.Z., V.M., A.S.C., A.B., R.D., I.L.S., C.W.R., M.V.); Biosciences, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom (C.M.-M., U.K.); and Department of Food and Nutritional Sciences, University of Reading, United Kingdom (D.T.)
| | - Ian L Sargent
- From the Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, United Kingdom (C.M.-M., N.K., W.Z., V.M., A.S.C., A.B., R.D., I.L.S., C.W.R., M.V.); Biosciences, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom (C.M.-M., U.K.); and Department of Food and Nutritional Sciences, University of Reading, United Kingdom (D.T.)
| | - Christopher W Redman
- From the Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, United Kingdom (C.M.-M., N.K., W.Z., V.M., A.S.C., A.B., R.D., I.L.S., C.W.R., M.V.); Biosciences, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom (C.M.-M., U.K.); and Department of Food and Nutritional Sciences, University of Reading, United Kingdom (D.T.)
| | - Uday Kishore
- From the Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, United Kingdom (C.M.-M., N.K., W.Z., V.M., A.S.C., A.B., R.D., I.L.S., C.W.R., M.V.); Biosciences, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom (C.M.-M., U.K.); and Department of Food and Nutritional Sciences, University of Reading, United Kingdom (D.T.)
| | - Manu Vatish
- From the Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, United Kingdom (C.M.-M., N.K., W.Z., V.M., A.S.C., A.B., R.D., I.L.S., C.W.R., M.V.); Biosciences, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom (C.M.-M., U.K.); and Department of Food and Nutritional Sciences, University of Reading, United Kingdom (D.T.).
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Cavalli RC, Cerdeira AS, Pernicone E, Korkes HA, Burke SD, Rajakumar A, Thadhani RI, Roberts DJ, Bhasin M, Karumanchi SA, Kopcow HD. Induced Human Decidual NK-Like Cells Improve Utero-Placental Perfusion in Mice. PLoS One 2016; 11:e0164353. [PMID: 27736914 PMCID: PMC5063315 DOI: 10.1371/journal.pone.0164353] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 09/23/2016] [Indexed: 12/21/2022] Open
Abstract
Decidual NK (dNK) cells, a distinct type of NK cell, are thought to regulate uterine spiral artery remodeling, a process that allows for increased blood delivery to the fetal-placental unit. Impairment of uterine spiral artery remodeling is associated with decreased placental perfusion, increased uterine artery resistance, and obstetric complications such as preeclampsia and intrauterine growth restriction. Ex vivo manipulation of human peripheral blood NK (pNK) cells by a combination of hypoxia, TGFß-1 and 5-aza-2'-deoxycytidine yields cells with phenotypic and in vitro functional similarities to dNK cells, called idNK cells. Here, gene expression profiling shows that CD56Bright idNK cells derived ex vivo from human pNK cells, and to a lesser extent CD56Dim idNK cells, are enriched in the gene expression signature that distinguishes dNK cells from pNK cells. When injected into immunocompromised pregnant mice with elevated uterine artery resistance, idNK cells homed to the uterus and reduced the uterine artery resistance index, suggesting improved placental perfusion.
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Affiliation(s)
- Ricardo C. Cavalli
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Ana Sofia Cerdeira
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
- Gulbenkian Programme for Advanced Medical Education, Lisbon, Portugal
| | - Elizabeth Pernicone
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Henri A. Korkes
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Suzanne D. Burke
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
- Howard Hughes Medical Institute, Chevy Chase, MD, United States of America
| | - Augustine Rajakumar
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
- Howard Hughes Medical Institute, Chevy Chase, MD, United States of America
| | - Ravi I. Thadhani
- Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Drucilla J. Roberts
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Manoj Bhasin
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - S. Ananth Karumanchi
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
- Howard Hughes Medical Institute, Chevy Chase, MD, United States of America
| | - Hernan D. Kopcow
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
- * E-mail:
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Abstract
Preeclampsia is a pregnancy-specific disease characterized by new onset hypertension and proteinuria after 20 wk of gestation. It is a leading cause of maternal and fetal morbidity and mortality worldwide. Exciting discoveries in the last decade have contributed to a better understanding of the molecular basis of this disease. Epidemiological, experimental, and therapeutic studies from several laboratories have provided compelling evidence that an antiangiogenic state owing to alterations in circulating angiogenic factors leads to preeclampsia. In this review, we highlight the role of key circulating antiangiogenic factors as pathogenic biomarkers and in the development of novel therapies for preeclampsia.
