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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Inflammatory response is a major component in physiopathology of preeclampsia and intra-uterine growth retardation. Endothelium is a main connection between placental ischemia and clinical manifestations during vascular pregnancy complications. In this review recent findings concerning inflammatory response and its links with endothelium are reported. Studies concerning isolated intra-uterine growth retardation confirm the hypothesis of a similar pathophysiology with an activation confined to utero-placental bed or at a lower level. Current information on oxidative stress, atherosclerosis, and apoptosis in vascular pregnancy complications are available in this review. These concepts offer innovative possibilities of treatment.
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PMID:[New insight in physiopathology of preeclampsia and intra-uterine growth retardation: role of inflammation]. 1521 62

Preeclampsia and intrauterine growth restriction are both characterized by placental malfunction. The pathological processes of abnormal trophoblast invasion, partial absence of maternal spiral artery modification, increased apoptosis of trophoblast cells, and placental ischemia are all associated with the release of specific molecules. These proteins, as well as cell-free fetal DNA and RNA might be detected in the maternal peripheral circulation, quantified, and used for early identification and prediction of preeclampsia and intrauterine growth restriction, prior to the appearance of the clinical symptoms. As preeclampsia and intrauterine growth restriction are associated with increased maternal, perinatal, and neonatal morbidity and mortality, early identification of these pregnancy associated complications will permit the design of appropriate preventive measures. In this review a variety of factors reported to be useful as potential markers for early detection of pregnancies at increased risk will be discussed. Molecules associated with the establishment of the placenta and essential in fetal-maternal interactions, like interleukin 2-receptor, insulinlike growth factor-1, and insulinlike growth factor binding protein-1, placenta growth factor, hepatocyte growth factor, inhibin A, activin A, and human chorionic gonadotrophin seem to be the most likely candidates for presymptomatic markers for preeclampsia and/or intrauterine growth restriction. Detection and discrimination of these molecules through the placental RNA in maternal plasma based strategy has become a realistic option.
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PMID:Markers for presymptomatic prediction of preeclampsia and intrauterine growth restriction. 1536 50

There have been many attempts to produce animal models that mimic the hypertensive disorders of pregnancy, especially preeclampsia, but most are incomplete when compared to the full spectrum of the human disease. This review assesses a number of these models, organized according to the investigators attempt to focus on a specific pathogenic mechanism believed to play a role in the human disease. These mechanisms include uterine ischemia, impairments in the nitric oxide system, insulin resistance, overactivity of the autonomic nervous and/or renin-angiotensin systems, activation of a systemic inflammatory response, and most recently, activation of circulating proteins that interfere with angiogenesis. In addition a model of renal disease that mimics superimposed preeclampsia is discussed. Defining these animal models should help in our quest to understand the cause, as well as to test preventative and therapeutic strategies in the management of these hypertensive disorders of pregnancy.
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PMID:Animal models of preeclampsia. 1552 95

Emerging evidence supports a novel view of hypertension as a disease of inadequate or aberrant responses to angiogenic growth factors (AGF). Patients with hypertension have reduced microvascular density, with some evidence supporting a primary role for rarefaction in causing hypertension. Two clinical models have demonstrated a link between inhibition of AGF activity and hypertension. A major side effect of bevacizumab, a monoclonal antibody to vascular endothelial growth factor (VEGF), is hypertension. Pre-eclampsia is accompanied by high circulating levels of soluble VEGF receptor-1, which forms inactive complexes with VEGF and placental growth factor (PlGF). Paradoxically, early studies have demonstrated high circulating levels of AGF in hypertension. Several mechanisms may account for this finding including increased vascular stretch, tissue ischemia, compensatory responses, decreased clearance or a combination of these mechanisms. High AGF in hypertension could contribute to clinical sequelae such as peripheral and pulmonary edema, microalbuminuria, and progression of atherosclerosis. However, a role for altered angiogenesis in the pathogenesis of hypertension or its sequelae has not been established. Novel studies to understand the roles of AGF in hypertensive patients are warranted.
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PMID:Angiogenic growth factors and hypertension. 1560 74

