Preeclampsia Phenotype Research Articles

EoPred: predicting the placental phenotype of early-onset preeclampsia using public DNA methylation data.

Background: A growing body of literature has reported molecular and histological changes in the human placenta in association with preeclampsia (PE). Placental DNA methylation (DNAme) and transcriptomic patterns have revealed molecular subgroups of PE that are associated with placental histopathology and clinical phenotypes of the disease. However, the clinical and molecular heterogeneity of PE both across and within subtypes complicates the study of this disease. PE is most strongly associated with placental pathology and adverse fetal and maternal outcomes when it develops early in pregnancy. We focused on placentae from pregnancies affected by preeclampsia that were delivered before 34weeks of gestation to develop eoPred, a predictor of the DNAme signature associated with the placental phenotype of early-onset preeclampsia (EOPE). Results: Public data from 83 placental samples (HM450K), consisting of 42 EOPE and 41 normotensive preterm birth (nPTB) cases, was used to develop eoPred-a supervised model that relies on a highly discriminative 45 CpG DNAme signature of EOPE in the placenta. The performance of eoPred was assessed using cross-validation (AUC = 0.95) and tested in an independent validation cohort (n = 49, AUC = 0.725). A subset of fetal growth restriction (FGR) and late-PE cases showed a similar DNAme profile at the 45 predictive CpGs, consistent with the overlap in placental pathology between these conditions. The relationship between the EOPE probability generated by eoPred and various phenotypic variables was also assessed, revealing that it is associated with gestational age, and it is not driven by cell composition differences. Conclusion: eoPred relies on a 45-CpG DNAme signature to predict a homogeneous placental phenotype of EOPE in a discrete or continuous manner. Using this classifier should 1) aid in the study of placental insufficiency and improve the consistency of future placental DNAme studies of PE, 2) facilitate identifying the placental phenotype of EOPE in public data sets and 3) importantly, standardize the placental diagnosis of EOPE to allow better cross-cohort comparisons. Lastly, classification of cases with eoPred will be useful for investigating the relationship between placental pathology and genetic or environmental variables.

Abstract P206: Novel Dual-function Redox Modulator Therapy For Preeclampsia

Introduction: Preeclampsia is a hypertensive disorder of pregnancy which is associated with substantial morbidity for the mother and fetus. Reduced nitric oxide bioavailability and oxidative stress are key in the maternal and fetal pathophysiology of preeclampsia. Method: In this study, we assessed the potential therapeutic effect and mechanisms of action of a novel dual-function nitric oxide donor/redox modulator, AKT-1005, in an animal model of Ad.sFlt1-induced hypertension, proteinuria, and glomerular endotheliosis. Ad.sFlt1-overexpressing CD1 mice were treated via minipump with AKT-1005 (20 mg/kg) or vehicle (n=15 per group). Results: Treatment with AKT-1005 for 7 days significantly reduced sFlt1-induced hypertension and endotheliosis of the kidney glomeruli. Kidney function was also assessed by cystatin C ELISA, which showed significant reduction in AKT-1005 treated mice compared to controls. AKT-1005 treatment increased NO bioavailabilty as assessed by Griess method. The increase of free plasma sEndoglin (anti-angiogenic factor) following Ad.sFlt-1 was ameliorated after treatment with AKT-1005. Similarly, sEndoglin expression in placental tissue was reduced in the AKT-1005 treated group, which correlated with improved placental histology, reduced oxidative stress and increased endothelial expression of CD31. Moreover, wire myography studies in female mesenteric vessels have shown vasodilating capacity of AKT-1005. Conclusion: Our findings suggest that AKT-1005 significantly extenuates the sFlt-1-induced preeclampsia phenotypes by inhibiting oxidative stress, anti-angiogenic response, and increasing NO bioavailability. Further studies are needed to assess safety and efficacy of this type of dual-function redox-modulator therapy in animal models. Additional research is warranted to investigate the role of AKT-1005 as a novel therapeutic agent for vascular disorders such as preeclampsia.

Relationship between STOX1 gene variations and preeclampsia in Turkish population

Preeclampsia (PE) is a common pregnancy disease that occurs in the second trimester of pregnancy and is characterized by high blood pressure and proteinuria. Recent studies have shown that the STOX1 gene, which is associated with the FOX multigene family and expressed in the early placenta, can directly affect the PE phenotype. STOX1 is a transcription factor that affects the high prevalence of human gestational disease by targeting genes in the pathways that affect cell proliferation and migration. In this study, the effects of STOX1 gene variations Y153H and -922 T > C polymorphisms, previously associated with PE by our team, were evaluated on each other and the disease phenotype. In the study, the results obtained from our previous polymorphism studies were used. As a result of statistical analysis, it was observed that STOX1 Y153H and -922 T > C variations were effective together in the development of early-onset Preeclampsia (EOPE). Our in-silico analysis revealed the deleterious impact of the mutation on the structure and function of the protein. Although PE is a disease that occurs with pregnancy and shows its effects mostly during this period, it has been stated that women and children with a history of PE are more prone to various disorders, especially cardiovascular disease in the following years. Therefore, understanding the pathogenesis of the disease is important for both prevention and treatment process. The variations on STOX1 gene appear to be important in terms of disease risk.

