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Murali S, Miller K, McDermott M. Preeclampsia, eclampsia, and posterior reversible encephalopathy syndrome. HANDBOOK OF CLINICAL NEUROLOGY 2020; 172:63-77. [PMID: 32768095 DOI: 10.1016/b978-0-444-64240-0.00004-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Preeclampsia is a disorder of pregnancy associated with gestational hypertension and end-organ dysfunction. Patients with eclampsia, by definition, have seizures as part of the clinical syndrome. However, patients with preeclampsia can also have other neurologic symptoms and deficits. Both disorders can be associated with radiographic abnormalities similar to that of posterior reversible encephalopathy syndrome, suggesting a common pathophysiology or unified clinical spectrum of disorders. This chapter reviews the pathophysiology, clinical presentation, diagnostic findings, and prognosis of patients with neurologic complications associated with preeclampsia and eclampsia.
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Affiliation(s)
- Sadhana Murali
- Department of Neurology, University of Michigan Stroke Program, Ann Arbor, MI, United States
| | - Kristin Miller
- Department of Neurology, University of Illinois at Chicago, Stroke Program, Chicago, IL, United States
| | - Mollie McDermott
- Department of Neurology, University of Michigan Stroke Program, Ann Arbor, MI, United States.
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Qiao S, Wang F, Chen H, Jiang SW. Inducible knockout of Syncytin-A gene leads to an extensive placental vasculature deficiency, implications for preeclampsia. Clin Chim Acta 2017; 474:137-146. [PMID: 28935154 DOI: 10.1016/j.cca.2017.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 09/17/2017] [Accepted: 09/17/2017] [Indexed: 02/05/2023]
Abstract
Syncytin-1, a human endogenous retroviral envelope gene (HERVW1), is specifically expressed in placental trophoblasts and mediates the formation of syncytiotrophoblasts through a fusogenic activity. Syncytin-1 expression deficiency has been repeatedly observed in preeclamptic/IUGR placentas. Previous gene knockout studies indicated that in mice, complete syncytin-A null mouse embryos died in utero between 11.5 and 13.5days of gestation. However, the complete knockout model could not fully recapitulate the mid- to third-trimester, time-specific syncytin-1 deficiency in preeclampsia patients. To construct a preeclampsia model and to better investigate the function of syncytin in placental development, we created a mouse inducible knockout model of syncytin-1A gene. It was found that the disruption of syncytin-A at E11.5 to E17.5 is associated with significant morphological changes in placentas and fetuses. Moreover, syncytin-A disruption led to extensive vasculature abnormalities in the labyrinth, with irregular distribution and reduced number of fetal microvessels. Moreover, Syncytin-A knockout affected neovascularization-related gene expression in labyrinth and the maternal plasma level of sVEGFR-1, and a dramatic increase of sFlt-1/PlGF ratio. These findings indicate that syncytin-A may be involved in the placenta angiogenesis and potentially, the development of preeclampsia. The new model could be a useful tool for studying the pathogenesis and management of preeclampsia.
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Affiliation(s)
- Shan Qiao
- School of Basic Medical Science, Capital Medical University, Beijing 100069, China
| | - Fengchao Wang
- National Institute of Biological Sciences, Beijing 102206, China
| | - Haibin Chen
- Department of Histology and Embryology, Shantou University Medical College, Shantou 515041, China
| | - Shi-Wen Jiang
- School of Basic Medical Science, Capital Medical University, Beijing 100069, China; Department of Biomedical Science, Mercer University School of Medicine, Savannah, GA 30405, USA.