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Affiliation(s)
- Tammy Hod
- Department of Medicine, Obstetrics & Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02214
| | - Ana Sofia Cerdeira
- Department of Medicine, Obstetrics & Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02214 Gulbenkian Program for Advanced Medical Education, 1067-001 Lisbon, Portugal
| | - S Ananth Karumanchi
- Department of Medicine, Obstetrics & Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02214 Howard Hughes Medical Institute, Chevy Chase, Maryland 20815
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Affiliation(s)
| | - Ravi Thadhani
- Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
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Palomaki GE, Haddow JE, Haddow HRM, Salahuddin S, Geahchan C, Cerdeira AS, Verlohren S, Perschel FH, Horowitz G, Thadhani R, Karumanchi SA, Rana S. Modeling risk for severe adverse outcomes using angiogenic factor measurements in women with suspected preterm preeclampsia. Prenat Diagn 2015; 35:386-93. [PMID: 25641027 PMCID: PMC4409832 DOI: 10.1002/pd.4554] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 12/13/2014] [Accepted: 12/23/2014] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Preeclampsia (PE) is a pregnancy-specific syndrome associated with adverse maternal and fetal outcomes. Patient-specific risks based on angiogenic factors might better categorize those who might have a severe adverse outcome. METHODS Women evaluated for suspected PE at a tertiary hospital (2009-2012) had pregnancy outcomes categorized as 'referent' or 'severe', based solely on maternal/fetal findings. Outcomes that may have been influenced by a PE diagnosis were considered 'unclassified'. Soluble fms-like tyrosine kinase (sFlt1) and placental growth factor (PlGF) were subjected to bivariate discriminant modeling, allowing patient-specific risks to be assigned for severe outcomes. RESULTS Three hundred twenty-eight singleton pregnancies presented at ≤34.0 weeks' gestation. sFlt1 and PlGF levels were adjusted for gestational age. Risks above 5 : 1 (10-fold over background) occurred in 77% of severe (95% CI 66 to 87%) and 0.7% of referent (95% CI <0.1 to 3.8%) outcomes. Positive likelihood ratios for the modeling and validation datasets were 19 (95% CI 6.2-58) and 15 (95% CI 5.8-40) fold, respectively. CONCLUSIONS This validated model assigns patient-specific risks of any severe outcome among women attending PE triage. In practice, women with high risks would receive close surveillance with the added potential for reducing unnecessary preterm deliveries among remaining women. © 2015 The Authors. Prenatal Diagnosis published by John Wiley & Sons Ltd.
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Affiliation(s)
- Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital/Alpert Medical School at Brown University, Providence, RI, USA; Savjani Institute for Health Research, Windham, ME, USA
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34
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Rana S, Rajakumar A, Geahchan C, Salahuddin S, Cerdeira AS, Burke SD, George E, Granger J, Ananth Karumanchi S. [27-OR]. Pregnancy Hypertens 2015. [DOI: 10.1016/j.preghy.2014.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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35
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Palomaki GE, Haddow JE, Haddow H, Salahuddin S, Geahchan C, Cerdeira AS, Verlohren S, Perschel FH, Horowitz G, Thadhani R, Karumanchi SA, Rana S. [24-OR]. Pregnancy Hypertens 2015. [DOI: 10.1016/j.preghy.2014.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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36
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de Carvalho Cavalli R, Cerdeira AS, Korkes H, Burke S, Rajakumar A, Bhasin M, Karumanchi SA, Kopcow H. [31-OR]. Pregnancy Hypertens 2015. [DOI: 10.1016/j.preghy.2014.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Korkes HA, Sass N, Moron AF, Câmara NOS, Bonetti T, Cerdeira AS, Da Silva IDCG, De Oliveira L. Lipidomic assessment of plasma and placenta of women with early-onset preeclampsia. PLoS One 2014; 9:e110747. [PMID: 25329382 PMCID: PMC4201564 DOI: 10.1371/journal.pone.0110747] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 09/25/2014] [Indexed: 01/09/2023] Open