Mitochondrial-targeted antioxidant attenuates preeclampsia-like phenotypes induced by syncytiotrophoblast-specific Gq signaling

Generalized cellular ‘stress’ (i.e., oxidative, mitochondrial) within the syncytiotrophoblast (STB) layer of placenta is theorized to drive the pathogenesis of preeclampsia (PE), but the causes and consequences of this stress have yet to be clearly elucidated. Many hormones implicated in the disorder signal through the Gq pathway and have been associated with placental oxidative damage and maternal symptoms. Here, we provide novel evidence of elevated Gq stimulation (n=8-10 normalized area PLCB protein, control 1340±370, PE 3350±750, P=0.04) and an antioxidant response (n=8 normalized area SOD2 protein, control 3020±1160, PE 6700±1250, P=0.04) within STB cells of PE placenta. Thus, we hypothesized excess STB-specific Gq signaling would be sufficient to cause phenotypes of PE and that administration of a mitochondrial-targeted antioxidant (mitoquinone) would mitigate these effects. Activation of the Gq cascade in STB cells was achieved by crossing dams harboring a Cre-dependent Gq-coupled DREADD (hM3Dq) with Gcm1-Cre+/- sires and injecting clozapine N-oxide (CNO) or saline mid-gestation (GD12.5-14.5) before tissue collection at GD14.5. Gq stimulation increased mean arterial pressure (n=6-8, CNO 115±2mmHg, saline 110±2mmHg, GD 13-16.5, P=0.04), exacerbated urine protein excretion (n=9-11 CNO 43±4mg/d, saline 28±3mg/day, P=0.001), and elevated circulating pro-inflammatory factors (MCP5, LIX, TIMP1, MIP3B, GCSF, IL12p40, MDC, P<0.05). Placental assessments revealed decreased labyrinth vascularization (n=10 CD31-positive area, Cre+ 19±1%, Cre– 24±1%, saline 23±1%, P<0.01 Cre+ vs. each), diminished spiral artery diameter (n=7-12 Cre+ 113±10μm, saline 149±12μm, P=0.03), and augmented oxidant defenses to mitochondrial-derived superoxide (n=7-9 normalized area SOD2 protein, Cre+ 18.2±3, saline 4.5±0.4, P=0.003; RNA sequencing enrichment of genes related to superoxide metabolic process, FDR=0.09). Remarkably, administration of mitoquinone in CNO-injected pregnancies reduced urine protein excretion (22±4mg/day, P=0.005), decreased circulating pro-inflammatory factors (LIX, IL12p40, MDC, P<0.05), attenuated plasma sFLT1 (P=0.048), and maintained placental vascularization (n=8 CD31-positive labyrinth, 23±1%, P=0.04; n=7 spiral artery diameter, 164±18 μm P=0.02). These data support a causative relationship between syncytiotrophoblast stress and the development of preeclampsia and identify elevated Gαq signaling as a contributing mechanism involving mitochondrial-derived reactive oxygen species. NIH: HL134850, HL084207, DK133121, HL150340; AHA: 826132, 18EIA33890055 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Adoptive transfer of CD4+ T cells from women with preeclampsia with or without a history of COVID during pregnancy contribute to hypertension, AT1-AA, and neurovascular dysfunction in pregnant rats

