Pré-eclâmpsia: estresse oxidativo, inflamação e disfunção endotelial

Abstract

Preeclampsia is a systemic syndrome characterized by inflammatory and antiangiogenic states. The pathogenesis of preeclampsia involves deficient trophoblast invasion that is responsible for altered uterine blood flow and placental oxidative stress. The damaged placenta produces higher concentrations of sFlt-1, a soluble receptor for VEGF and PlGF that is released in the maternal circulation and is involved in endothelial dysfunction. Actually, all processes involved in inflammation, endothelial dysfunction and oxidative stress are strongly correlated and act in a synergistic way. Recent data have shown that an increase in serum concentrations of sFlt-1 initiates 5 to 6 weeks before the clinical manifestations of preeclampsia and these alterations correlate with a decrease in serum concentrations of PlGF. Therefore, both sFlt-1 and PlGF have been suggested to be useful for an early-diagnosis of preeclampsia. The knowledge about the role of antiangiogenic factors in the pathogenesis of preeclampsia has raised the possibility of a therapy involving these factors.In this article we revisited the pathogenesis of preeclampsia addressing its antiangiogenic and inflammatory states.In conclusion, we correlated these alterations with the higher risk for cardiovascular diseases presented by these women in future life.

Lipidomic Assessment of Plasma and Placenta of Women with Early-Onset Preeclampsia

“…Preeclampsia is a systemic disease characterized by intense inflammatory response, endothelial injury, platelet aggregation, coagulation system activation and increase vascular resistance. It affects about 5–8% of all pregnant women [1] – [3] . The diagnosis of preeclampsia is based on the development of hypertension (≥140/90 mmHg) and significant proteinuria (≥300 mg/24 hours) after 20 weeks of gestation [4] .…”

“…Despite its relevance, preeclampsia pathogenesis is not completely understood. It has been established that the trophoblast has a key role in this process and many other conditions related to chronic inflammation can be relevant in different stages of the disease [3] .…”

The Inflammasome in Reproductive Biology: A Promising Target for Novel Therapies

“…A disorder associated with hypertension and proteinuria starting on the 20th week of pregnancy (38), preeclampsia has a significantly heightened inflammatory response in which the inflammasome plays a contributing role (39). In regards to inflammasome regulation in preeclampsia, Weel and colleagues showed that the NLRP3 inflammasome is upregulated, and that it contributes to the damaging effects of inflammation present in preeclampsia (29), a finding that was then corroborated by Stodle et al who showed that cholesterol and uric acid crystals activated the NLRP3 inflammasome in preeclampsia (30).…”

<b>Expression of bradykinin in human placenta from healthy and preeclamptic women

“…They express only HLA-G, HLA-C and HLA-E. Saito, Sakai, Sasaki, Nakashima and Shiozaki (2007) demonstrated reduction in the percentage of regulatory T cells in patients with preeclampsia; this would lead to increased activation of lymphocytes and thus, greater inflammatory response. Therefore, one can infer that the breakdown of maternal-fetal or maternal-placental tolerance could lead to deficient placentation, inflammatory response and, consequently, to preeclampsia (Oliveira, Karumanchi, & Sass, 2010).…”