Uterine vein and maternal urinary levels of activin A and inhibin A in pre-eclampsia patients.
OBJECTIVE
The aims of this study were to investigate if (i) urinary concentrations of activin A and inhibin A are altered in pre-eclampsia (PE) and (ii) to study the relationship between uterine vein and peripheral vein concentrations of these hormones in PE patients.


METHODS
In a retrospective study, maternal peripheral vein and uterine vein serum and maternal urine samples collected at the time of delivery were analysed. There were three groups of patients; (i) group 1: term normal pregnancies (n = 19) (ii) group 2: patients who developed PE < or = 37 weeks (n = 17) and (iii) group 3: patients who developed PE 37-40 weeks (n = 8). Serum and urinary activin A, follistatin, inhibin A and pro alpha C and urinary creatinine levels were measured using enzyme immunoassays in the laboratory.


RESULTS
Normal pregnant urine samples had very low levels of activin A and inhibin A. Both groups 2 and 3 PE patients had significantly higher levels of inhibin A (P < 0.001) and activin A (P < 0.001) compared to the controls. Pro-alpha C was not altered and follistatin was below the detection limit of the assay in the urine. Maternal peripheral serum activin A and inhibin A were significantly higher in groups 2 (P < 0.001) and 3 (P < 0.05) patients compared to the controls. Pro-alpha C-containing inhibins were higher in group 2 patients (P < 0.05) compared to the controls in the peripheral circulation. Uterine vein serum activin A and inhibin A levels were also significantly higher in groups 2 (P < 0.001) and 3 (P < 0.05) patients compared to the controls. There was a highly significant positive correlation between peripheral and uterine vein serum concentrations of activin A, follistatin, inhibin A and pro alpha C, suggesting the same source for these proteins in PE.


CONCLUSIONS
Urinary activin A and inhibin A are raised in groups 2 and 3 PE patients. The magnitude of rise (> 25-fold) suggests these proteins may rise in patients before the onset of the clinical symptoms of PE. Uterine vein levels of these proteins are also raised in PE.
Department of Obstetrics and Gynaecology, Royal Free University College Medical School, London, UK. s.muttukrishna@ucl.ac.uk
S
S
Muttukrishna
J
J
Hyett
M
M
Paine
J
J
Moodley
N
N
Groome
C
C
Rodeck
D028341:Activins / Q000097:blood / Q000652:urine; D000328:Adult; D000704:Analysis of Variance; D016022:Case-Control Studies; D002406:Catheterization, Peripheral; D005260:Female; D038681:Follistatin / Q000032:analysis / Q000097:blood / Q000652:urine; D006801:Humans; D028322:Inhibin-beta Subunits / Q000097:blood / Q000652:urine; D007265:Inhibins / Q000032:analysis / Q000097:blood / Q000652:urine; D021041:Placental Circulation; D011225:Pre-Eclampsia / Q000097:blood / Q000652:urine; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011498:Protein Precursors / Q000032:analysis / Q000097:blood / Q000652:urine; D012189:Retrospective Studies; D014599:Uterus / Q000098:blood supply; D014680:Veins
D038681:Follistatin; D011498:Protein Precursors; C422405:activin A; C422362:inhibin A; C095971:inhibin-alpha subunit precursor; D028341:Activins; D007265:Inhibins; D028322:Inhibin-beta Subunits