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van den Berg CB, Duvekot JJ, Güzel C, Hansson SR, de Leeuw TG, Steegers EAP, Versendaal J, Luider TM, Stoop MP. Elevated levels of protein AMBP in cerebrospinal fluid of women with preeclampsia compared to normotensive pregnant women. Proteomics Clin Appl 2016; 11. [PMID: 27615121 DOI: 10.1002/prca.201600082] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/03/2016] [Accepted: 09/08/2016] [Indexed: 11/09/2022]
Abstract
PURPOSE To investigate the cerebrospinal fluid (CSF) proteome of patients with preeclampsia (PE) and normotensive pregnant women, in order to provide a better understanding of brain involvement in PE. EXPERIMENTAL DESIGN Ninety-eight CSF samples (43 women with PE and 55 normotensive controls) were analyzed by LC-MS/MS proteome profiling. CSF was obtained during the spinal puncture before caesarean delivery. RESULTS Eight proteins were higher abundant and 17 proteins were lower abundant in patients with PE. The most significantly differentially abundant protein was protein AMBP (alpha-1-microglobulin/bikunin precursor). This finding was validated by performing an ELISA experiment (p = 0.002). CONCLUSIONS AND CLINICAL RELEVANCE The current study showed a clear difference between the protein profiles of CSF from patients with PE and normotensive pregnant women. Protein AMBP is a precursor of a heme-binding protein that counteracts the damaging effects of free hemoglobin, which may be related to the presence of free hemoglobin in CSF. Protein levels showed correlations with clinical symptoms during pregnancy and postpartum. To our knowledge, this is the first LC-MS/MS proteome profiling study on a unique set of CSF samples from (severe) preeclamptic patients and normotensive pregnant women.
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Affiliation(s)
- Caroline B van den Berg
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Coşkun Güzel
- Department of Neurology, Neuro-Oncology, Clinical and Cancer Proteomics Laboratory, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Stefan R Hansson
- Department of Obstetrics and Gynecology, Clinical Sciences, Lund University, Lund, Sweden
| | - Thomas G de Leeuw
- Department of Anaesthesiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Johannes Versendaal
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Theo M Luider
- Department of Neurology, Neuro-Oncology, Clinical and Cancer Proteomics Laboratory, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marcel P Stoop
- Department of Neurology, Neuro-Oncology, Clinical and Cancer Proteomics Laboratory, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Li Y, Jenny D, Castaldo J. Posterior Reversible Encephalopathy Syndrome: Clinicoradiological Spectrum and Therapeutic Strategies. Hosp Pract (1995) 2015; 40:202-13. [PMID: 22406896 DOI: 10.3810/hp.2012.02.961] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Yuebing Li
- Physician, Division of Neurology, Department of Medicine, Lehigh Valley Health Network, Allentown, PA 18103, USA
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Wallace K, Tremble SM, Owens MY, Morris R, Cipolla MJ. Plasma from patients with HELLP syndrome increases blood-brain barrier permeability. Reprod Sci 2014; 22:278-84. [PMID: 25194151 DOI: 10.1177/1933719114549844] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Circulating inflammatory factors and endothelial dysfunction have been proposed to contribute to the pathophysiology of hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. To date, the occurrence of neurological complications in these women has been reported, but few studies have examined whether impairment in blood-brain barrier (BBB) permeability or cerebrovascular reactivity is present in women having HELLP syndrome. We hypothesized that plasma from women with HELLP syndrome causes increased BBB permeability and cerebrovascular dysfunction. Posterior cerebral arteries from female nonpregnant rats were perfused with 20% serum from women with normal pregnancies (n = 5) or women with HELLP syndrome (n = 5), and BBB permeability and vascular reactivity were compared. Plasma from women with HELLP syndrome increased BBB permeability while not changing myogenic tone and reactivity to pressure. Addition of the nitric oxide (NO) synthase inhibitor N(ω)-nitro-L-arginine methyl ester caused constriction of arteries that was not different with the different plasmas nor was dilation to the NO donor sodium nitroprusside different between the 2 groups. However, dilation to the small- and intermediate-conductance, calcium-activated potassium channel activator NS309 was decreased in vessels exposed to HELLP plasma. Thus, increased BBB permeability in response to HELLP plasma was associated with selective endothelial dysfunction.