Abstract
Introduction Adipose tissue is responsible for triggering chronic systemic inflammatory response and these changes may be involved in the pathophysiology of preeclampsia. Objective To characterize the lipid profile in the placenta and plasma of patients with preeclampsia. Methodology Samples were collected from placenta and plasma of 10 pregnant women with preeclampsia and 10 controls. Lipids were extracted using the Bligh–Dyer protocol and were analysed by MALDI TOF-TOF mass spectrometry. Results Approximately 200 lipid signals were quantified. The most prevalent lipid present in plasma of patients with preeclampsia was the main class Glycerophosphoserines-GP03 (PS) representing 52.30% of the total lipid composition, followed by the main classes Glycerophosphoethanolamines-GP02 (PEt), Glycerophosphocholines-GP01 (PC) and Flavanoids-PK12 (FLV), with 24.03%, 9.47% and 8.39% respectively. When compared to the control group, plasma samples of patients with preeclampsia showed an increase of PS (p<0.0001), PC (p<0.0001) and FLV (p<0.0001). Placental analysis of patients with preeclampsia, revealed the PS as the most prevalent lipid representing 56.28%, followed by the main class Macrolides/polyketides-PK04 with 32.77%, both with increased levels when compared with patients control group, PS (p<0.0001) and PK04 (p<0.0001). Conclusion Lipids found in placenta and plasma from patients with preeclampsia differ from those of pregnant women in the control group. Further studies are needed to clarify if these changes are specific and a cause or consequence of preeclampsia.
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Affiliation(s)
- Henri Augusto Korkes
- Department of Obstetrics – Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
- Laboratory of Clinical and Experimental Investigation – School Maternity Vila Nova Cachoeirinha, Sao Paulo, Sao Paulo, Brazil
- * E-mail:
| | - Nelson Sass
- Department of Obstetrics – Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
- Laboratory of Clinical and Experimental Investigation – School Maternity Vila Nova Cachoeirinha, Sao Paulo, Sao Paulo, Brazil
| | - Antonio F. Moron
- Department of Obstetrics – Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | | | - Tatiana Bonetti
- Department of Gynecology - Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Ana Sofia Cerdeira
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | - Leandro De Oliveira
- Department of Obstetrics – Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
- Laboratory of Clinical and Experimental Investigation – School Maternity Vila Nova Cachoeirinha, Sao Paulo, Sao Paulo, Brazil
- Department of Immunology – University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
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Rana S, Rajakumar A, Geahchan C, Salahuddin S, Cerdeira AS, Burke SD, George EM, Granger JP, Karumanchi SA. Ouabain inhibits placental sFlt1 production by repressing HSP27-dependent HIF-1α pathway. FASEB J 2014; 28:4324-34. [PMID: 24970393 DOI: 10.1096/fj.14-252684] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Up-regulation of placental soluble fms-like tyrosine kinase 1 (sFlt1) contributes to the pathogenesis of preeclampsia. To evaluate novel upstream pathways that regulate placental sFlt1 production, we screened a library of natural compounds (n=502) in human placental cell lines. Here, we report 3 compounds in the cardiac glycoside family, ouabain, gitoxigenin, and digitoxin, that inhibit placental sFlt1 production at nanomolar concentrations in vitro. We further characterized ouabain and demonstrated that it inhibits sFlt1 mRNA and protein expression in human placental cytotrophoblasts and explant cultures in a dose- and time-dependent manner. Ouabain down-regulated sFlt1 production by inhibiting hypoxia-inducible factor 1 (HIF-1α) protein expression in the placenta. Furthermore, we found that phosphorylation of heat-shock protein 27 (HSP27) was necessary for ouabain to inhibit HIF-1α translation. In a rat model of pregnancy-induced hypertension, ouabain reduced mean arterial pressure and enhanced placental HSP27 phosphorylation without any adverse effects on pups. Further studies are needed to explore the usefulness of targeting HIF-1α/HSP27 pathway in preeclampsia.