Objective: Preeclampsia (PE) is characterized by new onset hypertension during pregnancy and is associated with chronic inflammation and neurovascular dysfunction. The inflammation in PE includes activated CD4+ T cells and B cells producing agonistic antibodies against the angiotensin II type 1 receptor (AT1AA) which has also been shown to be produced in patients with COVID-19 (CV) infection. Interestingly, having had CV during pregnancy increases the incidence of a PE-like phenotype in that pregnancy. Both PE and CV have long lasting neurological implications and we have shown that AT1AA mediates neurovascular dysfunction in PE. Moreover, we have shown that CD4+ T cells from women with PE induce a PE syndrome in pregnant athymic nude recipient rats. Although CD4+T cells have been shown to contribute to neurovascular dysfunction, we do not know the role of CD4+ T cells in contributing to neurovascular dysfunction in PE or in patients with a history (Hx) CV during pregnancy. Therefore, we sought examine a role for CD4+ T cells from PE with or without a CV Hx to contribute to AT1AA in pregnancy as well as hypertension and cerebrovascular dysfunction postpartum. We utilized adoptive transfer of placental CD4+ T cells from PE and normotensive (NT) patients with or without a CV Hx during pregnancy into athymic nude recipient rats and determined the presence of a PE phenotype during pregnancy or postpartum. Methods: CD4+ T cells were isolated from placentas of normal pregnant (NP), PE, CV Hx normotensive (CV Hx NT), and Hx of CV with PE (CV Hx PE) at delivery. One million CD4+ T cells were injected i.p. into gestational day (GD) 12 nude athymic rats. At GD19 blood samples were collected to measure AT1AA by cardiomyocyte assay. At three months postpartum, MAP and CBF were measured by arterial catheter and laser Doppler flowmetry. A two-way ANOVA was used for statistical analysis. Results: In pregnant recipient rats, AT1AA was increased in PE (8±2 ΔBPM, n=4) and CV Hx PE (4±2 ΔBPM, n=4) compared to NP (-3±2 ΔBPM, n=4, p<0.05) and CV Hx NT (2±2 ΔBPM, n=2) respectively. At 3 months postpartum, MAP was increased in PE (115±2 mmHg, n=5) and CV Hx PE (111±4, n=4) compared to NP (99±3 mmHg, n=4 p<0.05) and CV Hx NT (100±4, n=5). PE and CV Hx PE had impaired autoregulation of CBF compared to CV Hx NT and NP rats. Conclusion: Our findings indicate that CD4+ T cells from PE or CV HX PE patients cause AT1-AA in pregnancy as well as hypertension and impaired CBF 3 months postpartum. Collectively, the data demonstrates that CD4+ T cells cause hypertension and inflammation in PE or CV Hx PE and may contribute to neurovascular dysfunction in patients with previous PE or CV Hx PE during pregnancy. RO1HD067541-06, P20GM121334, and AHA 19CDA34670055 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Expression of the serotonergic system components in the placenta in various types of preeclampsia

BACKGROUND: The serotonergic system plays an important role in the formation and development of the feto-placental complex. The study of the expression of the serotonin system components, including placental 5-HT2A (serotonin receptor) and SERT (serotonin transporter), in preeclampsia will create prerequisites for discovering new ways to correct hypertensive pregnancy complications and methods of influencing pregnancy outcomes.
 AIM: The aim of this study was to compare the expressions of 5-HT2A and SERT in placental tissue in pure preeclampsia and its combinations with other complications of pregnancy.
 MATERIALS AND METHODS: A comparative cohort study was conducted among patients with different preeclampsia phenotypes: preeclampsia (n = 6), preeclampsia and gestational diabetes mellitus (n = 6), gestational diabetes mellitus and superimposed preeclampsia (preeclampsia + chronic arterial hypertension) (n = 6), and normal pregnancy without pregnancy complications (n = 6). The expression of 5-HT2A (Abcam, USA) and SERT (BiossAntibodies, USA) was studied in placenta samples from all study groups by immunohistochemical method. Morphometric analysis was performed using the VideoTest-Morphology 5.2 program (Videotest Ltd., Russia). The database was constructed and statistical processing was performed using Microsoft Excel 2007 (Microsoft Corporation, USA) and the StatTech program v. 2.6.4 (Stattech Ltd., Russia).
 RESULTS: The expression of SERT and 5-HT2A is higher in the studied pregnancy complications when compared to the normal one. The relative 5-HT2A expression area in the placenta among the studied nosologies is higher in preeclampsia without gestational diabetes mellitus or in superimposed preeclampsia in combination with chronic arterial hypertension compared to expression in placentas in preeclampsia in combination with gestational diabetes mellitus or in preeclampsia in combination with gestational diabetes mellitus and chronic arterial hypertension (p = 0.02 and p = 0.017, respectively). The relative area of SERT expression is higher in preeclampsia without gestational diabetes mellitus or chronic arterial hypertension and in preeclampsia in combination with gestational diabetes mellitus compared to preeclampsia in combination with gestational diabetes mellitus and chronic arterial hypertension (p = 0.002 and p = 0.012, respectively).
 CONCLUSIONS: The highest expressions of 5-HT2A and SERT among the studied preeclampsia phenotypes were found in placentas in preeclampsia without gestational diabetes mellitus or chronic arterial hypertension.