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Affiliation(s)
- Kedra Wallace
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sarah M Tremble
- Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, VT, USA Department of Obstetrics, Gynecology & Reproductive Sciences, University of Vermont College of Medicine, Burlington, VT, USA Department of Pharmacology, University of Vermont College of Medicine, Burlington, VT, USA
| | - Michelle Y Owens
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Rachael Morris
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Marilyn J Cipolla
- Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, VT, USA Department of Obstetrics, Gynecology & Reproductive Sciences, University of Vermont College of Medicine, Burlington, VT, USA Department of Pharmacology, University of Vermont College of Medicine, Burlington, VT, USA
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Schreurs MPH, Hubel CA, Bernstein IM, Jeyabalan A, Cipolla MJ. Increased oxidized low-density lipoprotein causes blood-brain barrier disruption in early-onset preeclampsia through LOX-1. FASEB J 2013; 27:1254-63. [PMID: 23230281 PMCID: PMC3574277 DOI: 10.1096/fj.12-222216] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 11/19/2012] [Indexed: 11/11/2022]
Abstract
Early-onset preeclampsia (EPE) is a severe form of preeclampsia that involves life-threatening neurological complications. However, the underlying mechanism by which EPE affects the maternal brain is not known. We hypothesized that plasma from women with EPE increases blood-brain barrier (BBB) permeability vs. plasma from women with late-onset preeclampsia (LPE) or normal pregnancy (NP) and investigated its underlying mechanism by perfusing cerebral veins from nonpregnant rats (n=6-7/group) with human plasma from women with EPE, LPE, or NP and measuring permeability. We show that plasma from women with EPE significantly increased BBB permeability vs. plasma from women with LPE or NP (P<0.001). BBB disruption in response to EPE plasma was due to a 260% increase of circulating oxidized LDL (oxLDL) binding to its receptor, LOX-1, and subsequent generation of peroxynitrite (P<0.001). A rat model with pathologically high lipid levels in pregnancy showed symptoms of preeclampsia, including elevated blood pressure, growth-restricted fetuses, and LOX-1-dependent BBB disruption, similar to EPE (P<0.05). Thus, we have identified LOX-1 activation by oxLDL and subsequent peroxynitrite generation as a novel mechanism by which disruption of the BBB occurs in EPE. As increased BBB permeability is a primary means by which seizure and other neurological symptoms ensue, our findings highlight oxLDL, LOX-1, and peroxynitrite as important therapeutic targets in EPE.
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Affiliation(s)
| | - Carl A. Hubel
- Department of Obstetrics, Gynecology, and Reproductive Sciences and
- Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ira M. Bernstein
- Department of Obstetrics, Gynecology, and Reproductive Sciences, and
| | - Arun Jeyabalan
- Department of Obstetrics, Gynecology, and Reproductive Sciences and
- Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marilyn J. Cipolla
- Department of Neurology
- Department of Obstetrics, Gynecology, and Reproductive Sciences, and
- Department of Pharmacology, University of Vermont College of Medicine, Burlington, Vermont, USA; and
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Kalamatianos T, Stavrinou LC, Koutsarnakis C, Psachoulia C, Sakas DE, Stranjalis G. PlGF and sVEGFR-1 in chronic subdural hematoma: implications for hematoma development. J Neurosurg 2013; 118:353-7. [DOI: 10.3171/2012.10.jns12327] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Object
A considerable body of evidence indicates that inflammation and angiogenesis play a significant role in the development and progression of chronic subdural hematoma (CSDH). While various experimental and clinical studies have implicated placental growth factor (PlGF) in the processes that underpin pathological angiogenesis, no study has thus far investigated its expression in CSDH. The actions of PlGF and its related proangiogenic vascular endothelial growth factor (VEGF) are antagonized by a high-affinity soluble receptor, namely soluble VEGF receptor–1 (sVEGFR-1), and thus the ratio between sVEGFR-1 and angiogenic factors provides an index of angiogenic capacity.
Methods
In the present study, using an automated electrochemiluminescence assay, levels of PlGF and sVEGFR-1 were quantified in serum and hematoma fluid obtained in 16 patients with CSDH.
Results
Levels of PlGF and sVEGFR-1 were significantly higher in hematoma fluid than in serum (p < 0.0001). In serum, levels of sVEGFR-1 were higher than those of PlGF (p < 0.0001), whereas in hematoma fluid this difference was not apparent. Furthermore, the ratio of sVEGFR-1 to PlGF was significantly lower in hematoma fluid than in serum (p < 0.0001).
