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Geburtshilfe Frauenheilkd 2007; 67(3): 228-235
DOI: 10.1055/s-2007-964944
DOI: 10.1055/s-2007-964944
Übersicht
Georg Thieme Verlag KG Stuttgart · New York
Angiogenesefaktoren in der Schwangerschaft: Indikatoren für die Präeklampsie
Angiogenic Factors during Pregnancy: Indicators of PreeclampsiaFurther Information
Publication History
eingereicht 30.3.2006
revidiert 30.5.2006
akzeptiert 27.6.2006
Publication Date:
29 March 2007 (online)
Zusammenfassung
Die Präeklampsie ist eine der Hauptursachen maternaler, fetaler und neonataler Mortalität. Trotz intensiver wissenschaftlicher Untersuchungen ist die Ätiologie der Präeklampsie weitgehend ungeklärt. Bis heute gilt die inadäquate Umwandlung der myometranen Segmente der Spiralarterien in uteroplazentare Arterien durch eine unzureichende endovaskuläre Invasion des Trophoblasten als pathogenetische Voraussetzung einer Präeklampsie. Als Folge dieser gestörten Invasion des Trophoblasten und der geringen O2-Versorgung scheint auch die plazentare Angiogenese großen Veränderungen unterworfen und für die Entstehung einer Präeklampsie wichtig zu sein. Vascular endothelial growth factor (VEGF) und placental growth factor (PLGF) sind die wichtigsten Angiogenesefaktoren und Regulatoren einer adäquaten plazentaren Gefäßentwicklung. Diese Expression von VEGF und PLGF ist in präeklamptischen Schwangerschaften im Vergleich zu nicht präeklamptischen Schwangerschaften erniedrigt. Dagegen ist die Expression ihres Rezeptors, des löslichen fms-like tyrosine kinase receptors (sFlt-1), der anti-angiogenetische Eigenschaften besitzt, in präeklamptischen Schwangerschaften erhöht. Zusätzlich konnten wir zeigen, dass die Expression der CCN-Proteine CYR61 und NOV, die ebenfalls zu den pro-angiogenen Faktoren gehören, in der Plazenta präeklamptischer Patientinnen verringert ist. Diese Übersichtsarbeit fasst das derzeitige Verständnis der Rolle der Angiogenesefaktoren in der Entstehung einer Präeklampsie zusammen.
Abstract
Preeclampsia is a major cause of maternal, fetal and neonatal mortality worldwide. The etiology of preeclampsia is still unclear. Currently, the inadequate transformation of the smooth muscle cells of spiral arteries in the placental bed caused by an insufficient endovascular invasion of the trophoblast is considered to be the major reason for the development of preeclampsia. This insufficient invasion seems to lead to altered placental angiogenesis which thus has causal importance for the development of preeclampsia. Vascular endothelial growth factor (VEGF) and placental growth factor (PLGF) are the most important angiogenic factors with regulatory functions for placental vessel development. In preeclamptic pregnancies the expression of VEGF and PLGF was decreased. However, the expression of the corresponding receptor, the soluble fms-like tyrosine kinase receptor, which is considered to have anti-angiogenic properties, was elevated in preeclamptic pregnancies. CYR61 and NOV which belong to a group of proteins, the CCN-family, play also an important role in the regulation of placental angiogenesis. Recently, a decreased expression of both proteins in the placentae of preeclamptic women was detected. This review summarizes our current understanding of the role of angiogenic factors in the pathogenesis of preeclampsia.
Schlüsselwörter
Präeklampsie - Angiogenesefaktoren - Plazentation - CYR61 - NOV - Hypertonie
Key words
preeclampsia - angiogenic factors - placentation - CYR61 - NOV - hypertension
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Dr. med. Markus Schmidt
Klinik für Frauenheilkunde und Geburtshilfe
Universitätsklinikum Essen
Hufelandstraße 55
45122 Essen
Email: markus.schmidt@uk-essen.de