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Heras Benito M. [Implications of arginine-vasopressin and copeptin in normal gestation and in pre-eclampsia]. HIPERTENSION Y RIESGO VASCULAR 2024; 41:35-39. [PMID: 38388322 DOI: 10.1016/j.hipert.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/07/2023] [Accepted: 08/15/2023] [Indexed: 02/24/2024]
Abstract
Preeclampsia represents a specific complication of pregnancy hypertension, which appears de novo after the 20th week of gestation, accompanied by proteinuria and/or maternal or utero-placental organ dysfunction. Despite an uncertain etiopathogenesis, impaired vascular remodeling of the spiral artery and placental ischemia is the most widespread hypothesis. The finding of elevated levels of copeptin in women with preeclampsia compared to normal pregnant women has valued the involvement of arginine vasopressin in the etiopathogenesis of this complication. In this paper, its usefulness as a marker of preeclampsia is considered through the review of the main studies carried out with this molecule.
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Affiliation(s)
- M Heras Benito
- Servicio de Nefrología, Hospital Universitario de Salamanca, Salamanca, España.
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2
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Selective Serotonin Reuptake Inhibitor Use in Pregnancy and Protective Mechanisms in Preeclampsia. Reprod Sci 2023; 30:701-712. [PMID: 35984571 PMCID: PMC9944568 DOI: 10.1007/s43032-022-01065-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/11/2022] [Indexed: 01/25/2023]
Abstract
Depression and preeclampsia share risk factors and are bi-directionally associated with increased risk for each other. Despite epidemiological evidence linking selective serotonin reuptake inhibitors (SSRIs) in pregnancy to preeclampsia, serotonin (5-HT) and vasopressin (AVP) secretion mechanisms suggest that SSRIs may attenuate preeclampsia risk. However, there is a need to clarify the relationship between SSRIs and preeclampsia in humans to determine therapeutic potential. This retrospective cohort study included clinical data from 9558 SSRI-untreated and 9046 SSRI-treated pregnancies. In a subcohort of 233 pregnancies, early pregnancy (< 20 weeks) maternal plasma copeptin, an inert and stable AVP prosegment secreted 1:1 with AVP, was measured by enzyme-linked immunosorbent assay. Diagnoses and depression symptoms (Patient Health Questionnaire-9 [PHQ-9]) were identified via medical records review. Descriptive, univariate, and multivariate regression analyses were conducted (α = 0.05). SSRI use was associated with decreased preeclampsia after controlling for clinical confounders (depression severity, chronic hypertension, diabetes, body mass index, age) (OR = 0.9 [0.7-1.0], p = 0.05). Moderate-to-severe depression symptoms were associated with significantly higher copeptin secretion than mild-to-no depression symptoms (240 ± 29 vs. 142 ± 10 ng/mL, p < 0.001). SSRIs significantly attenuated first trimester plasma copeptin (78 ± 22 users vs. 240 ± 29 ng/ml non-users, p < 0.001). In preeclampsia, SSRI treatment was associated with significantly lower copeptin levels (657 ± 164 vs. 175 ± 134 ng/mL, p = 0.04). Interaction between SSRI treatment and preeclampsia was also significant (p = 0.04). SSRIs may modulate preeclampsia risk and mechanisms, although further studies are needed to investigate the relationships between 5-HT and AVP in depression and preeclampsia.
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3
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Szczepańska-Sadowska E, Żera T. Vasopressin: a possible link between hypoxia and hypertension. EXPLORATION OF MEDICINE 2022. [DOI: 10.37349/emed.2022.00103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Cardiovascular and respiratory diseases are frequently associated with transient and prolonged hypoxia, whereas hypoxia exerts pro-hypertensive effects, through stimulation of the sympathetic system and release of pressor endocrine factors. This review is focused on the role of arginine vasopressin (AVP) in dysregulation of the cardiovascular system during hypoxia associated with cardiovascular disorders. AVP is synthesized mainly in the neuroendocrine neurons of the hypothalamic paraventricular nucleus (PVN) and supraoptic nucleus (SON), which send axons to the posterior pituitary and various regions of the central nervous system (CNS). Vasopressinergic neurons are innervated by multiple neuronal projections releasing several neurotransmitters and other regulatory molecules. AVP interacts with V1a, V1b and V2 receptors that are present in the brain and peripheral organs, including the heart, vessels, lungs, and kidneys. Release of vasopressin is intensified during hypernatremia, hypovolemia, inflammation, stress, pain, and hypoxia which frequently occur in cardiovascular patients, and blood AVP concentration is markedly elevated in cardiovascular diseases associated with hypoxemia. There is evidence that hypoxia stimulates AVP release through stimulation of chemoreceptors. It is suggested that acting in the carotid bodies, AVP may fine-tune respiratory and hemodynamic responses to hypoxia and that this effect is intensified in hypertension. There is also evidence that during hypoxia, augmentation of pro-hypertensive effects of vasopressin may result from inappropriate interaction of this hormone with other compounds regulating the cardiovascular system (catecholamines, angiotensins, natriuretic peptides, steroids, nitric oxide). In conclusion, current literature indicates that abnormal mutual interactions between hypoxia and vasopressin may significantly contribute to pathogenesis of hypertension.
