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Response to Apheresis measured by Angiogenic Factors in Women with Early-Onset Preeclampsia and Antiphospholipid Syndrome
06 April 2017 (online)
Preeclampsia (PE) is a leading cause of mortality and morbidity during pregnancy in developed countries and complicates 1% to 7% of all pregnancies. Different mechanisms have been suggested to explain PE, including thrombosis, vascular and endothelial inflammation, or an imbalance of angiogenic and antiangiogenic placental factors, such as Endoglin (Eng), Endothelin-1(ET-1), Asymmetric dimethylarginine (ADMA), Symmetric dimethylarginine (SDMA) and soluble fms-like tyrosine kinase 1 (sFlt-1). One of the main problems in pregnancies complicated by PE, especially at early gestation is the lack of effective, especially causative therapeutic options. The removal of antiangiogenic markers and other pathogen factors via apheresis seems to be a logic therapeutic approach.
4 women with antiphospholipid syndrome were admitted at the department of obstetrics, Medical University Graz with early- onset PE between 18 and 21 weeks of gestation. Apheresis was started in order to prolong the pregnancy.
Angiogenic factors were measured via ELISA before and after first treatment, as well as at the following day.
Eng, ET-1, ADMA and SDMA- levels showed a significant decrease after treatment.
As expected, sflt-1- levels increased after apheresis due to the well-known effect of heparin releasing sflt-1 into the maternal circulation. However, sflt-1 measurements showed decreasing mean levels at the following day. The pregnancy could be prolonged for several weeks in all 4 women.
Due to the limited long-term therapeutical possibilities for pregnancies complicated by PE, apheresis seems to be a therapeutical option. This consideration refers especially to pregnancies with early-onset PE, in which, after first conventional treatment, prolongation of pregnancy should be above all. The immediate response to therapy and the evident removal of certain angiogenic factors supports the use of apheresis as treatment in pregnancies with PE, especially at early gestation, as well as in pregnancies with APS in order to reduce the risk of adverse obstetric outcome.