Preeclampsia: Pathophysiology, Challenges, and Perspectives
Sarosh Rana,Elizabeth R. Lemoine,Elizabeth R. Lemoine,Joey P. Granger,S. Ananth Karumanchi,S. Ananth Karumanchi +5 more
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TLDR
The current evidence for the role of abnormal placentation and therole of placental factors such as the antiangiogenic factor, sFLT1 (soluble fms-like tyrosine kinase 1) in the pathogenesis of the maternal syndrome of preeclampsia is discussed.Abstract:
Hypertensive disorders of pregnancy-chronic hypertension, gestational hypertension, and preeclampsia-are uniquely challenging as the pathology and its therapeutic management simultaneously affect mother and fetus, sometimes putting their well-being at odds with each other. Preeclampsia, in particular, is one of the most feared complications of pregnancy. Often presenting as new-onset hypertension and proteinuria during the third trimester, preeclampsia can progress rapidly to serious complications, including death of both mother and fetus. While the cause of preeclampsia is still debated, clinical and pathological studies suggest that the placenta is central to the pathogenesis of this syndrome. In this review, we will discuss the current evidence for the role of abnormal placentation and the role of placental factors such as the antiangiogenic factor, sFLT1 (soluble fms-like tyrosine kinase 1) in the pathogenesis of the maternal syndrome of preeclampsia. We will discuss angiogenic biomarker assays for disease-risk stratification and for the development of therapeutic strategies targeting the angiogenic pathway. Finally, we will review the substantial long-term cardiovascular and metabolic risks to mothers and children associated with gestational hypertensive disorders, in particular, preterm preeclampsia, and the need for an increased focus on interventional studies during the asymptomatic phase to delay the onset of cardiovascular disease in women.read more
Citations
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Preeclampsia-Pathophysiology and Clinical Presentations: JACC State-of-the-Art Review.
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Combining Biomarkers to Predict Pregnancy Complications and Redefine Preeclampsia: The Angiogenic-Placental Syndrome.
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References
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Journal ArticleDOI
Excess placental soluble fms-like tyrosine kinase 1 (sFlt1) may contribute to endothelial dysfunction, hypertension, and proteinuria in preeclampsia
Sharon Maynard,Jiang Yong Min,Jaime R. Merchan,Kee-Hak Lim,Jianyi Li,Susanta Mondal,Towia A. Libermann,James P. Morgan,Frank W. Sellke,Isaac E. Stillman,Franklin H. Epstein,Vikas P. Sukhatme,S. Ananth Karumanchi +12 more
TL;DR: It is confirmed that placental soluble fms-like tyrosine kinase 1 (sFlt1), an antagonist of VEGF and placental growth factor (PlGF), is upregulated in preeclampsia, leading to increased systemic levels of sFlt 1 that fall after delivery, and observations suggest that excess circulating sFelt1 contributes to the pathogenesis of preeClampsia.
Journal ArticleDOI
Hypertension in pregnancy: Executive summary
James M. Roberts,Phyllis August,George Bakris,John R. Barton,Ira M. Bernstein,Maurice L. Druzin,Robert R. Gaiser,Joey P. Granger,Arun Jeyabalan,Donna D. Johnson,S. Ananth Karumanchi,Marshall D. Lindheimer,Michelle Y. Owens,Geroge R. Saade,Bahaeddine M Sibai,Catherine Y. Spong,Eleni Tsigas,Gerald E. Joseph,Nancy O'Reilly,Alyssa Politzer,Sarah Son,Karina Ngaiza +21 more
Journal ArticleDOI
Circulating Angiogenic Factors and the Risk of Preeclampsia
Richard J. Levine,Sharon Maynard,Cong Qian,Kee-Hak Lim,Lucinda England,Kai F. Yu,Enrique F. Schisterman,Ravi Thadhani,Benjamin P. Sachs,Franklin H. Epstein,Bahaeddine M Sibai,Vikas P. Sukhatme,S. Ananth Karumanchi +12 more
TL;DR: Alterations in the levels of sFlt-1 and free PlGF were greater in women with an earlier onset of preeclampsia and in women in whom preeClampsia was associated with a small-for-gestational-age infant.
Journal ArticleDOI
Bidirectional cytokine interactions in the maternal-fetal relationship: is successful pregnancy a TH2 phenomenon?
TL;DR: In this article, the authors hypothesize that TH2 cytokines inhibit TH1 responses, improving fetal survival but impairing responses against some pathogens, since pregnant females are susceptible to intracellular pathogens and are biased towards humoral rather than cell mediated immunity.
Journal ArticleDOI
Infant mortality, childhood nutrition, and ischaemic heart disease in England and Wales.
David J.P. Barker,Clive Osmond +1 more
TL;DR: Although the rise in ischaemic heart disease in England and Wales has been associated with increasing prosperity, mortality rates are highest in the least affluent areas.
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