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Affiliation(s)
- Ewa Szczepańska-Sadowska
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Tymoteusz Żera
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, 02-097 Warsaw, Poland
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4
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Marek A, Stojko R, Drosdzol-Cop A. Copeptin in Patients with Pregnancy-Induced Hypertension. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126470. [PMID: 34203843 PMCID: PMC8296291 DOI: 10.3390/ijerph18126470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 11/25/2022]
Abstract
Pregnancy-induced hypertension (PIH) occurs in 6–8% of pregnancies, and increases the risk of many severe obstetric complications. The etiology of PIH has not been fully explained, and hence, treatment is only palliative in nature, and prevention is not fully effective. It has been proposed that PIH development is influenced by the arginine vasopressin pathway, whose surrogate biomarker is copeptin. The aim of this study is a prospective assessment of the relationship between the level of copeptin in pregnant women and the occurrence of PIH, and to identify its usefulness in predicting complications. The study involved a group of 21 pregnant women who developed PIH and 37 women with uncomplicated pregnancies as a control group. Blood samples were collected at the three trimesters of gestation (<13 HBD, between 13 and 26 and >26 HBD) and then frozen. Copeptin levels [pg/mL] were measured in serum samples obtained in the first, second and third trimesters of gestation from women in the PIH and control groups. The concentration of copeptin in the second and third trimesters of pregnancy was statistically significantly higher in the PIH group (p < 0.05). For copeptin determined in the first trimester, which could be used to screen for PIH, the area under the ROC curve was 0.650. The highest risk of PIH occurred in patients with high concentrations of copeptin in the first trimester of pregnancy and obesity OR = 5.5 (95% CI 1.0–31.3). The risk of PIH was augmented in patients with high levels of copeptin and an abnormal Doppler result of the uterine arteries OR = 28.4 (95% CI 5.3–152). In conclusion, copeptin levels were found to be elevated in pregnant women before the diagnosis of PIH; however, copeptin should not be used as a stand-alone marker. The combination of copeptin concentration with the other risk factors (diabetes, maternal age and preeclampsia in previous pregnancy) did not improve the diagnostic values of the use of copeptin in the PIH risk assessment, but the combination of copeptin concentration with BMI may be useful in clinical practice. Measurement of copeptin together with a Doppler examination of uterine arteries in the first trimester of pregnancy may be a useful marker in predicting the development of PIH.
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Bellos I, Pergialiotis V, Papapanagiotou A, Loutradis D, Daskalakis G. Association between serum copeptin levels and preeclampsia risk: A meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 250:66-73. [PMID: 32388342 DOI: 10.1016/j.ejogrb.2020.04.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/18/2020] [Accepted: 04/24/2020] [Indexed: 02/08/2023]
Abstract
The role of vasopressin in preeclampsia pathogenesis has been recently supported by experimental studies. This meta-analysis aims to accumulate literature evidence and evaluate whether serum copeptin levels differ among preeclamptic and healthy pregnant women. Medline, Scopus, CENTRAL, Web of Science and Google Scholar databases were systematically searched from inception. All observational studies reporting serum copeptin values among preeclamptic and healthy pregnant women were deemed eligible. Sixteen studies were included, comprising 2105 women. Preeclampsia was linked to significantly higher copeptin levels during the 1st (Standardized Mean Difference-SMD: 2.25, 95% Confidence Intervals-CI: 0.86-3.67), 2nd (SMD: 1.73, 95% CI: 0.31-3.14) and 3rd (SMD: 1.74, 95% CI: 0.96-2.53) trimester. This association was present for severe, non-severe, early and late-onset preeclampsia. Women with the severe form of the disease displayed significantly elevated copeptin levels (SMD: 1.47, 95% CI: 1.10-1.84) compared to those with the non-severe one, while no difference was evident between early and late-onset preeclampsia (SMD: -0.30, 95% CI: -0.91 to 0.31). In conclusion, the present meta-analysis suggests that preeclampsia is associated with significantly increased serum copeptin levels in all pregnancy trimesters, irrespective of disease severity and onset. Future large-scale cohort studies should confirm these findings and introduce cut-off values in order to clarify the exact accuracy of copeptin for the prediction of preeclampsia early in the course of pregnancy.