Conclusions
Given previous evidence indicating a role for PlGF in promoting angiogenesis, inflammatory cell chemotaxis, and stimulation, as well as its ability to amplify VEGF-driven signaling under conditions favoring pathological angiogenesis, enhanced expression of PlGF in hematoma fluid suggests the involvement of this factor in the mechanisms of inflammation and angiogenesis in CSDH. Furthermore, a reduced ratio of sVEGFR-1 to PlGF in hematoma fluid is consistent with the proangiogenic capacity of CSDH. Future studies are warranted to clarify the precise role of PlGF and sVEGFR-1 in CSDH.
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Affiliation(s)
- Theodosis Kalamatianos
- 1Hellenic Centre of Neurosurgical Research “Professor Petros S. Kokkalis”
- 2Department of Neurosurgery, University of Athens; and
| | - Lampis C. Stavrinou
- 1Hellenic Centre of Neurosurgical Research “Professor Petros S. Kokkalis”
- 2Department of Neurosurgery, University of Athens; and
| | - Christos Koutsarnakis
- 1Hellenic Centre of Neurosurgical Research “Professor Petros S. Kokkalis”
- 2Department of Neurosurgery, University of Athens; and
| | | | - Damianos E. Sakas
- 1Hellenic Centre of Neurosurgical Research “Professor Petros S. Kokkalis”
- 2Department of Neurosurgery, University of Athens; and
| | - George Stranjalis
- 1Hellenic Centre of Neurosurgical Research “Professor Petros S. Kokkalis”
- 2Department of Neurosurgery, University of Athens; and
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Mary S, Patil GV, Kulkarni AV, Kulkarni MJ, Joshi SR, Mehendale SS, Giri AP. Dynamic proteome in enigmatic preeclampsia: an account of molecular mechanisms and biomarker discovery. Proteomics Clin Appl 2012; 6:79-90. [PMID: 22447695 DOI: 10.1002/prca.201100089] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The coevolution of genomics and proteomics has led to advancements in the field of diagnosis and molecular mechanisms of disease. Proteomics is now stepping into the field of obstetrics, where early diagnosis of pregnancy complication such as preeclampsia (PE) is imperative. PE is a multifactorial disease characterized by hypertension with proteinuria, which is a leading cause of maternal and neonatal morbidity and mortality occurring in 5-7% of pregnancies worldwide. This review discusses the probable molecular mechanisms that lead to PE and summarizes the proteomics research carried out in understanding the pathogenicity of PE, and for identifying the candidate biomarker for diagnosis of the disease.
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Affiliation(s)
- Sheon Mary
- Division of Biochemical Sciences, National Chemical Laboratory (CSIR), Pune, Maharashtra, India
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Xu Y, Zhang Y, Guo Z, Yin H, Zeng K, Wang L, Luo J, Zhu Q, Wu L, Zhang X, Chen D. Increased Placental Growth Factor in Cerebrospinal Fluid of Patients with Epilepsy. Neurochem Res 2011; 37:665-70. [DOI: 10.1007/s11064-011-0646-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 10/24/2011] [Accepted: 11/02/2011] [Indexed: 01/07/2023]
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Amburgey OA, Chapman AC, May V, Bernstein IM, Cipolla MJ. Plasma from preeclamptic women increases blood-brain barrier permeability: role of vascular endothelial growth factor signaling. Hypertension 2010; 56:1003-8. [PMID: 20855653 DOI: 10.1161/hypertensionaha.110.158931] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Circulating factors in preeclamptic women are thought to cause endothelial dysfunction and thereby contribute to the progression of this hypertensive condition. Despite the involvement of neurological complications in preeclampsia, there is a paucity of data regarding the effect of circulating factors on cerebrovascular function. Using a rat model of pregnancy, we investigated blood-brain barrier permeability, myogenic activity, and the influence of endothelial vasodilator mechanisms in cerebral vessels exposed intraluminally to plasma from normal pregnant or preeclamptic women. In addition, the role of vascular endothelial growth factor signaling in mediating changes in permeability in response to plasma was investigated. A 3-hour exposure to 20% normal pregnant or preeclamptic plasma increased blood-brain barrier permeability by ≈6.5- and 18.0-fold, respectively, compared with no plasma exposure (P<0.01). Inhibition of vascular endothelial growth factor receptor kinase activity prevented the increase in permeability in response to preeclamptic plasma but had no effect on changes in permeability of vessels exposed to normal pregnant plasma. Circulating factors in preeclamptic plasma did not affect myogenic activity or the influence of endothelium on vascular tone. These findings demonstrate that acute exposure to preeclamptic plasma has little effect on reactivity of cerebral arteries but significantly increases blood-brain barrier permeability. Prevention of increased permeability by inhibition of vascular endothelial growth factor signaling suggests that activation of this pathway may be responsible for increased blood-brain barrier permeability after exposure to preeclamptic plasma.