Definition and Quantification of Three-Dimensional Imaging Targets to Phenotype Pre-Eclampsia Subtypes: An Exploratory Study

Pre-eclampsia is a severe placenta-related complication of pregnancy with limited early diagnostic and therapeutic options. Aetiological knowledge is controversial, and there is no universal consensus on what constitutes the early and late phenotypes of pre-eclampsia. Phenotyping of native placental three-dimensional (3D) morphology offers a novel approach to improve our understanding of the structural placental abnormalities in pre-eclampsia. Healthy and pre-eclamptic placental tissues were imaged with multiphoton microscopy (MPM). Imaging based on inherent signal (collagen, and cytoplasm) and fluorescent staining (nuclei, and blood vessels) enabled the visualization of placental villous tissue with subcellular resolution. Images were analysed with a combination of open source (FIJI, VMTK, Stardist, MATLAB, DBSCAN), and commercially (MATLAB) available software. Trophoblast organization, 3D-villous tree structure, syncytial knots, fibrosis, and 3D-vascular networks were identified as quantifiable imaging targets. Preliminary data indicate increased syncytial knot density with characteristic elongated shape, higher occurrence of paddle-like villous sprouts, abnormal villous volume-to-surface ratio, and decreased vascular density in pre-eclampsia compared to control placentas. The preliminary data presented indicate the potential of quantifying 3D microscopic images for identifying different morphological features and phenotyping pre-eclampsia in placental villous tissue.

Heterogenous Differences in Cellular Senescent Phenotypes in Pre-Eclampsia and IUGR following Quantitative Assessment of Multiple Biomarkers of Senescence

Premature ageing of the placenta in pregnancy outcomes is associated with the persistent presence of oxidative stress and placental insufficiency reducing its functional capacity. In this study, we investigated cellular senescence phenotypes of pre-eclampsia and IUGR pregnancies by simultaneously measuring several biomarkers of senescence. Maternal plasma and placental samples were collected at term gestation from nulliparous women undergoing pre-labour elective caesarean section with pre-eclampsia without intrauterine growth restriction (PE; n = 5), pre-eclampsia associated with intrauterine growth restriction (n = 8), intrauterine growth restriction (IUGR < 10th centile; n = 6), and age-matched controls (n = 20). Placental absolute telomere length and senescence gene analysis was performed by RTqPCR. The expression of cyclin-dependent kinase inhibitors (p21 and p16) was determined by Western blot. Senescence-associated secretory phenotypes (SASPs) were evaluated in maternal plasma by multiplex ELISA assay. Placental expression of senescence-associated genes showed significant increases in CHEK1, PCNA, PTEN, CDKN2A, and CCNB-1 (p < 0.05) in pre-eclampsia, while TBX-2, PCNA, ATM, and CCNB-1 expression were evident (p < 0.05) and were significantly decreased in IUGR compared with controls. Placental p16 protein expression was significantly decreased in pre-eclampsia only compared with controls (p = 0.028). IL-6 was significantly increased in pre-eclampsia (0.54 pg/mL ± 0.271 vs. 0.3 pg/mL ± 0.102; p = 0.017) while IFN-γ was significantly increased in IUGR (4.6 pg/mL ± 2.2 vs. 2.17 pg/mL ± 0.8; p = 0.002) compared with controls. These results provide evidence of premature senescence in IUGR pregnancies, and while cell cycle checkpoint regulators are activated in pre-eclampsia, the cellular phenotype is one of cell repair and subsequent proliferation rather than progression to senescence. The heterogeneity of these cellular phenotypes highlights the complexity of characterising cellular senescence and may equally be indicative of the differing pathophysiological insults unique to each obstetric complication.

Comparison of different modified operations in the reduced uteroplacental perfusion pressure rat model of preeclampsia

IntroductionAnimal models are indispensable tools in studying the mechanisms underlying the diseases. Rat models with reduced uterine perfusion pressure (RUPP) were able to mimic the pathophysiological traits of placental ischemia and hypoxia in preeclampsia (PE). However, ischemic injury can lead to a cascade of damage to lower limb ischemia in RUPP. Therefore, the aim of our study was to compare three modified surgical procedures of reducing uteroplacental perfusion pressure, and to provide a reference for the recognition of different PE phenotypes in the future. Material and methodsTo establish a specific uteroplacental malperfusion model of PE in rats, we bilaterally ligated uterine vessels (UU), ovarian vessels distal to ovarian branches (OO), or both (sRUPP) at 13.5 days post coitum. 21 Sprague-Dawley rats in total were used and were divided into four groups: Sham (n = 4), UU (n = 6), OO (n = 5) and sRUPP (n = 8). ResultsThe results showed that the OO and sRUPP groups could successfully mimic the phenotypes of PE while UU group not. Then, autophagy, apoptosis, and synthesis of unsaturated fatty acids were increased in both the OO and sRUPP groups compared with the Sham group, while inflammation were not statistically different. ConclusionsThe OO and sRUPP groups could successfully establish the rat model of PE while the UU group not. Notably, between the OO and sRUPP groups, the OO group has a higher fetal survival rate and might be more suitable for studying fetal-related questions, while the sRUPP group has a heavier phenotypic profile and is more suitable for studying maternal phenotypes related to PE.