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Affiliation(s)
- Ioannis Bellos
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Vasilios Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Angeliki Papapanagiotou
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Loutradis
- First Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Daskalakis
- First Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Erfanian S, Yazdanpour L, Javeshghani D, Roustazadeh A. Association of arginine vasopressin (AVP) promoter polymorphisms with preeclampsia. Pregnancy Hypertens 2019; 18:122-125. [PMID: 31593833 DOI: 10.1016/j.preghy.2019.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 09/05/2019] [Accepted: 09/24/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Preeclampsia (PE) is a disease of pregnancy characterized by early onset of maternal hypertension and proteinuria. New findings indicate that arginine vasopressin (AVP) may be a contributing factor to ignite PE. The aim of this study was to identify if there is any correlation between arginine vasopressin promoter polymorphisms and PE. STUDY DESIGN Venous blood samples of 100 PE and 100 normal pregnant women were obtained for DNA extraction to identify the polymorphisms of AVP promoter by RFLP and nested-PCR techniques. MAIN OUTCOME rs3729965 polymorphism of PE women was detected to have significant correlation with body mass index (BMI) (P = 0.028). RESULTS Statistical analysis of three polymorphisms namely rs3729965, rs61138008 and rs3761249 of preeclamptic women (PEW) and none preeclamptic pregnant women (NPEW) revealed that rs3729965 genotypic distribution was significantly different between both groups (P = 0.04). Further analysis revealed that rs3729965 CT genotype of PEW had significant correlation to their BMI (P = 0.028). CONCLUSION Polymorphic variants located on the promoter region of AVP are associated with PE. Thus we hypothesize that allelic variation may have a role in increasing the risk of developing PE.
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Affiliation(s)
- Saiedeh Erfanian
- Research Center for Non-Communicable Diseases, Department of Advanced Medical Sciences and Technologies, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
| | | | - Danesh Javeshghani
- Department of Physiology, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Abazar Roustazadeh
- Department of Biochemistry, Department of Advanced Medical Sciences and Technologies, Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran.
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Gyselaers W, Thilaganathan B. Preeclampsia: a gestational cardiorenal syndrome. J Physiol 2019; 597:4695-4714. [PMID: 31343740 DOI: 10.1113/jp274893] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/13/2019] [Indexed: 12/12/2022] Open
Abstract
It is generally accepted today that there are two different types of preeclampsia: an early-onset or placental type and a late-onset or maternal type. In the latent phase, the first one presents with a low output/high resistance circulation eventually leading in the late second or early third trimester to an intense and acutely aggravating systemic disorder with an important impact on maternal and neonatal mortality and morbidity; the other type presents initially as a high volume/low resistance circulation, gradually evolving to a state of circulatory decompensation usually in the later stages of pregnancy, with a less severe impact on maternal and neonatal outcome. For both processes, numerous dysfunctions of the heart, kidneys, arteries, veins and interconnecting systems are reported, most of them presenting earlier and more severely in early- than in late-onset preeclampsia; however, some very specific dysfunctions exist for either type. Experimental, clinical and epidemiological observations before, during and after pregnancy are consistent with gestation-induced worsening of subclinical pre-existing chronic cardiovascular dysfunction in early-onset preeclampsia, and thus sharing the pathophysiology of cardiorenal syndrome type II, and with acute volume overload decompensation of the maternal circulation in late-onset preeclampsia, thus sharing the pathophysiology of cardiorenal syndrome type 1. Cardiorenal syndrome type V is consistent with the process of preeclampsia superimposed upon clinical cardiovascular and/or renal disease, alone or as part of a systemic disorder. This review focuses on the specific differences in haemodynamic dysfunctions between the two types of preeclampsia, with special emphasis on the interorgan interactions between heart and kidneys, introducing the theoretical concept that the pathophysiological processes of preeclampsia can be regarded as the gestational manifestations of cardiorenal syndromes.