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Affiliation(s)
- Sarosh Rana
- Maternal Fetal Medicine/Obstetrics and Gynecology and Harvard Medical School, Boston, Massachusetts, USA;
| | - Augustine Rajakumar
- Center for Vascular Biology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Howard Hughes Medical Institute, Boston, Massachusetts, USA; and
| | - Carl Geahchan
- Center for Vascular Biology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Saira Salahuddin
- Maternal Fetal Medicine/Obstetrics and Gynecology and Harvard Medical School, Boston, Massachusetts, USA
| | - Ana Sofia Cerdeira
- Center for Vascular Biology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Suzanne D Burke
- Center for Vascular Biology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Howard Hughes Medical Institute, Boston, Massachusetts, USA; and
| | - Eric M George
- Department of Physiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Joey P Granger
- Department of Physiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - S Ananth Karumanchi
- Maternal Fetal Medicine/Obstetrics and Gynecology and Center for Vascular Biology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Howard Hughes Medical Institute, Boston, Massachusetts, USA; and
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Rana S, Schnettler WT, Powe C, Wenger J, Salahuddin S, Cerdeira AS, Verlohren S, Perschel FH, Arany Z, Lim KH, Thadhani R, Karumanchi SA. Clinical characterization and outcomes of preeclampsia with normal angiogenic profile. Hypertens Pregnancy 2014; 32:189-201. [PMID: 23725084 DOI: 10.3109/10641955.2013.784788] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare the clinical characteristics and outcomes of preeclamptic women presenting with a normal plasma angiogenic profile with those subjects who are characterized by an abnormal angiogenic profile. METHODS This was a secondary analysis of a prospective cohort study in women presenting to obstetrical triage at <37 weeks of gestation and diagnosed with preeclampsia within 2 weeks of enrollment and in whom angiogenic factors (sFlt1 and PlGF) measurements were available. Patients were divided into two groups based on their circulating levels of these factors described as a ratio; the sFlt1/PlGF ratio, non-angiogenic preeclampsia (sFlt1/PlGF ratio <85) and angiogenic preeclampsia (sFlt1/PlGF ratio ≥85). The data are presented by sFlt1/PlGF category using median and quartile 1-quartile 3 for continuous variables and by frequency and sample sizes for categorical variables. RESULTS In our cohort, the patients with non-angiogenic preeclampsia (N = 46) were more obese [BMI: 35.2 (31.6, 38.7) versus 31.1 (28.0, 39.0), p = 0.04], more likely to have preexisting diabetes (21.7% versus 2.0%, p = 0.002) and presented at a later gestational age [35 (32, 37) versus 32 (29, 34) weeks, p < 0.0001] as compared with women with angiogenic preeclampsia (N = 51). Women with non-angiogenic preeclampsia had no serious adverse outcomes (elevated liver function tests/low platelets: 0% versus 23.5%, abruption: 0% versus 9.8%, pulmonary edema: 0% versus 3.9%, eclampsia: 0% versus 2.0 %, small for gestational age: 0% versus 17.7% and fetal/neonatal death: 0% versus 5.9%) as compared with women with angiogenic preeclampsia. The rate of preterm delivery <34 weeks was 8.7% in non-angiogenic preeclampsia compared with 64.7% in angiogenic preeclampsia (p < 0.0001). Interestingly, delivery between 34 and 37 weeks and resource utilization (hospital admission days) were similar in the two groups. CONCLUSION In contrast to the angiogenic form, the non-angiogenic form of preeclampsia is characterized by little to no risk of preeclampsia-related adverse outcomes, other than iatrogenic prematurity. Incorporation of angiogenic biomarkers in the evaluation of preeclampsia may allow accurate and early identification of severe disease.