Adverse maternal outcomes of patients with preeclampsia complicated by fetal growth restriction

It has been suggested that fetal growth restriction (FGR) is associated with a more severe preeclampsia phenotype. We sought to determine whether the presence of FGR among women with preeclampsia was associated with increased odds of adverse maternal outcomes compared to those without FGR.

PS-B12-10: CLASSIC CARDIOVASCULAR PROTECTIVE SIGNALING IN ANGIOTENSIN II-INDUCED NOVEL PREECLAMPSIA RAT MODEL

Angiotensin II (Ang II)-induces vasoconstriction, in vivo perfusion has been shown to induce preeclampsia (PE) in pregnant rats. In this study, we aimed to examine the protein and mRNA expressions of endothelial and neuronal NOS (eNOS, nNOS) as well as angiotensin II type 2 receptor (AT2R) in normal pregnant and Ang II-induced PE rats. Pregnant (8 weeks) and non-pregnant SD rats (8 weeks, GD-8) were infused with Ang II via an osmotic minipump (1 ug/kg/min), and the rats (GD-21) were sacrificed 13 days later. Pregnant and non-pregnant rats without Ang II were taken as sham controls. The fetal weight, crown-rump length and placental weight of PE rats were significantly lower compared to those without Ang II infusion. Immunohistochemistry results showed an approximately 30% increase in glomerular volume, suggesting morphological changes in the kidney and Ang II infusion exhibits a PE phenotype. Ang II infusion did not affect AT2R, AT1R and nNOS protein or mRNA expression in the uterus of non-pregnant or pregnant rats. However, eNOS mRNA expression was reduced in PE rats (p &lt; 0.0001) although protein expression was not affected by Ang II infusion. However, in the placenta, AT1R and AT2R protein expression were not different in PE, but AT2R mRNA was decreased (p &lt; 0.0001). eNOS protein was only expressed in fetal vascular endothelial cells, and eNOS protein expression was higher in PE rats (P = 0.001) but eNOS mRNA was decreased (p = 0.0096). Notably, strong nNOS expression was observed in placental trophoblast cell groups of sham and PE rats, and both mRNA and protein expression of nNOS was decreased in placental lysates of Ang II rats (respectively p = 0.0287 and p &lt; 0.0001). These results demonstrate that we have recapitulated the PE model of Ang II infusion in rats. The expression of nNOS was reduced, and the localization of nNOS in the trophoblast suggested a new functional remodeling in the fetal vasculature. In the placenta, decreased expression of AT2R and nNOS may be a novel mechanism of impaired fetal development.

CD4+ T-Cells cause cognitive dysfunction in preeclampsia or COVID-19 infection in a pregnant rat model

Preeclampsia (PE), new onset hypertension (HTN) during pregnancy, is associated with increased cerebral blood flow (CBF), impaired cognitive function, and memory loss. We have shown adoptive transfer of placental CD4+ T cells from PE women into athymic nude pregnant rats causes HTN and increased circulating factors associated with PE. COVID-19 (CV) during pregnancy is associated with increased diagnosis of PE. However, the role of CD4+ T cells stimulated in response to CV in contributing to the PE phenotype in patients with a Hx of CV during pregnancy is unknown.

Soluble suppression of tumorigenicity-2 in pregnancy with a small-for-gestational-age fetus and with preeclampsia

Objective Preeclampsia and fetal growth disorders are pregnancy-specific conditions that share common pathophysiological mechanisms. Yet, why some patients develop preeclampsia while others experience fetal growth restriction, or a combination of both clinical presentations, is unknown. We propose that the difference in severity of the maternal inflammatory response can contribute to the clinical phenotypes of preeclampsia vs. small for gestational age (SGA). To assess this hypothesis, we measured maternal plasma concentrations of the soluble isoform of suppression of tumorigenicity-2 (sST2), a member of the interleukin-1 receptor family that buffers proinflammatory responses. Previous reports showed that serum sST2 concentrations rise in the presence of intravascular inflammation and Th1-type immune responses and are significantly higher in patients with preeclampsia compared to those with normal pregnancy. The behavior of sST2 in pregnancies complicated by SGA has not been reported. This study was conducted to compare sST2 plasma concentrations in normal pregnancies, in those with preeclampsia, and in those with an SGA fetus. Methods This retrospective cross-sectional study included women with an SGA fetus (n = 52), women with preeclampsia (n = 106), and those with normal pregnancy (n = 131). Maternal plasma concentrations of sST2 were determined by enzyme-linked immunosorbent assay. Doppler velocimetry of the uterine and umbilical arteries was available in a subset of patients with SGA (42 patients and 43 patients, respectively). Results (1) Women with an SGA fetus had a significantly higher median plasma concentration of sST2 than normal pregnant women (p = .008); (2) women with preeclampsia had a significantly higher median plasma concentration of sST2 than those with normal pregnancy (p < .001) and those with an SGA fetus (p < .001); (3) patients with SGA and abnormal uterine artery Doppler velocimetry had a higher median plasma concentration of sST2 than controls (p < .01) and those with SGA and normal uterine artery Doppler velocimetry (p = .02); (4) there was no significant difference in the median plasma sST2 concentration between patients with SGA who had normal uterine artery Doppler velocimetry and controls (p = .4); (5) among patients with SGA, those with abnormal and those with normal umbilical artery Doppler velocimetry had higher median plasma sST2 concentrations than controls (p = .001 and p = .02, respectively); and (6) there was no significant difference in the median plasma sST2 concentrations between patients with SGA who did and those who did not have abnormal umbilical artery Doppler velocimetry (p = .06). Conclusions Preeclampsia and disorders of fetal growth are conditions characterized by intravascular inflammation, as reflected by maternal plasma concentrations of sST2. The severity of intravascular inflammation is highest in patients with preeclampsia.