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Affiliation(s)
- Wilfried Gyselaers
- Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.,Department Physiology, Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium
| | - Basky Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, UK.,Molecular and Clinical Sciences Research Institute, St George's University of London, UK
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Abstract
Pre-eclampsia is a common disorder that particularly affects first pregnancies. The clinical presentation is highly variable but hypertension and proteinuria are usually seen. These systemic signs arise from soluble factors released from the placenta as a result of a response to stress of syncytiotrophoblast. There are two sub-types: early and late onset pre-eclampsia, with others almost certainly yet to be identified. Early onset pre-eclampsia arises owing to defective placentation, whilst late onset pre-eclampsia may center around interactions between normal senescence of the placenta and a maternal genetic predisposition to cardiovascular and metabolic disease. The causes, placental and maternal, vary among individuals. Recent research has focused on placental-uterine interactions in early pregnancy. The aim now is to translate these findings into new ways to predict, prevent, and treat pre-eclampsia.
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Affiliation(s)
- Graham J Burton
- Department of Physiology, Development & Neuroscience, University of Cambridge, UK
- Centre for Trophoblast Research, University of Cambridge, UK
| | | | - James M Roberts
- Magee-Womens Research Institute, Depts. Obstetric Gynecology and Reproductive Sciences, Epidemiology, and Clinical and Translational Research, University of Pittsburgh, USA
| | - Ashley Moffett
- Centre for Trophoblast Research, University of Cambridge, UK
- Dept of Pathology, University of Cambridge, UK
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9
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Govender N, Moodley J, Naicker T. Copeptin in Preeclampsia Development. CURRENT WOMEN S HEALTH REVIEWS 2019. [DOI: 10.2174/1573404815666190110094636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background:
Preeclampsia complicates 2-8% of all pregnancies worldwide and is one of
the leading causes of maternal and neonatal morbidity and mortality. It occurs after the 20th week of
gestation and is characterized by high blood pressure, proteinuria or end-organ disease. The heterogeneous
and multi-systemic nature of this disease has led to the elusive pathophysiology which
delays timely diagnoses and the clinical treatment of those affected.
Objective:
Despite the extensive investigations surrounding the inclusion of various potential markers
for PE prediction, early diagnosis remains unresolved. Quantification of copeptin, a stable component
of the arginine vasopressin (AVP) precursor is shown to be relatively reliable in confirming
the circulating levels of AVP.
Conclusion:
Elevated copeptin levels confirmed in pregnant women have also provided clinical
support for its role in PE development. However, its clinical use in predicting disease severity in
early-onset pre-eclampsia has been debatable. This review thus recapitulates the current literature
surrounding copeptin and its potential as a risk indicator for PE development.</P>
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Affiliation(s)
- Nalini Govender
- Department of Basic Medical Sciences, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Jagidesa Moodley
- Women's Health and HIV Research Group, College of Health Sciences, University of Kwa Zulu-Natal, Durban, South Africa
| | - Thajasvarie Naicker
- Discipline of Optics and Imaging, College of Health Sciences, University of Kwa Zulu-Natal, Durban, South Africa
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10
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Maternal Venous Hemodynamic Dysfunction in Proteinuric Gestational Hypertension: Evidence and Implications. J Clin Med 2019; 8:jcm8030335. [PMID: 30862007 PMCID: PMC6462953 DOI: 10.3390/jcm8030335] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 02/26/2019] [Accepted: 03/05/2019] [Indexed: 01/21/2023] Open
Abstract
This review summarizes current knowledge from experimental and clinical studies on renal function and venous hemodynamics in normal pregnancy, in gestational hypertension (GH) and in two types of preeclampsia: placental or early-onset preeclampsia (EPE) and maternal or late-onset (LPE) preeclampsia, presenting at <34 weeks and ≥34 weeks respectively. In addition, data from maternal venous Doppler studies are summarized, showing evidence for (1) the maternal circulation functioning closer to the upper limits of capacitance than in non-pregnant conditions, with intrinsic risks for volume overload, (2) abnormal venous Doppler measurements obtainable in preeclampsia, more pronounced in EPE than LPE, however not observed in GH, and (3) abnormal venous hemodynamic function installing gradually from first to third trimester within unique pathways of general circulatory deterioration in GH, EPE and LPE. These associations have important clinical implications in terms of screening, diagnosis, prevention and management of gestational hypertensive diseases. They invite for further hypothesis-driven research on the role of retrograde venous congestion in the etiology of preeclampsia-related organ dysfunctions and their absence in GH, and also challenge the generally accepted view of abnormal placentation as the primary cause of preeclampsia. The striking similarity between abnormal maternal venous Doppler flow patterns and those observed at the ductus venosus and other abdominal veins of the intra-uterine growth restricted fetus, also invites to explore the role of venous congestion in the intra-uterine programming of some adult diseases.
