Vascular Mechanisms and Molecular Targets in Hypertensive Pregnancy and Preeclampsia

American Journal of Physiology. Heart and Circulatory Physiology
Hongmei Qu, Raouf A Khalil

Abstract

Preeclampsia is a major complication of pregnancy manifested as hypertension and often intrauterine growth restriction, but the underlying pathophysiological mechanisms are unclear. Predisposing genetic and environmental factors cause placental maladaptations leading to defective placentation, apoptosis of invasive cytotrophoblasts, inadequate expansive remodeling of the spiral arteries, reduced uteroplacental perfusion pressure and placental ischemia. Placental ischemia promotes the release of bioactive factors into the maternal circulation, causing an imbalance between anti-angiogenic soluble fms-like tyrosine kinase-1 and soluble endoglin, and pro-angiogenic vascular endothelial growth factor, placental growth factor and transforming growth factor-β. Placental ischemia also stimulates the release of proinflammatory cytokines, hypoxia-inducible factor, reactive oxygen species, and angiotensin type 1 receptor agonistic autoantibodies. These circulating factors target the vascular endothelium, causing generalized endotheliosis in systemic, renal, cerebral and hepatic vessels, leading to decreases in endothelium-derived vasodilators such as nitric oxide, prostacyclin and hyperpolarization factor, and increases in vasoconstrictor...Continue Reading

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Citations

Apr 3, 2021·American Journal of Physiology. Heart and Circulatory Physiology·María M PereiraDaniel Bia
May 8, 2021·Clinical Science·Anna E StanhewiczGary L Pierce
May 6, 2021·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Luca ValsecchiGianpaolo Zerbini

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