Maternal plasma proteome profiling of biomarkers and pathogenic mechanisms of early-onset and late-onset preeclampsia

Preeclampsia is still the leading cause of morbidity and mortality in pregnancy without a cure. There are two phenotypes of preeclampsia, early-onset (EOPE) and late-onset (LOPE) with poorly defined pathogenic differences. This study aimed to facilitate better understanding of the mechanisms of pathophysiology of EOPE and LOPE, and identify specific biomarkers or therapeutic targets. In this study, we conducted an untargeted, label-free quantitative proteomic analyses of plasma samples from pregnant women with EOPE (n = 17) and LOPE (n = 11), and age, BMI-matched normotensive controls (n = 18). Targeted proteomics approach was also employed to validate a subset of proteins (n = 17). In total, there were 26 and 20 differentially abundant proteins between EOPE or LOPE, and normotensive controls, respectively. A series of angiogenic and inflammatory proteins, including insulin-like growth factor-binding protein 4 (IGFBP4; EOPE: FDR = 0.0030 and LOPE: FDR = 0.00396) and inter-alpha-trypsin inhibitor heavy chain H2-4 (ITIH2-4), were significantly altered in abundance in both phenotypes. Through validation we confirmed that ITIH2 was perturbed only in LOPE (p = 0.005) whereas ITIH3 and ITIH4 were perturbed in both phenotypes (p < 0.05). Overall, lipid metabolism/transport proteins associated with atherosclerosis were highly abundant in LOPE, however, ECM proteins had a more pronounced role in EOPE. The complement cascade and binding and uptake of ligands by scavenger receptors, pathways, were associated with both EOPE and LOPE.

1,25(OH)2D3 alleviates LPS-induced preeclampsia-like rats impairment in the protective effect by TLR4/NF-kB pathway

IntroductionAccumulating epidemiological studies support that Vitamin D deficiency is associated with the pathogenesis of preeclampsia. However, it is unknown whether vitamin D can be used as a treatment for preeclampsia. This study aimed to explore whether vitamin D supplementation could improve the rat model of preeclampsia. MethodsLPS was used to establish a rat model of preeclampsia. Inflammatory cytokines were examined by QRT-PCR and ELISA assays, and the concentration of sfit-1 and NO was assessed by ELISA. Analyzing the pathological features of the placenta with hematoxylin-eosin. The spatial learning and memory abilities of offspring were evaluated by the Morris water maze. Immune histology and western blot were performed to evaluate the expression levels of inflammatory pathway-associated Factor and vascular endothelium-associated Factor in the placenta. ResultsVitamin D treatment reduced the blood pressure and urine protein of PE model rats, alleviated pathological damage to the placenta and pregnancy outcomes, and protected PE offspring from impaired memory and learning abilities. Moreover, TLR4 signaling pathway in the placenta was inhibited. Furthermore, vitamin D supplementation increased the expression of endothelial growth factor and vascular relaxing factor, and there was no significant difference compared with the control group. DiscussionWe generated the result that Vitamin D supplementation significantly improved the phenotype of preeclampsia and adverse pregnancy outcome caused by an abnormal inflammatory reaction and endothelial dysfunction in the placenta, and improved the learning and cognitive ability of offspring.