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Sandgren JA, Deng G, Linggonegoro DW, Scroggins SM, Perschbacher KJ, Nair AR, Nishimura TE, Zhang SY, Agbor LN, Wu J, Keen HL, Naber MC, Pearson NA, Zimmerman KA, Weiss RM, Bowdler NC, Usachev YM, Santillan DA, Potthoff MJ, Pierce GL, Gibson-Corley KN, Sigmund CD, Santillan MK, Grobe JL. Arginine vasopressin infusion is sufficient to model clinical features of preeclampsia in mice. JCI Insight 2018; 3:99403. [PMID: 30282823 DOI: 10.1172/jci.insight.99403] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 08/17/2018] [Indexed: 12/29/2022] Open
Abstract
Copeptin, a marker of arginine vasopressin (AVP) secretion, is elevated throughout human pregnancies complicated by preeclampsia (PE), and AVP infusion throughout gestation is sufficient to induce the major phenotypes of PE in mice. Thus, we hypothesized a role for AVP in the pathogenesis of PE. AVP infusion into pregnant C57BL/6J mice resulted in hypertension, renal glomerular endotheliosis, intrauterine growth restriction, decreased placental growth factor (PGF), altered placental morphology, placental oxidative stress, and placental gene expression consistent with human PE. Interestingly, these changes occurred despite a lack of placental hypoxia or elevations in placental fms-like tyrosine kinase-1 (FLT1). Coinfusion of AVP receptor antagonists and time-restricted infusion of AVP uncovered a mid-gestational role for the AVPR1A receptor in the observed renal pathologies, versus mid- and late-gestational roles for the AVPR2 receptor in the blood pressure and fetal phenotypes. These findings demonstrate that AVP is sufficient to initiate phenotypes of PE in the absence of placental hypoxia, and indicate that AVP may mechanistically (independently, and possibly synergistically with hypoxia) contribute to the development of clinical signs of PE in specific subtypes of human PE. Additionally, they identify divergent and gestational time-specific signaling mechanisms that mediate the development of PE phenotypes in response to AVP.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Donna A Santillan
- Department of Obstetrics & Gynecology.,University of Iowa Hospitals & Clinics Center for Hypertension Research
| | - Matthew J Potthoff
- Department of Pharmacology.,University of Iowa Hospitals & Clinics Center for Hypertension Research.,François M. Abboud Cardiovascular Research Center.,Fraternal Order of Eagles' Diabetes Research Center, and.,Obesity Research & Education Initiative, University of Iowa, Iowa City, Iowa USA
| | - Gary L Pierce
- Department of Health & Human Physiology.,University of Iowa Hospitals & Clinics Center for Hypertension Research.,François M. Abboud Cardiovascular Research Center
| | - Katherine N Gibson-Corley
- Department of Pathology.,University of Iowa Hospitals & Clinics Center for Hypertension Research.,Fraternal Order of Eagles' Diabetes Research Center, and
| | - Curt D Sigmund
- Department of Pharmacology.,University of Iowa Hospitals & Clinics Center for Hypertension Research.,François M. Abboud Cardiovascular Research Center.,Fraternal Order of Eagles' Diabetes Research Center, and.,Obesity Research & Education Initiative, University of Iowa, Iowa City, Iowa USA
| | - Mark K Santillan
- Department of Obstetrics & Gynecology.,University of Iowa Hospitals & Clinics Center for Hypertension Research
| | - Justin L Grobe
- Department of Pharmacology.,University of Iowa Hospitals & Clinics Center for Hypertension Research.,François M. Abboud Cardiovascular Research Center.,Fraternal Order of Eagles' Diabetes Research Center, and.,Obesity Research & Education Initiative, University of Iowa, Iowa City, Iowa USA
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12