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Affiliation(s)
- Odül A Amburgey
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont College of Medicine, Burlington, VT, USA
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Nadarajah VD, Min RGLY, Judson JP, Jegasothy R, Ling EHP. Maternal plasma soluble fms-like tyrosine kinase-1 and placental growth factor levels as biochemical markers of gestational hypertension for Malaysian mothers. J Obstet Gynaecol Res 2010; 35:855-63. [PMID: 20149032 DOI: 10.1111/j.1447-0756.2009.01037.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To establish baseline levels of maternal plasma soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) among normotensive Malaysian mothers and to compare the marker levels between normotensives and mothers with gestational hypertension (GH). METHODS Plasma sFlt-1 and PlGF were measured by enzyme-linked immunosorbent assay in an unmatched, case-control study. The results were subjected to normality testing and analyzed by Mann-Whitney U-tests. RESULTS Among normotensive mothers, both sFlt-1and PlGF showed a general increase in levels from the 24th to 32nd weeks of pregnancy. PlGF levels in normotensive mothers with gestational diabetes mellitus were reduced compared to those without the disease, while levels of sFlt-1 were elevated. Mothers with GH had reduced levels of PlGF with increased levels of sFlt-1 when compared to normotensive mothers. Among the normotensive mothers followed up until delivery, the inversed pattern of reduced PlGF and increased sFlt-1 marker levels was found in 40% of those who developed GH later in pregnancy. CONCLUSIONS Plasma levels of sFlt-1and PlGF in normotensive mothers may be influenced by gestational diabetes mellitus and GH. GH mothers show an inversed pattern of marker levels compared to normotensive mothers.
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Affiliation(s)
- Vishna D Nadarajah
- Human Biology Section, International Medical University, Kuala Lumpur, Malaysia.
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Higa GM, Abraham J. Biological mechanisms of bevacizumab-associated adverse events. Expert Rev Anticancer Ther 2009; 9:999-1007. [PMID: 19589038 DOI: 10.1586/era.09.68] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The perception that inhibition of cancer-associated angiogenesis would be an effective treatment strategy was based on the fundamental difference in cell cycle activity between neoplastic and normal endothelial cells. Selective targeting of tumor vessels could have additional benefits, such as circumventing development of acquired resistance to these types of agents, overcoming intrinsic tumor resistance, exhibiting broad anti-tumor activity and decreasing normal tissue toxicity. Successful translation of anti-angiogenic therapy into the clinical setting was achieved only 5 years ago with the approval of bevacizumab for metastatic colorectal cancer. Although the benefits demonstrated in clinical trials led to the approval of bevacizumab for treatment of colorectal, lung and breast cancers, and most recently glioblastoma, a number of serious soft-tissue and vascular toxicities have also been observed in patients receiving this anti-angiogenic agent. This review assesses the relationship between inhibition of VEGF and toxicity, and proposes the pathogenic mechanisms that lead to the adverse events.
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Affiliation(s)
- Gerald M Higa
- Associate Professor, Schools of Pharmacy and Medicine and the Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, WV 26506, USA
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Deisenhammer F, Egg R, Giovannoni G, Hemmer B, Petzold A, Sellebjerg F, Teunissen C, Tumani H. EFNS guidelines on disease-specific CSF investigations. Eur J Neurol 2009; 16:760-70. [DOI: 10.1111/j.1468-1331.2009.02595.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bibliography. Current world literature. Women's health. Curr Opin Obstet Gynecol 2006; 18:666-74. [PMID: 17099340 DOI: 10.1097/gco.0b013e328011ef42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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