Diffuse neurological manifestations of preeclampsia are due to endothelial involvement that lead to ischemia, hemorrhage, or edema. We analyzed clinical and radiological features and the course of brainstem ischemic strokes in a preeclampsia patient. We report a case of severe preeclampsia in a 30-year-old woman who was admitted 10 hr after a vaginal delivery at home. The pregnancy was at 39 wk, with no prenatal care. At her admission, she was conscious, and she had tetraparesia, swinging deep tendon reflex testing, drowsiness, and dysarthria; the BP was at 160/100 mmHg and 4 + proteinuria; magnetic resonance imaging revealed brainstem ischemic stroke. The evolution was favorable with symptomatic treatment. The patient was discharged on the 16th day; 2 months later she had a normal recovery. Brainstem strokes are rare. They are frequently due to hemorrhage; sometimes, they can also be ischemic. Their course is favorable.
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PMID:Brainstem ischemia and preeclampsia. 1561 26

Preeclampsia complicating 3-5 % of all pregnancies in the world. Its origin is abnormal placentation around 12th week pregnancy. It associates hypertension and proteinuria appeared after 20th week pregnancy. Many risk factors with various mechanism of action have been identified (primigravida, younger age, twin pregnancy...). The main consequence of placental ischemia is generalized endothelial dysfunction responsible for clinical symptoms and complications (eclampsia, placental abruption, HELLP syndrome). It's an important cause of maternal death and is associated with increased risk of neonatal mortality, particularly in developing country. There is no consensus with regard to management particularly utilisation of drugs and break indication of pregnancy. Low dose aspirin is the only efficient preventive strategy in high-risk subjects. The therapeutic aspects are discussed as many in the benefit and the modalities of the antihypertensive treatment, as the indications of pregnancy interuption. Prevention is an up coming way but for the moment, only acetylsalicylic acid has proven its efficacity among the high risk patients.
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PMID:[Preeclampsia: current aspects of physiopathology, clinic and treatment]. 1577 11

Altered apoptosis is involved in each step of the pathogenesis of preeclampsia. While deficient apoptosis may induce a maternal immune response against the fetus, enhanced apoptosis may interfere with the process of placentation, placental ischemia and subsequently, systemic endothelial damage. Thus, treatment modalities to inhibit or acclerate apoptosis cannot be employed in early pregnancy for prevention. Later in pregnancy, it would make sense to test treatment modalities that inhibit hypoxia-mediated apoptosis in patients in whom early testing, such as abnormal Doppler of the uterine artery, indicates the initiation of preeclampsia. This, however, has first to be tested in animal models. Since multiple different mechanisms, rather than a single factor, could contribute to the development of apoptosis, further studies to clarify the signaling mechanisms of apoptosis in preeclampsia should be conducted before any investigational treatment modalities are employed.
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PMID:The role of apoptosis in preeclampsia. 1579 65