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Affiliation(s)
- Sarosh Rana
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
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Cerdeira AS, Rajakumar A, Royle CM, Lo A, Husain Z, Thadhani RI, Sukhatme VP, Karumanchi SA, Kopcow HD. Conversion of peripheral blood NK cells to a decidual NK-like phenotype by a cocktail of defined factors. J Immunol 2013; 190:3939-48. [PMID: 23487420 DOI: 10.4049/jimmunol.1202582] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
NK cells that populate the decidua are important regulators of normal placentation. In contrast to peripheral blood NK cells, decidual NK (dNK) cells lack cytotoxicity, secrete proangiogenic factors, and regulate trophoblast invasion. In this study we show that exposure to a combination of hypoxia, TGF-β1, and a demethylating agent results in NK cells that express killer cell Ig-like receptors, the dNK cell markers CD9 and CD49a, and a dNK pattern of chemokine receptors. These cells secrete vascular endothelial growth factor (a potent proangiogenic molecule), display reduced cytotoxicity, and promote invasion of human trophoblast cell lines. These findings have potential therapeutic applications for placental disorders associated with altered NK cell biology.
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Affiliation(s)
- Ana Sofia Cerdeira
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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Abstract
During fetal development, the human placenta undergoes high levels of both angiogenesis and vasculogenesis. Additionally, the developing placenta undergoes a process of vascular mimicry (referred to as pseudovasculogenesis) as cytotrophoblasts convert from an epithelial to an endothelial phenotype. The initiation, maturation, and maintenance of the placental vasculature are of critical importance. Failure to do so can lead to adverse obstetric outcomes such as preeclampsia and/or intrauterine growth restriction (IUGR). Furthermore, the foundation of many aspects of adult health is laid in utero. In this context, normal placental function is not only critical for normal fetal development but can also permanently influence long-term health and disease. Understanding the mechanisms that regulate placental vasculogenesis and angiogenesis is therefore of critical importance. This chapter will focus on placental vascular development with a particular emphasis on the role of angiogenic factors in the pathogenesis of the maternal syndrome of preeclampsia and related disorders.
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Affiliation(s)
- Ana Sofia Cerdeira
- Department of Medicine, Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02114, USA
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Rajakumar A, Cerdeira AS, Rana S, Zsengeller Z, Edmunds L, Jeyabalan A, Hubel CA, Stillman IE, Parikh SM, Karumanchi SA. Transcriptionally active syncytial aggregates in the maternal circulation may contribute to circulating soluble fms-like tyrosine kinase 1 in preeclampsia. Hypertension 2012; 59:256-64. [PMID: 22215706 DOI: 10.1161/hypertensionaha.111.182170] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The cardinal manifestations of the pregnancy-specific disorder preeclampsia, new-onset hypertension, and proteinuria that resolve with placental delivery have been linked to an extracellular protein made by the placenta, soluble fms-like tyrosine kinase 1 (sFlt1), that injures the maternal vasculature. However, the mechanisms by which sFlt1, which is heavily matrix bound, gain access to the systemic circulation remain unclear. Here we report that the preeclamptic placenta's outermost layer, the syncytiotrophoblast, forms abundant "knots" that are enriched with sFlt1 protein. These syncytial knots easily detach from the syncytiotrophoblast, resulting in free, multinucleated aggregates (50-150 μm diameter) that are loaded with sFlt1 protein and mRNA, are metabolically active, and are capable of de novo gene transcription and translation. At least 25% of the measurable sFlt1 in the third-trimester maternal plasma is bound to circulating placental microparticles. We conclude that detachment of syncytial knots from the placenta results in free, transcriptionally active syncytial aggregates that represent an autonomous source of sFlt1 delivery into the maternal circulation. The process of syncytial knot formation, shedding of syncytial aggregates, and appearance of placental microparticles in the maternal circulation appears to be greatly accelerated in preeclampsia and may contribute to the maternal vascular injury that characterizes this disorder.
