Role of angiogenic factors in the pathogenesis and management of pre‐eclampsia

Abstract

The cause of pre-eclampsia is unknown. Different postulates have been developed to explain its pathogenesis. The two-stage theory and angiogenic imbalance are two notable postulates of the disease. Together, they propose that there is a lack of cytotrophoblastic invasion of the uterine spiral arteries in pre-eclampsia. The lumen of these arteries remains narrow instead of converting to the wide channels seen in normal pregnancy, and result in poor placental perfusion. Coupled with maternal susceptibility, this process leads to the release of mediators, including an excess of anti-angiogenic factors that result in the clinical manifestations of the disease. Circulating levels of anti-angiogenic factors such as soluble fms-like tyrosine kinase-1 increase, whereas pro-angiogenic factors such as placental growth factor decrease. Assessment of the circulating concentrations of these angiogenic factors, such as the soluble fms-like tyrosine kinase-1/placental growth factor ratio, has diverse clinical relevance in pre-eclampsia. The present review describes the role of angiogenic factors in the pathogenesis and management of pre-eclampsia.

Magnesium Sulfate–Mediated Vascular Relaxation and Calcium Channel Activity in Placental Vessels Different From Nonplacental Vessels

“…This means when MgSO 4 is used for reducing maternal high blood pressure, vasorelaxation effects by the drug are relatively weaker in the placenta, which may benefit the maintenance of placental vascular tension for a sufficient local perfusion and circulation. Notably, a number of studies reported that preeclampsia is accompanied by poor placental perfusion and ischemia 21, 22…”

Preeclampsia – Prediction and Monitoring Factors

“…The vascular endothelial growth factor (VEGF) is proangiogenic factor mostly synthesized by endothelial cells, macrophages, T-cells, tumor cells and cytothrophoblast in response to stimulation by hypoxia or various mediators (interleukins, transforming growth factor β -TGF-β, platelet derived growth factors) (45). There are five members of VEGF family in mammals, VEGF-A, VEGF-B, VEGF-C, VEGF-D and placental growth factor (PlGF).…”

Preeklampsja – choroba kobiet w ciąży

“…Centralnym elementem w badaniu etiologii preeklampsji jest łożysko, gdyż jak wiadomo rozwiązanie ciąży i usunięcie łożyska jest konieczne w celu zlikwidowania objawów choroby [43,44]. Badanie łożyska pochodzącego od kobiet z zaawansowanym stanem preeklampsji pokazało, że występują w nim zwężone tętniczki oraz liczne obszary charakteryzujące się martwicą niedokrwienną [45].…”