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Scroggins SM, Santillan DA, Lund JM, Sandgren JA, Krotz LK, Hamilton WS, Devor EJ, Davis HA, Pierce GL, Gibson-Corley KN, Sigmund CD, Grobe JL, Santillan MK. Elevated vasopressin in pregnant mice induces T-helper subset alterations consistent with human preeclampsia. Clin Sci (Lond) 2018; 132:419-436. [PMID: 29371289 PMCID: PMC5947858 DOI: 10.1042/cs20171059] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/03/2018] [Accepted: 01/04/2018] [Indexed: 01/08/2023]
Abstract
The pathogenesis of preeclampsia (PreE), a hypertensive disorder of pregnancy, involves imbalanced T helper (TH) cell populations and resultant changes in pro- and anti-inflammatory cytokine release. Elevated copeptin (an inert biomarker of arginine vasopressin (AVP)), secretion precedes the development of symptoms in PreE in humans, and infusion of AVP proximal to and throughout gestation is sufficient to initiate cardiovascular and renal phenotypes of PreE in wild-type C57BL/6J mice. We hypothesize that AVP infusion in wild-type mice is sufficient to induce the immune changes observed in human PreE. AVP infusion throughout gestation in mice resulted in increased pro-inflammatory interferon γ (IFNg) (TH1) in the maternal plasma. The TH17-associated cytokine interleukin (IL)-17 was elevated in the maternal plasma, amniotic fluid, and placenta following AVP infusion. Conversely, the TH2-associated anti-inflammatory cytokine IL-4 was decreased in the maternal and fetal kidneys from AVP-infused dams, while IL-10 was decreased in the maternal kidney and all fetal tissues. Collectively, these results demonstrate the sufficiency of AVP to induce the immune changes typical of PreE. We investigated if T cells can respond directly to AVP by evaluating the expression of AVP receptors (AVPRs) on mouse and human CD4+ T cells. Mouse and human T cells expressed AVPR1a, AVPR1b, and AVPR2. The expression of AVPR1a was decreased in CD4+ T cells obtained from PreE-affected women. In total, our data are consistent with a potential initiating role for AVP in the immune dysfunction typical of PreE and identifies putative signaling mechanism(s) for future investigation.
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Affiliation(s)
- Sabrina M Scroggins
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA 52242, U.S.A
- Center for Immunology and Immune Based Diseases, University of Iowa, Iowa City, IA 52242, U.S.A
| | - Donna A Santillan
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA 52242, U.S.A
- Center for Immunology and Immune Based Diseases, University of Iowa, Iowa City, IA 52242, U.S.A
- Center for Hypertension Research, University of Iowa, Iowa City, IA 52242, U.S.A
| | - Jenna M Lund
- Carver College of Medicine, University of Iowa, Iowa City, IA 52242, U.S.A
| | - Jeremy A Sandgren
- Carver College of Medicine, University of Iowa, Iowa City, IA 52242, U.S.A
- Department of Pharmacology, University of Iowa, Iowa City, IA 52242, U.S.A
| | - Lindsay K Krotz
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA 52242, U.S.A
| | - Wendy S Hamilton
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA 52242, U.S.A
| | - Eric J Devor
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA 52242, U.S.A
| | - Heather A Davis
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA 52242, U.S.A
| | - Gary L Pierce
- Center for Hypertension Research, University of Iowa, Iowa City, IA 52242, U.S.A
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, U.S.A
| | | | - Curt D Sigmund
- Center for Hypertension Research, University of Iowa, Iowa City, IA 52242, U.S.A
- Department of Pharmacology, University of Iowa, Iowa City, IA 52242, U.S.A
| | - Justin L Grobe
- Center for Hypertension Research, University of Iowa, Iowa City, IA 52242, U.S.A.
- Department of Pharmacology, University of Iowa, Iowa City, IA 52242, U.S.A
- Obesity Research and Education Initiative, University of Iowa, Iowa City, IA 52242, U.S.A
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA 52242, U.S.A
| | - Mark K Santillan
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA 52242, U.S.A.