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Affiliation(s)
- Augustine Rajakumar
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
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Matos A, Ferreira J, Portelinha A, Cerdeira AS, Braga J, Patrício B, Rebelo I, Bicho M, Marinho C. P24. Study of C677T methylene tetrahydrofolate reductase (MTHFR) polymorphism in preeclampsia. Pregnancy Hypertens 2011; 1:284. [PMID: 26009115 DOI: 10.1016/j.preghy.2011.08.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Andreia Matos
- Genetic Laboratory, Centre of Endocrinology and Metabolism, Lisbon Medical School, Portugal; Bento Rocha Cabral Institute, Lisbon, Portugal
| | - Joana Ferreira
- Genetic Laboratory, Centre of Endocrinology and Metabolism, Lisbon Medical School, Portugal
| | - Ana Portelinha
- Institute for Molecular and Cell Biology, University of Porto, Portugal
| | | | - Jorge Braga
- Department of Obstetrics, Sto António Hospital, Porto, Portugal
| | - Belmiro Patrício
- Department of Obstetrics and Gynecology, Porto Medical School, S. João Hospital, Porto, Portugal; Faculty of Pharmacy, Biochemical Department, University of Porto, Portugal
| | - Irene Rebelo
- Institute for Molecular and Cell Biology, University of Porto, Portugal; Faculty of Pharmacy, Biochemical Department, University of Porto, Portugal
| | - Manuel Bicho
- Genetic Laboratory, Centre of Endocrinology and Metabolism, Lisbon Medical School, Portugal; Bento Rocha Cabral Institute, Lisbon, Portugal
| | - Claudia Marinho
- Genetic Laboratory, Centre of Endocrinology and Metabolism, Lisbon Medical School, Portugal; Bento Rocha Cabral Institute, Lisbon, Portugal.
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Belchior I, Cerdeira AS, Santos M, Braga JS, Aragão I, Martins A. [Successful pregnancy in a severely hypoxemic patient with pulmonary alveolar proteinosis]. Rev Port Pneumol 2011; 17:139-42. [PMID: 21549673 DOI: 10.1016/j.rppneu.2011.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 11/03/2010] [Indexed: 10/18/2022] Open
Abstract
Pulmonary alveolar proteinosis (PAP) is a rare disorder characterized by abnormal accumulation of a lipoproteinaceous material in the alveoli, which may lead to respiratory failure and has an associated high risk for infections. The mainstay treatment for PAP is whole lung lavage. A pregnant woman, previously diagnosed with primary PAP, the most common form of PAP, was admitted with dyspnea and worsening respiratory function. In one month period, a whole-lung bronchopulmonary lavage was performed twice, with clinical and functional improvement. Pregnancy was carried to term and a healthy baby was delivered. The mechanisms of respiratory impairment are discussed as well as treatment options and response.
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Affiliation(s)
- I Belchior
- Pneumologia, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal.
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Abstract
Preeclampsia/eclampsia remains a major cause of maternal and fetal morbidity worldwide. It also remains a leading cause of iatrogenic prematurity as delivery is currently the only way to successfully treat the disorder. The mechanisms that initiate preeclampsia in humans have been remarkably elusive, but some parts of the puzzle have begun to come together. Recently, it has been suggested that its major phenotypes, such as hypertension, proteinuria and endothelial dysfunction, are due to circulating anti-angiogenic proteins such as soluble fms-like tyrosine kinase-1 and soluble endoglin. Abnormalities in these circulating angiogenic proteins are not only present during clinical preeclampsia, but also antedate clinical symptoms by at least 5-6 weeks. The availability of automated platforms for the measurement of these angiogenic proteins has allowed clinicians to evaluate the role of these biomarkers as an aid in the diagnosis and prediction of preeclampsia. This review will highlight the recent clinical studies that have evaluated the utility of these biomarkers in preeclampsia and its related complications.
