New Ideas for the Prevention and Treatment of Preeclampsia and Their Molecular Inspirations

Abstract

Preeclampsia (PE) is a pregnancy-specific disorder affecting 4–10% of all expectant women. It greatly increases the risk of maternal and foetal death. Although the main symptoms generally appear after week 20 of gestation, scientific studies indicate that the mechanism underpinning PE is initiated at the beginning of gestation. It is known that the pathomechanism of preeclampsia is strongly related to inflammation and oxidative stress, which influence placentation and provoke endothelial dysfunction in the mother. However, as of yet, no “key players” regulating all these processes have been discovered. This might be why current therapeutic strategies intended for prevention or treatment are not fully effective, and the only effective method to stop the disease is the premature induction of delivery, mostly by caesarean section. Therefore, there is a need for further research into new pharmacological strategies for the treatment and prevention of preeclampsia. This review presents new preventive methods and therapies for PE not yet recommended by obstetrical and gynaecological societies. As many of these therapies are in preclinical studies or under evaluation in clinical trials, this paper reports the molecular targets of the tested agents or methods.

Mesenchymal stem cell-derived exosomes: a promising alternative in the therapy of preeclampsia

“…PE can result in adverse maternal and fetal pregnancy outcomes, which are common pregnancy complications [ 3 ]. However, the treatment options for PE are limited, often leading to pregnancy termination due to ineffective control of disease progression [ 92 ]. MSC-Exos carry numerous proteins, nucleic acids, and lipids that can be transported across cell membranes to modify signal transduction and gene expression in the target cells [ 33 ], thereby regulating the biological function of the target cells and promoting angiogenesis by improving the function of trophoblasts and endothelial cells.…”

Exploring the role of exosomal MicroRNAs as potential biomarkers in preeclampsia

“…Traditionally, exercise, low-dose aspirin and calcium intake are recommended to prevent PE in high-risk women by professional societies ( 197 ). Nowadays, statins, etanercept, sulfasalazine, hydroxychloroquine, eculizumab, metformin, and proton pump inhibitors are gaining more and more attention from researchers ( 9 , 198 ). This review may provide a new idea for the prevention of PE.…”

The Management of Preeclampsia: A Comprehensive Review of Current Practices and Future Directions

“…The timing of initiation affects how well aspirin supplementation works. There is very minimal benefit to PE if it is started after 16 weeks of gestation [ 31 ].…”

“…HCQ inhibits NFĸB activity by blocking the phosphorylation of kappa B inhibitor, thereby downregulating inflammatory factors controlled by NFĸB. As a result of HCQ supplementation, cytotrophoblastic cells exhibit reduced sFlt1 secretion and increased proangiogenic factors [ 31 ]. Furthermore, HCQ's antithrombotic activity may prevent fibrin formation, mitigating the risk of placental insufficiency and PE development.…”

“…Furthermore, HCQ's antithrombotic activity may prevent fibrin formation, mitigating the risk of placental insufficiency and PE development. Numerous studies suggest that HCQ holds promise against PE, with findings indicating higher rates of live births, lower pregnancy morbidity, and reduced likelihood of PE development [ 31 ].…”