Excess placental soluble fms-like tyrosine kinase 1 (sFlt1) may contribute to endothelial dysfunction, hypertension, and proteinuria in preeclampsia.
Preeclampsia, a syndrome affecting 5% of pregnancies, causes substantial maternal and fetal morbidity and mortality. The pathophysiology of preeclampsia remains largely unknown. It has been hypothesized that placental ischemia is an early event, leading to placental production of a soluble factor or factors that cause maternal endothelial dysfunction, resulting in the clinical findings of hypertension, proteinuria, and edema. Here, we confirm that placental soluble fms-like tyrosine kinase 1 (sFlt1), an antagonist of VEGF and placental growth factor (PlGF), is upregulated in preeclampsia, leading to increased systemic levels of sFlt1 that fall after delivery. We demonstrate that increased circulating sFlt1 in patients with preeclampsia is associated with decreased circulating levels of free VEGF and PlGF, resulting in endothelial dysfunction in vitro that can be rescued by exogenous VEGF and PlGF. Additionally, VEGF and PlGF cause microvascular relaxation of rat renal arterioles in vitro that is blocked by sFlt1. Finally, administration of sFlt1 to pregnant rats induces hypertension, proteinuria, and glomerular endotheliosis, the classic lesion of preeclampsia. These observations suggest that excess circulating sFlt1 contributes to the pathogenesis of preeclampsia.
Maynard
Sharon E
SE
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02115, USA.
Min
Jiang-Yong
JY
Merchan
Jaime
J
Lim
Kee-Hak
KH
Li
Jianyi
J
Mondal
Susanta
S
Libermann
Towia A
TA
Morgan
James P
JP
Sellke
Frank W
FW
Stillman
Isaac E
IE
Epstein
Franklin H
FH
Sukhatme
Vikas P
VP
Karumanchi
S Ananth
SA
D016228:Endothelial Growth Factors / Q000032:analysis / Q000037:antagonists & inhibitors; D004730:Endothelium, Vascular / Q000502:physiology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D036341:Intercellular Signaling Peptides and Proteins / Q000032:analysis; D007668:Kidney / Q000473:pathology; D008222:Lymphokines / Q000032:analysis / Q000037:antagonists & inhibitors; D018919:Neovascularization, Physiologic; D000072483:Placenta Growth Factor; D011225:Pre-Eclampsia / Q000209:etiology* / Q000628:therapy; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000032:analysis / Q000037:antagonists & inhibitors; D011507:Proteinuria / Q000209:etiology*; D042461:Vascular Endothelial Growth Factor A; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000502:physiology*; D042442:Vascular Endothelial Growth Factors
D016228:Endothelial Growth Factors; D036341:Intercellular Signaling Peptides and Proteins; D008222:Lymphokines; C000608036:PGF protein, human; C000608038:Pgf protein, rat; D011257:Pregnancy Proteins; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors; D000072483:Placenta Growth Factor; D040281:Vascular Endothelial Growth Factor Receptor-1