Pathogenesis of endotheliosis in preeclampsia


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Abstract

Objective. To study vascular endothelium function in pregnant women with preeclampsia (PE) for optimizing the assessment of its degree and the efficiency of performed therapy. Subjects and methods. A cohort prospective study was conducted in 88 patients: 62 women with PE (a study group) and 26 women with physiological pregnancy and labor (a control group). A solid-phase enzyme-linked immuno-absorbent assay was used to determine endothelial dysfunction markers (TNF-α, VCAM, ICAM, VEGF, PIGF, sFlt-1, and NSE) in the patents’ sera before and during therapy and in the first 5-6 days after childbirth. In the control group, the markers were explored at 8 weeks’ gestation once monthly and in the first 5- 6 days postpartum. Results. As PE developed and progressed, there was a significant decrease in VEGF and PIGF and an increase in sFlt-1, TNF-α, VCAM, ICAM, NSE, and TNF-α as compared to the healthy pregnant women. During therapy for moderate PE, there was a reduction in TNFα, VCAM, and NSE, a less significant decrease in ICAM and sFlt-1 and a rise in VEGF and PIGF; however, the concentrations of the markers in question remained abnormal and significantly exceeded those in the control group. Therapy for severe PE was ineffective. The markers under study became normal on 2-5 days after delivery in patients with PE. Conclusion. PE is characterized by the development and gradual progression of gestational endotheliosis that ceases only when pathological pregnancy ends.

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About the authors

Iraida Stepanovna Sidorova

I.M. Sechenov First Moscow State Medical University

MD, Professor, RAMS Corresponding Member, Honoured Scientist of the Russian Federation, Obstetrics and Gynecology Department One, Faculty of Therapeutics

Natalya Aleksandrovna Nikitina

I.M. Sechenov First Moscow State Medical University

Email: natnikitina@list.ru
Candidate of Medical Sciences, Associate Professor of Obstetrics and Gynecology Department One, Faculty of Therapeutics