Hypertension and sodium retention are features of a diminished 11beta-hydroxysteroid dehydrogenase type 2 (11beta-HSD2). The activity of this enzyme is reduced in various disease states with abnormal renal sodium retention and hypertension, including preeclampsia. ATP release to the extracellular compartment is observed with shear stress, inflammation, and placental ischemia. It was hypothesized that ATP downregulates 11beta-HSD2 activity. For that purpose, cell lines from different tissues that previously were used to study the regulation of 11beta-HSD2 were investigated: JEG-3, a vascular trophoblastic; LLCPK1, a renal tubular; and SW620, a colonic epithelial cell line. The 11beta-HSD2 activity, assessed by the conversion of 3H-cortisol to cortisone, was reversibly reduced during incubation with ATP or its stable analogue ATPgammaS in intact JEG-3 and LLCPK1, but not in SW620 cells. In JEG-3 cells, the purinergic antagonist pyridoxalphosphate-6-azophenyl-2',4'-disulphonic acid but not suramin reversed the inhibition. Incubation with UTP and ADP and their degradation products including adenosine and alpha,beta-methylene-ATP did not inhibit 11beta-HSD2 activity. In contrast, 11beta-HSD2 activity increased almost 2.5-fold after incubation with 2'-methylthio-ATP. This indicates a bidirectional regulation by nucleotides via purinergic receptors. In JEG-3 cells, ATP/ATPgammaS did not alter 11beta-HSD2 promoter activity but reduced 11beta-HSD2 protein and mRNA concentration and half-life, suggesting a posttranscriptional regulation. In conclusion, ATP inhibits cell type specifically via purinergic receptors the expression and activity of the 11beta-HSD2 by a posttranscriptional mechanism.
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PMID:Extracellular ATP determines 11beta-hydroxysteroid dehydrogenase type 2 activity via purinergic receptors. 1625 Dec 42

The initiating event in preeclampsia is thought be to reduced uteroplacental perfusion. Although we have reported previously that chronic reductions in uterine perfusion pressure (RUPP) in pregnant rats results in hypertension and enhanced endothelin production, the factors linking placental ischemia and endothelial cell activation remain unclear. The purpose of this study was to determine the role of angiotensin II type-1 (AT1) receptor activation on endothelin production induced by serum from pregnant rats exposed to reductions in uterine perfusion. To achieve this goal, human umbilical vein endothelial cells were exposed to sera collected from RUPP rats or normal pregnant rats. Arterial pressure was significantly higher in RUPP rats (135+/-2 mm Hg) than in pregnant rats (106+/-1 mm Hg). Six hours after exposure to RUPP serum (n=17), cell media endothelin concentration was 18.4+/-2.7 pg/mL as compared with 9.22+/-1.3 pg/mL from cells exposed to serum from normal pregnant rats (n=9). Eighteen hours after exposure to RUPP serum (n=7), endothelin concentration was 30.5+/-3.8 pg/mL as compared with 12.8+/-5.3 pg/mL from cells exposed to normal pregnant rat serum (n=6). In contrast, serum from RUPP rats did not increase endothelin production in human umbilical vein endothelial cells pretreated with an AT1 receptor antagonist, losartan (15 micromol/L). Eighteen hours after exposure to RUPP serum and losartan (n=14), endothelin concentration was 21.3+/-2.2 pg/mL as compared with 16.4+/-3.3 pg/mL from cells exposed to normal pregnant rat serum and losartan (n=10). These data indicate that serum from pregnant rats exposed to reductions in uterine perfusion enhances endothelin production by endothelial cells via by AT1 receptor activation.
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PMID:Enhanced endothelin synthesis by endothelial cells exposed to sera from pregnant rats with decreased uterine perfusion. 1639 Nov 74

In pregnancy there is an attenuated response to vasoconstrictors and pressor agents, including Angiotensin II (Ang II). This effect is reverted in preeclampsia. We evaluated the renal pressor response induced by Ang II in an experimental model of preeclampsia based on the development of feto-placental ischemia produced by a subrenal aortic coarctation (SRAC). Dose-response curves for Ang II were obtained in an isolated perfused kidney preparation comparing groups of SRAC pregnant and non-pregnant rats in the presence and absence of losartan (AT1 antagonist) or PD123319 (AT2 antagonist). Kidneys from the experimental model of pre-eclampsia showed an enhanced response to AngII. In addition, losartan (10 nM) inhibited the vasopressor effect to Ang II in this model but not in the control group. PD 123319 (1 nM), increased the response in both groups, but the effect was more evident in the pre-eclamptic group. This suggests modifications in the relative participation of renal vascular receptors AT1/AT2 induced by an experimental model of pre-eclampsia, with an increased participation of AT1 and a decreased participation of AT2.
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PMID:Renal vascular responses in an experimental model of preeclampsia. 1641 59


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