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Affiliation(s)
- Ana Sofia Cerdeira
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School Boston, MA, USA
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Portelinha A, Cerdeira AS, Belo L, Braga J, Tejera E, Pinto A, Pinto F, Areias MJ, Patrício B, Rebelo I. Haemostatic factors in women with history of preeclampsia. Thromb Res 2008; 124:52-6. [PMID: 19049844 DOI: 10.1016/j.thromres.2008.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Revised: 10/12/2008] [Accepted: 10/20/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Evaluation of haemostatic parameters--Plasma tissue plasminogen activator (t-PA), plasminogen activator inhibitor type 1 (PAI-1) and fibrin fragment D-dimer several years after the end of pregnancy to investigate if they are modified in women with history of preeclampsia (PE). STUDY DESIGN 65 healthy women with history of PE and 54 control women with previous normal pregnancy were enrolled in this study. Groups were matched for age, time period since delivery, smoking status and alcohol consumption. t-PA, PAI-1 and fibrin fragment D-dimer antigen levels were quantified using standards commercial ELISA methods. Plasma fibrinogen was measured using automated capillary zone electrophoresis. RESULTS Systolic and diastolic blood pressures were higher in women with history of PE. Levels of t-PA, PAI-1 and fibrinogen were similar between groups as well as the t-PA/PAI-1 ratio. A significant increase in D-dimer levels was observed in women with history of PE. CONCLUSION The increase in D-dimer level suggests an abnormal haemostatic potential namely increased intravascular coagulation. This, together with the increased blood pressure, can reflect a tendency for an increased risk of cardiovascular/thrombotic events later in life.
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Affiliation(s)
- Ana Portelinha
- Institute for Molecular and Cell Biology, University of Porto, Portugal.
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Cerdeira AS, Brás-Silva C, Leite-Moreira AF. Endothelin-converting enzyme inhibitors: their application in cardiovascular diseases. Rev Port Cardiol 2008; 27:385-408. [PMID: 18551924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Endothelin, a potent vasoconstrictor first described in 1988 by Yanagisawa, is an important regulator of cardiovascular function. Hyperactivation of the endothelin system has been implicated in the pathogenesis of various cardiovascular disorders including myocardial infarction, restenosis, hypertension, heart failure and Chagas cardiopathy. Various attempts have been made to suppress this axis. Although promising, the results of clinical trials on endothelin receptor antagonists have been disappointing. There is growing interest in blockade of endothelin formation. Several selective and non-selective endothelin-converting enzyme (ECE) inhibitors have been developed, the latter with the possibility of simultaneously blocking angiotensin-converting enzyme and neutral endopeptidase, combining inhibition more than one axis. This article reviews the different ECE inhibitors, with particular emphasis on their potential clinical application in cardiovascular diseases.
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Affiliation(s)
- Ana Sofia Cerdeira
- Serviço de Fisiologia da Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Brunner F, Brás-Silva C, Cerdeira AS, Leite-Moreira AF. Cardiovascular endothelins: essential regulators of cardiovascular homeostasis. Pharmacol Ther 2006; 111:508-31. [PMID: 16457892 DOI: 10.1016/j.pharmthera.2005.11.001] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2005] [Accepted: 11/01/2005] [Indexed: 02/04/2023]
Abstract
The endothelin (ET) system consists of 3 ET isopeptides, several isoforms of activating peptidases, and 2 G-protein-coupled receptors, ETA and ETB, that are linked to multiple signaling pathways. In the cardiovascular system, the components of the ET family are expressed in several tissues, notably the vascular endothelium, smooth muscle cells, and cardiomyocytes. There is general agreement that ETs play important physiological roles in the regulation of normal cardiovascular function, and excessive generation of ET isopeptides has been linked to major cardiovascular pathologies, including hypertension and heart failure. However, several recent clinical trials with ET receptor antagonists were disappointing. In the present review, the authors take the stance that ETs are mainly and foremost essential regulators of cardiovascular function, hence that antagonizing normal ET actions, even in patients, will potentially do more harm than good. To support this notion, we describe the predominant roles of ETs in blood vessels, which are (indirect) vasodilatation and ET clearance from plasma and interstitial spaces, against the background of the subcellular mechanisms mediating these effects. Furthermore, important roles of ETs in regulating and adapting heart functions to different needs are addressed, including recent progress in understanding the effects of ETs on diastolic function, adaptations to changes in preload, and the interactions between endocardial-derived ET-1 and myocardial pump function. Finally, the potential dangers (and gains) resulting from the suppression of excessive generation or activity of ETs occurring in some cardiovascular pathological states, such as hypertension, myocardial ischemia, and heart failure, are discussed.
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Affiliation(s)
- Friedrich Brunner
- Department of Pharmacology and Toxicology, University of Graz, Universitätsplatz 2, 8010-Graz, Austria.
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