Efficacy of L-arginine for preventing preeclampsia in high-risk pregnancies: A double-blind, randomized, clinical trial

Ee, Camarena Pulido; L, García Benavides; Jg, Panduro Barón; S, Pascoe Gonzalez; Aj, Madrigal Saray; Fe, García Padilla; Sutto, Totsuka

doi:10.3109/10641955.2015.1137586

Cited by 55 publications

(50 citation statements)

References 22 publications

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“…In a more recent clinical trial, supplementation with l ‐arginine in women who were at a high risk of developing preeclampsia significantly reduced blood pressure and preterm birth rates, and the number of women developing preeclampsia, while increasing birth weight relative to placebo‐treated women . The previous adverse effects listed by Vadillo‐Ortega et al, were absent in the more recent study, likely due to a reduction in the dose of l ‐arginine supplementation. However, dyspepsia was reported in the l ‐arginine–supplemented women, but was not severe enough to discontinue treatment.…”

Section: No Pathwaymentioning

confidence: 89%

“…Unfortunately, one study using l ‐arginine and antioxidant supplementation reported numerous mild adverse effects, including headaches, palpitations, dizziness, and dyspepsia . In a more recent clinical trial, supplementation with l ‐arginine in women who were at a high risk of developing preeclampsia significantly reduced blood pressure and preterm birth rates, and the number of women developing preeclampsia, while increasing birth weight relative to placebo‐treated women . The previous adverse effects listed by Vadillo‐Ortega et al, were absent in the more recent study, likely due to a reduction in the dose of l ‐arginine supplementation.…”

Section: No Pathwaymentioning

confidence: 92%

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Targeting the vascular dysfunction: Potential treatments for preeclampsia

et al. 2019

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Preeclampsia is a pregnancy-specific disorder clinically characterized by new-onset hypertension (>20 weeks' gestation) with one or more of proteinuria and maternal organ dysfunction such as renal insufficiency, liver dysfunction, neurological complications, fetal growth restriction, or uteroplacental dysfunction. 1,2 Each year, preeclampsia is the principal cause of death in over 60 000 women and in more than 500 000 babies globally. 3 The pathophysiological mechanisms underlying the disease are still not entirely clear. Briefly, In 2017, Sarah was awarded her PhD at the University of Melbourne, Australia, and is currently an NHMRC Peter Doherty Research Fellow in the Department of Obstetrics and Gynecology at Monash University, Australia. The focus of her research is to assess the potential of new and old therapeutics to target the vascular dysfunction of preeclampsia, and translate these studies into clinical application. AbstractPreeclampsia is a pregnancy-specific disorder, primarily characterized by new-onset hypertension in combination with a variety of other maternal or fetal signs. The pathophysiological mechanisms underlying the disease are still not entirely clear.Systemic maternal vascular dysfunction underlies the clinical features of preeclampsia. It is a result of oxidative stress and the actions of excessive anti-angiogenic factors, such as soluble fms-like tyrosine kinase, soluble endoglin, and activin A, released by a dysfunctional placenta. The vascular dysfunction then leads to impaired regulation and secretion of relaxation factors and an increase in sensitivity/production of constrictors. This results in a more constricted vasculature rather than the relaxed vasodilated state associated with normal pregnancy. Currently, the only effective "treatment" for preeclampsia is delivery of the placenta and therefore the baby.Often, this means a preterm delivery to save the life of the mother, with all the attendant risks and burdens associated with fetal prematurity. To lessen this burden, there is a pressing need for more effective treatments that target the maternal vascular dysfunction that underlies the hypertension. This review details the vascular effects of key drugs undergoing clinical assessment as potential treatments for women with preeclampsia.

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Section: No Pathwaymentioning

confidence: 89%

Section: No Pathwaymentioning

confidence: 92%

Targeting the vascular dysfunction: Potential treatments for preeclampsia

et al. 2019

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“…Thus, the prediction of preeclampsia is paramount in performing appropriate procedures to reduce the prevalence of the disease by modifying antenatal care and pharmacological interventions in a timely manner. 9,10 Several clinical, biochemical and biophysical tests have been proposed to predict PE; however, none of them have proved to be useful in isolation to classify the preexisting maternal risk for PE with sufficient specificity and sensitivity for clinical use. Ideally, the predictive model should be simple, inexpensive, and easy to apply, so that it can be widely used in the clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Clinical Procedures for the Prevention of Preeclampsia in Pregnant Women: A Systematic Review