- Center for Immunology and Immune Based Diseases, University of Iowa, Iowa City, IA 52242, U.S.A
- Center for Hypertension Research, University of Iowa, Iowa City, IA 52242, U.S.A
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13
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Joosen AM, van der Linden IJ, Schrauwen L, Theeuwes A, de Groot MJ, Ermens AA. Reference intervals and longitudinal changes in copeptin and MR-proADM concentrations during pregnancy. ACTA ACUST UNITED AC 2017; 56:113-119. [DOI: 10.1515/cclm-2017-0110] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/25/2017] [Indexed: 12/17/2022]
Abstract
Abstract
Background:
Vasopressin and adrenomedullin and their stable by-products copeptin and midregional part of proadrenomedullin (MR-proADM) are promising biomarkers for the development of preeclampsia. However, clinical use is hampered by the lack of trimester-specific reference intervals. We therefore estimated reference intervals for copeptin and MR-proADM in disease-free Dutch women throughout pregnancy.
Methods:
Apparently healthy low risk pregnant women were recruited. Exclusion criteria included current or past history of endocrine disease, multiple pregnancy, use of medication known to influence thyroid function and current pregnancy as a result of hormonal stimulation. Women who miscarried, developed hyperemesis gravidarum, hypertension, pre-eclampsia, hemolysis elevated liver enzymes and low platelets, diabetes or other disease, delivered prematurely or had a small for gestational age neonate were excluded from analyses. Blood samples were collected at 9–13 weeks (n=98), 27–29 weeks (n=94) and 36–39 weeks (n=91) of gestation and at 4–13 weeks post-partum (PP) (n=89). Sixty-two women had complete data during pregnancy and PP. All analyses were performed on a Kryptor compact plus.
Results:
Copeptin increases during pregnancy, but 97.5th percentiles remain below the non-pregnant upper reference limit (URL) provided by the manufacturer. MR-proADM concentrations increase as well during pregnancy. In trimesters 2 and 3 the 97.5th percentiles are over three times the non-pregnant URL provided by the manufacturer.
Conclusions:
Trimester- and assay-specific reference intervals for copeptin and MR-proADM should be used. In addition, consecutive measurements and the time frame between measurements should be considered as the differences seen with or in advance of preeclampsia can be expected to be relatively small compared to the reference intervals.
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Affiliation(s)
- Annemiek M.C.P. Joosen
- Laboratory of Clinical Chemistry and Haematology , Franciscus Gasthuis and Vlietland , Kleiweg 500 , 3045 PM Rotterdam , The Netherlands
| | | | - Lianne Schrauwen
- Laboratory of Clinical Chemistry and Haematology , Amphia Hospital , Breda , The Netherlands
| | - Alisia Theeuwes
- Laboratory of Clinical Chemistry and Haematology , Elisabeth-TweeSteden Hospital , Tilburg , The Netherlands
| | - Monique J.M. de Groot
- Laboratory of Clinical Chemistry and Haematology , Amphia Hospital , Breda , The Netherlands
- Laboratory of Clinical Chemistry and Haematology , Elisabeth-TweeSteden Hospital , Tilburg , The Netherlands
| | - Antonius A.M. Ermens
- Laboratory of Clinical Chemistry and Haematology , Amphia Hospital , Breda , The Netherlands
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Tayyar A, Temel Yuksel I, Koroglu N, Tanay Tayyar A, Alici Davutoglu E, Akkaya Firat A, Aslan Cetin B. Maternal copeptin levels in intrahepatic cholestasis of pregnancy. J Matern Fetal Neonatal Med 2017; 31:2066-2070. [DOI: 10.1080/14767058.2017.1335708] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Ahmet Tayyar
- Maternal-Fetal Medicine Unit, Istanbul Health Sciences University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Ilkbal Temel Yuksel
- Department of Obstetrics and Gynecology, Istanbul Health Sciences University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Nadiye Koroglu
- Department of Obstetrics and Gynecology, Istanbul Health Sciences University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Ahter Tanay Tayyar
- Department of Obstetrics and Gynecology, Istanbul Health Sciences University, Zeynep Kamil Maternity and Children’s Training and Research Hospital, Istanbul, Turkey
| | - Ebru Alici Davutoglu
- Department of Obstetrics and Gynecology, Istanbul Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Asuman Akkaya Firat
- Department of Biochemistry, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Berna Aslan Cetin
- Department of Obstetrics and Gynecology, Istanbul Health Sciences University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
