Preeclampsia: new insights.
OBJECTIVE
Preeclampsia is a disorder of gestation characterized by hypertension and proteinuria and can be complicated by eclamptic seizures. This review describes recent advances in the role of the renin-angiotensin system and angiogenic and anti-angiogenic factors of placental origin in its pathogenesis.


RESULTS
Deficient uteroplacental perfusion has been recognized to be a feature in all preeclampsia syndromes. Increased renin expression observed in humans and animal models supports the concept that activation of the decidual renin-angiotensin system may mediate the pathogenesis of preeclampsia. Novel angiotensin II-related biomolecular mechanisms, angiotensin II type 1-B2 receptor heterodimerization and autoantibody against angiotensin II type 1 have recently been described in preeclampsia. New evidence suggests that vascular endothelial growth factor and its receptors, antagonists, and reduced placental growth factor may play a role in the development of proteinuria and other renal injury-mediated manifestations in preeclampsia.


CONCLUSIONS
Vascular maladaptation, with increased vasomotor tone, endothelial dysfunction, increased sensitivity to angiotensin II and norepinephrine, and multiorgan dysfunction seen in preeclampsia, may be explained by angiotensin II-mediated mechanisms. Future investigations need to define the mechanism of activation of the decidual renin-angiotensin system and the release of placental factors in the pathogenesis of preeclampsia.
Shah
Dinesh M
DM
University of Wisconsin School of Medicine and Public Health, Meriter Hospital, Madison, Wisconsin 53715, USA. dmshah@wisc.edu
D020533:Angiogenesis Inhibitors / Q000378:metabolism*; D042501:Angiogenic Proteins / Q000378:metabolism*; D000818:Animals; D015703:Antigens, CD / Q000378:metabolism; D000071063:Endoglin; D004730:Endothelium, Vascular / Q000503:physiopathology; D005260:Female; D006801:Humans; D010920:Placenta / Q000098:blood supply / Q000378:metabolism / Q000503:physiopathology*; D000072483:Placenta Growth Factor; D021041:Placental Circulation; D011225:Pre-Eclampsia / Q000378:metabolism / Q000503:physiopathology*; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000378:metabolism; D011956:Receptors, Cell Surface / Q000378:metabolism; D012084:Renin-Angiotensin System; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000378:metabolism
D020533:Angiogenesis Inhibitors; D042501:Angiogenic Proteins; D015703:Antigens, CD; C064206:ENG protein, human; D000071063:Endoglin; C000608036:PGF protein, human; D011257:Pregnancy Proteins; D011956:Receptors, Cell Surface; D042461:Vascular Endothelial Growth Factor A; D000072483:Placenta Growth Factor; D040281:Vascular Endothelial Growth Factor Receptor-1