Moura

Gomes

Rodrigues

et al. 2020

Rev Bras Ginecol Obstet

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Objective To identify the most effective procedures recommended for the prevention of preeclampsia. Data Sources A systematic review was performed in the following databases: Pubmed/MEDLINE, CINAHL, Web of Science, Cochrane and LILACS via the Virtual Health Library (VHL). A manual search was also performed to find additional references. The risk of bias, the quality of the evidence, and the classification of the strength of the recommendations were evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Selection of Studies In the initial search in the databases, the total number of articles retrieved was 351, and 2 were retrieved through the manual search; after duplicate articles were removed, 333 citations remained. After a thorough review of the titles and abstracts, 315 references were excluded. Accordingly, 18 articles were maintained for selection of the complete text (phase 2). This process led to the exclusion of 6 studies. In total, 12 articles were selected for data extraction and qualitative synthesis. Data Collection The articles selected for the study were analyzed, and we inserted the synthesis of the evidence in the online software GRADEpro Guideline Development Tool (GDT) (McMaster University and Evidence Prime Inc. All right reserved. McMaster University, Hamilton, Ontário, Canada); thus, it was possible to develop a table of evidence, with the quality of the evidence and the classification of the strength of the recommendations. Data Synthesis In total, seven studies recommended the individual use of aspirin, or aspirin combined with calcium, heparin or dipyridamole. The use of calcium alone or in combination with phytonutrients was also highlighted. All of the studies were with women at a high risk of developing preeclampsia. Conclusion According to the studies evaluated, the administration of aspirin is still the best procedure to be used in the clinical practice to prevent preeclampsia.

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“…Oxidative stress of the placenta is able to result in endothelial dysfunction. Several important antioxidants, such as superoxide dismutase (SOD) and glutathione peroxidase (GPx), are significantly decreased in the maternal circulation of women with preeclampsia [ 4 ]. A simple in vitro model wherein endothelial cell monolayers are exposed to hypoxia/reoxygenation (H/R) is widely used to mimic the microvascular dysfunction that is induced by oxidative stress [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Fasudil attenuates soluble fms-like tyrosine kinase-1 (sFlt-1)-induced hypertension in pregnant mice through RhoA/ROCK pathway

Feng

et al. 2017

Oncotarget

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Preeclampsia (PE) has become the leading cause of maternal and fetal morbidity and mortality in the world, which is characterized by a systemic maternal inflammatory response associated with endothelial dysfunction, hypertension, and proteinuria. The development of PE is still barely predictable and thus challenging to prevent and manage clinically. Fasudil (FSD), the first-generation Rho/ROCK inhibitor, has been studied widely and applied in clinical practice with high safety and efficacy in treating hypertension and other cardiovascular diseases. However, few studies have focused on the effect of fasudil on preeclampsia in vivo and in vitro. Therefore, the aim of this study is to investigate the effects of fasudil on hypoxia/reoxygenation injury in vitro and its role on preeclamptic animal model. Here, we found that RhoA/ROCK pathway was significantly activated in H/R-challenged endothelial cells and in placenta and umbilical vessel of PE mice. And fasudil pre-treatment can protect vascular endothelial cells from H/R-induced apoptosis. In addition, inhibition of RhoA/ROCK pathway with fasudil can reduce the high blood pressure and urine protein levels as well as the concentration of s-Flt in peripheral and umbilical blood in a dose-dependent manner, thus resulting in prevention of the development of PE. Thus, Fasudil attenuates soluble fms-like tyrosine kinase-1 (sFlt-1)-induced hypertension in pregnant mice through RhoA/ROCK pathway, which would become a potential strategy for PE therapy.

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Efficacy of L-arginine for preventing preeclampsia in high-risk pregnancies: A double-blind, randomized, clinical trial

Abstract: L-arginine is effective for preventing preeclampsia.

Cited by 55 publications

References 22 publications

Targeting the vascular dysfunction: Potential treatments for preeclampsia

Targeting the vascular dysfunction: Potential treatments for preeclampsia

Clinical Procedures for the Prevention of Preeclampsia in Pregnant Women: A Systematic Review

Fasudil attenuates soluble fms-like tyrosine kinase-1 (sFlt-1)-induced hypertension in pregnant mice through RhoA/ROCK pathway

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