References

  1. Evans C.S., Gooch L., Flotta D., Lykins D., Powers R.W., Landsittel D. et al. Cardiovascular system during the postpartum state in women with a history of preeclampsia. Hypertension. 2011; 58(1): 57-62.
  2. Freeman D.J., McManus F., Brown E.A., Cherry L., Norrie J., Ramsay J.E. et al. Short- and long-term changes in plasma inflammatory markers associated with preeclampsia. Hypertension. 2004; 44(5): 708-14.
  3. Kvehaugen A.S., Dechend R., Ramstad H.B., Troisi R., Fugelseth D., Staff A.C. Endothelial function and circulating biomarkers are disturbed in women and children after preeclampsia. Hypertension. 2011; 58(1): 63-9.
  4. Lampinen K.H., Rönnback M., Kaaja R.J., Groop P.H. Impaired vascular dilatation in women with a history of pre-eclampsia. J. Hypertens. 2006; 24(4): 751-6.
  5. Lazdam M., Davis E.F., Lewandowski A.J., Worton S.A., Kenworthy Y., Kelly B., Leeson P. Prevention of vascular dysfunction after preeclampsia: a potential long-term outcome measure and an emerging goal for treatment. J. Pregnancy. 2012; 2012: 704146.
  6. Mosca L., Benjamin E.J., Berra K., Bezanson J.L., Dolor R.J., Lloyd-Jones D.M. et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women - 2011 update: a guideline from the American Heart Association. Circulation. 2011; 123(11): 1243-62.
  7. Uzan J., Carbonnel M., Piconne I. О., Asmar R., Ayoubi J.-M. Pre-eclampsia: pathophysiology, diagnosis and management. Vasc. Health Risk Manag. 2011; 7: 467-74.
  8. Yinon Y., Kingdom J.C., Odutayo A., Moineddin R., Drewlo S., Lai V. et al. Vascular dysfunction in women with a history of preeclampsia and intrauterine growth restriction: insights into future vascular risk. Circulation. 2010; 122(18): 1846-53.
  9. Bellamy L., Casas J.P., Hingorani A.D., Williams D.J. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and metaanalysis. Br. Med. J. 2007; 335(7627): 974-7.
  10. Irgens H.U., Reisaeter L., Irgens L.M., Lie R.T. Long term mortality of mothers and fathers after pre-eclampsia: population based cohort study. Br. Med. J. 2001; 323(7323): 1213-7.
  11. George E.M., Granger J.P. Endothelin: key mediator of hypertension in preeclampsia. Am. J. Hypertens. 2011; 24(9): 964-9.
  12. Sezer S.D., Küçük M., Yenisey C., Yüksel H., Odabaşi A.R., Türkmen M.K. et al. Comparison of angiogenic and anti- angiogenic factors in maternal and umbilical cord blood in early-and late-onset pre-eclampsia. Gynecol. Endocrinol. 2012; 28(8): 628-32.
  13. Петрищев Н.Н. Дисфункция эндотелия: причины, механизмы, фармакологическая коррекция. СПб.: Изд-во СПбГМУ; 2003. 181 с.
  14. Anderson U.D., Olsson M.G., Kristensen K.H., Akerström B., Hansson S.R. Biochemical markers to predict preeclampsia. Placenta. 2012; 33(Suppl.): S42-7.
  15. Burger D., Touyz R.M. Cellular biomarkers of endothelial health: microparticles, endothelial progenitor cells, and circulating endothelial cells. J. Am. Soc. Hypertens. 2012; 6(2): 85-99.
  16. Marusic J., Prusac I.K., Tomas S.Z., Karara J.R., Roje D. Expression of inflammatory cytokines in placentas from pregnancies complicated with preeclampsia and HELLP syndrome. J. Matern. Fetal Neonatal Med. 2013; 26(7): 680-5.
  17. Lamarca B. Endothelial dysfunction. An important mediator in the pathophysiology of hypertension during pre-eclampsia. Minerva Ginecol. 2012; 64(4): 309-20.
  18. Eiland E., Nzerue C., Faulkner M. Preeclampsia 2012. J. Pregnancy. 2012; 2012: 586578.
  19. Kingdom J.C., Drewlo S. Is heparin a placental anticoagulant in high-risk pregnancies? Blood. 2011; 118(18): 4780-8.
  20. Stillman I.E., Karumanchi S.A. The glomerular injury of preeclampsia. J. Am. Soc. Nephrol. 2007; 18(8): 2281-4.
  21. Чехонин В.П., Дмитриева Т.Б., Жирков Ю.А. Иммунохимический анализ нейроспецифических антигенов. М.: Медицина; 2000. 416 с. [Chekhonin V.P., Dmitrieva T.B., Zhirkov Yu.A. Immunochemical analysis of neurospecific antigens. M.: Medicine; 2000. 416 p. (in Russian)]
  22. ВОЗ. Материнская смертность. Информационный бюллетень №348. Май 2012 г. Available at: http://www.who.int/mediacentre/factsheets/ fs348/ru/index.html. [WHO. Maternal mortality. Fact sheet №348. May 2012 Available at: http://www.who.int/mediacentre/factsheets/fs348/ru/ index.html. (in Russian)]
  23. Laskowska M., Laskowska K., Leszczyńska-Gorzelak B., Oleszczuk J. Are the maternal and umbilical VEGF-A and SVEGF-R1 altered in pregnancies complicated by preeclampsia with or without intrauterine foetal growth retardation? Preliminary communication. Med. Wieku Rozwoj. 2008; 12(1): 499-506.
  24. Chaitanya G.V., Cromer W., Wells S., Jennings M., Mathis J.M., Minagar A., Alexander J.S. Metabolic modulation of cytokine-induced brain endothelial adhesion molecule expression. Microcirculation. 2012; 19(2): 155-65.
  25. Smith G.C., Crossley J.A., Aitken D.A., Jenkins N., Lyall F., Cameron A.D. et al. Circulating angiogenic factors in early pregnancy and the risk of preeclampsia, intrauterine growth restriction, spontaneous preterm birth, and stillbirth. Obstet. Gynecol. 2007; 109(6): 1316-24.
  26. Erez O., Romero R., Espinoza J., Fu W., Todem D., Kusanovic J.P. et al. The change in concentrations of angiogenic and anti-angiogenic factors in maternal plasma between the first and second trimesters in risk assessment for the subsequent development of preeclampsia and small-for-gestational age. J. Matern. Fetal Neonatal Med. 2008; 21(5): 279-87.
  27. Slavik L., Prochazkova J., Prochazka M., Simetka O., Hlusi A., Ulehlova J. The pathophysiology of endothelial function in pregnancy and the usefulness of endothelial markers. Biomed. Pap. Med. Fac. Univ. Palacky Olomouc Czech. Repub. 2011; 155(4): 333-8.
  28. Soto E., Romero R., Kusanovic J.P., Ogge G., Hussein Y., Yeo L. et al. Late-onset preeclampsia is associated with an imbalance of angiogenic and anti angiogenic factors in patients with and without placental lesions consistent with maternal underperfusion. J. Matern. Fetal Neonatal Med. 2012; 25(5): 498-507.

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