Increased production of inflammatory cytokines and activation of microglia in the fetal brain of preeclamptic mice induced by angiotensin II

Preeclampsia (PE) is a hypertensive obstetric disorder with poor prognosis for both the mother and offspring. Infants born to mothers with PE are known to be at increased risk of developing higher brain dysfunction, such as autism. However, how maternal PE can affect the environment in the fetal brain has not been fully elucidated. Here, we examined the impact of PE on the fetal brain in a mouse model of PE induced by angiotensin II (Ang II), focusing on changes in the inflammatory condition. We confirmed that pregnant mice which were continuously administered Ang II exhibited PE phenotypes, including high blood pressure, proteinuria, and fetal growth restriction. Quantitative RT-PCR analysis demonstrated that the brain of fetuses on embryonic day 17.5 (E17.5) in the Ang II-administered pregnant mice showed increased expression of cytokines, interleukin (IL)− 6, IL-17a, tumor necrosis factor-α, interferon-γ, IL-12, IL-4, and IL-10. Immunohistochemical analysis over a wide area, from the tip of the frontal lobe to the posterior cerebral end, on E17.5 revealed that the microglia in the fetal brain of the Ang II-administered group displayed higher solidity and circularity than those of the control group, indicating that the microglia had transformed to an amoeboid morphology and were activated. Our findings suggest that maternal PE may cause altered inflammatory conditions in the fetal brain, which might be associated with the pathological mechanism connecting maternal PE and brain dysfunction in the offspring.

Effects of Maternal Pre-Pregnancy BMI and Gestational Weight Gain on the Development of Preeclampsia and Its Phenotypes: A Prospective Cohort Study in China.

Preeclampsia (PE) is a common and serious pregnancy-specific disorder, which is closely linked with adverse maternal and neonatal outcomes. This study aimed to evaluate whether maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) was associated with preeclampsia and its phenotypes. In this prospective study, 32,531 women with singleton pregnancies were finally included. Compared with women with normal pre-pregnancy BMI, women with overweight and obesity were at increased risk of PE (RR = 1.62, 95%CI: 1.57–1.66; RR = 2.04, 95%CI: 1.97–2.11, respectively), while those who were underweight had a lower risk of PE (RR = 0.84, 95%CI: 0.81–0.88). When compared with women who gained adequate GWG, pregnant women with inadequate GWG and excessive GWG had an increased risk of PE (RR = 1.15, 95%CI: 1.12–1.19; RR = 1.56, 95%CI: 1.52–1.60, respectively). The observed increased risk was generally similar for mild-, severe-, early- and late-onset PE, and the reduced risk was similar for severe- and late-onset PE. No significant interactions between GWG and pre-pregnancy BMI on the risk of PE were identified (p-interaction > 0.05). In conclusion, pre-pregnancy overweight or obesity and excessive GWG have established risk factors for PE, and that the potential risk may vary according to PE phenotypes. Moreover, the synergistic effect that may exist between pre-pregnancy BMI and GWG.

Abstract 102: Mitoquinone Reduces Preeclamptic Phenotypes Associated With Syncytiotrophoblast-Specific Gq Signaling

Syncytiotrophoblast (STB) stress is theorized to drive the pathogenesis of preeclampsia (PE), and Gq-activating hormones implicated in PE have been associated with placenta oxidative damage, mitochondrial dysfunction, and maternal symptomology. As the causes and consequences of STB stress remain largely unknown, we used an in vivo model to determine whether excess STB-specific Gq signaling is sufficient to cause phenotypes of PE and if a mitochondrial-targeted antioxidant (mitoquinone) mitigates these effects. Activation of Gq signaling in STB cells was achieved by crossing dams harboring a cre-dependent Gq-coupled DREADD (hM3Dq) with Gcm1 -Cre +/- sires and injecting clozapine N-oxide (CNO) or saline mid-gestation (GD12.5-14.5) before tissue collection at GD14.5. Gq activation resulted in maternal proteinuria (n=9-11 CNO 43±4 vs saline 28±3mg/day; p=0.01), mild segmental congestion of glomerular capillaries, and elevated circulating IP-10 (p=0.03), MCP-5 (p=0.04), and IL-12p40 (p=0.01). hM3Dq stimulation reduced labyrinth vascularization (n=10 Cre + 19±1%, Cre - 24±1%, saline 23±1%; p&lt;0.01 Cre + vs each), spiral artery diameter (n=7-11 Cre + 110±11μm, Cre - 135±9, saline 149±12 μm; p=0.03), placenta mass (n=10-13 Cre + 0.12±0.01, Cre - 0.14±0.01, saline 0.13±0.01g; p&lt;0.01), and fetal mass (n=10-13 Cre + 0.23±0.03, Cre - 0.30±0.02, saline 0.29±0.02g; p&lt;0.01). Preliminary data suggest a placental oxidative defense response to Gq induction based on increased protein levels of SOD2 and catalase, and decreased malondyaldehyde. Mitoquinone (5mg/kg) corrected maternal proteinuria (n=8 22±4mg/day, p&lt;0.01), decreased circulating IL-12p40 (p=0.03), and protected both labyrinth vascularization (n=8 23±1%, p=0.05) and spiral artery diameter (n=8 164±18μm, p=0.02). These data indicate that elevated Gq signaling in the STB layer is sufficient to cause pathological features of PE, via a mechanism involving mitochondrial stress.