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Conrad KP. G-Protein-coupled receptors as potential drug candidates in preeclampsia: targeting the relaxin/insulin-like family peptide receptor 1 for treatment and prevention. Hum Reprod Update 2016; 22:647-64. [PMID: 27385360 DOI: 10.1093/humupd/dmw021] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/16/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Important roles for G-protein-coupled receptors (GPCRs) have been identified in the maternal physiological adaptations to pregnancy and in the pathogenesis of preeclampsia. On this basis, GPCRs are potential therapeutic targets for preeclampsia. OBJECTIVES AND RATIONALE In this review, vasopressin and apelin are initially considered in this context before the focus on the hormone relaxin and its cognate receptor, the relaxin/insulin-like family peptide receptor 1 (RXFP1). Based on both compelling scientific rationale and a promising safety profile, the relaxin ligand-receptor system is comprehensively evaluated as a potential therapeutic endpoint in preeclampsia. SEARCH METHODS The published literature relating to the topic was searched through January 2016 using PubMed. OUTCOMES Relaxin is a peptide hormone secreted by the corpus luteum; it circulates in the luteal phase and during pregnancy. Activation of RXFP1 is vasodilatory; thus, relaxin supplementation is expected to at least partly restore the fundamental vasodilatory changes of normal pregnancy, thereby alleviating maternal organ hypoperfusion, which is a major pathogenic manifestation of severe preeclampsia. Specifically, by exploiting its pleiotropic hemodynamic attributes in preeclampsia, relaxin administration is predicted to (i) reverse robust arterial myogenic constriction; (ii) blunt systemic and renal vasoconstriction in response to activation of the angiotensin II receptor, type 1; (iii) mollify the action of endogenous vasoconstrictors on uterine spiral arteries with failed remodeling and retained smooth muscle; (iv) increase arterial compliance; (v) enhance insulin-mediated glucose disposal by promoting skeletal muscle vasodilation and (vi) mobilize and activate bone marrow-derived angiogenic progenitor cells, thereby repairing injured endothelium and improving maternal vascularity in organs such as breast, uterus, pancreas, skin and fat. By exploiting its pleiotropic molecular attributes in preeclampsia, relaxin supplementation is expected to (i) enhance endothelial nitric oxide synthesis and bioactivity, as well as directly reduce vascular smooth muscle cytosolic calcium, thus promoting vasodilation; (ii) improve the local angiogenic balance by augmenting arterial vascular endothelial and placental growth factor (VEGF and PLGF) activities; (iii) ameliorate vascular inflammation; (iv) enhance placental peroxisome proliferator-activated receptor gamma, coactivator 1 alpha (PCG1α) expression, and hence, peroxisome proliferator-activated receptor gamma (PPAR-γ) activity and (v) confer cytotrophoblast and endothelial cytoprotection. Insofar as impaired endometrial maturation (decidualization) predisposes to the development of preeclampsia, relaxin administration in the late secretory phase and during early pregnancy would be anticipated to improve decidualization, and hence trophoblast invasion and spiral artery remodeling, thereby reducing the risk of preeclampsia. Relaxin has a favorable safety profile both in the non-pregnant condition and during pregnancy. WIDER IMPLICATIONS There is a strong scientific rationale for RXFP1 activation in severe preeclampsia by administration of relaxin, relaxin analogs or small molecule mimetics, in order to mollify the disease pathogenesis for safe prolongation of pregnancy, thus allowing time for more complete fetal maturation, which is a primary therapeutic endpoint in treating the disease. In light of recent data implicating deficient or defective decidualization as a potential etiological factor in preeclampsia and the capacity of relaxin to promote endometrial maturation, the prophylactic application of relaxin to reduce the risk of preeclampsia is a plausible therapeutic approach to consider. Finally, given its pleiotropic and beneficial attributes particularly in the cardiovascular system, relaxin, although traditionally considered as a 'pregnancy' hormone, is likely to prove salutary for several disease indications in the non-pregnant population.
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Affiliation(s)
- Kirk P Conrad
- Department of Physiology and Functional Genomics and Department of Obstetrics and Gynecology, D.H. Barron Reproductive and Perinatal Biology Research Program, University of Florida, 1600 SW Archer Road, PO Box 100274 M522, Gainesville, FL 32610, USA
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