Abstract 018: B Cells Induce Hypertension, AT1AA, And Complement Activation In Preeclampsia Or In Response To A Prior Covid-19 Infection During Pregnancy

Preeclampsia (PE), new onset hypertension (HTN) during pregnancy, is associated with placental ischemia and chronic inflammation that includes increased CD4+ T cells, B cells secreting agonistic autoantibodies against the angiotensin II type 1 receptor (AT1AA), and activation of the complement system. Previous studies have shown AT1-AA is produced in patients with COVID-19 infection. Interestingly, having had COVID-19 during pregnancy is associated with increased incidence of developing a PE phenotype during pregnancy. We have previously shown an important role for B cell depletion or AT1AA inhibition to attenuate HTN in rat models of PE. Collectively, this data suggests B cells contribute to PE development and that B cells may increase incidence of PE in patients with a history (Hx) of COVID-19 during pregnancy through production of the AT1AA. We hypothesize B cells from PE or CV Hx PE patients produce AT1AA resulting in HTN and complement activation in pregnancy. Placental B cells were isolated from normal pregnant (NP), PE, normotensive (NT) CV Hx, or PE CV Hx patients at delivery. B cells were transferred i.p. into pregnant athymic rats at gestation (GD) 12. On GD18, carotid catheters were inserted. On GD19, blood pressure was measured and tissues collected. PE B cell recipients had increased Mean Arterial Pressure (MAP) (115±3 mmHg n=6) compared to NP B cell recipients (97±4 mmHg n=6 p&lt;0.05). PE B cell recipients had increased AT1AA (20±2 ΔBPM n=4) compared to NP B cell recipients (6±1 ΔBPM n=4 p&lt;0.05). PE B cell recipients had increased markers of complement activation such as reduced plasma C4 (1302±169 μg/mL n=4) and C3 (516±45 μg/mL n=4) compared to recipients of NP B cells (2348±338 μg/mL n=4 p&lt;0.05) and (790±66 μg/mL n=4 p&lt;0.05) respectively. CV Hx PE B cell recipients had elevated MAP (108±3 mmHg n=4) compared to CV Hx NT B cell recipients (101±7 mmHg n=4) and increased AT1AA (24±3 ΔBPM n=3) compared to CV Hx NT B cell Recipients (4±1 ΔBPM n=4 p&lt;0.05). Collectively, this study demonstrates an important role for B cells to cause HTN during pregnancy; and indicates that B cells contribute to a higher incidence of PE in women with a Hx of CV infection during pregnancy possibly by secreting AT1-AA.

Primary Human Trophoblasts Mimic the Preeclampsia Phenotype after Acute Hypoxia-Reoxygenation Insult.

Preeclampsia (PE) is a pregnancy-specific disorder that affects 3 to 5% of pregnancies worldwide and is one of the leading causes of maternal and fetal morbidity and mortality. Nevertheless, how these events occur remains unclear. We hypothesized that the induction of hypoxic conditions in vitro in primary human trophoblast cells would mimic several characteristics of PE found in vivo. We applied and characterized a model of primary cytotrophoblasts isolated from healthy pregnancies that were placed under different oxygen concentrations: ambient O2 (5% pCO2, 21%pO2, 24 h, termed “normoxia”), low O2 concentration (5% pCO2, 1.5% pO2, 24 h, termed “hypoxia”), or “hypoxia/reoxygenation” (H/R: 6 h intervals of normoxia and hypoxia for 24 h). Various established preeclamptic markers were assessed in this cell model and compared to placental tissues obtained from PE pregnancies. Seventeen PE markers were analyzed by qPCR, and the protein secretion of soluble fms-like tyrosine kinase 1 (sFlT-1) and the placenta growth factor (PlGF) was determined by ELISA. Thirteen of seventeen genes associated with angiogenesis, the renin–angiotensin system, oxidative stress, endoplasmic reticulum stress, and the inflammasome complex were susceptible to H/R and hypoxia, mimicking the expression pattern of PE tissue. In cell culture supernatants, the secretion of sFlT-1 was increased in hypoxia, while PlGF release was significantly reduced in H/R and hypoxia. In the supernatants of our cell models, the sFlT-1/PlGF ratio in hypoxia and H/R was higher than 38, which is a strong indicator for PE in clinical practice. These results suggest that our cellular models reflect important pathological processes occurring in PE and are therefore suitable as PE in vitro models.