title: Soluble FMS-like tyrosine kinase-1 (sFlt-1) and serum placental growth factor (PlGF) as biomarkers for ectopic pregnancy and missed abortion.
abstract: BACKGROUND
  Diagnosis of early pregnancy failure is hampered by the lack of reliable serological markers.
  
  
  OBJECTIVE
  We assessed whether a single serum measurement of placental growth factor (PlGF) and the soluble Flt-1 (sFlt-1) receptor of vascular endothelial growth factor at 6-8 wk gestation could differentiate failed pregnancies, whether ectopic pregnancies (EP) or missed abortions (MA), from healthy intrauterine pregnancies (IUP).
  
  
  METHODS
  We conducted a prospective clinical study at a tertiary university hospital between January 2009 and February 2011.
  
  
  METHODS
  A total of 78 consecutive patients (38 EP, 40 MA) with failed early pregnancy and 50 IUP (control group) participated in the study.
  
  
  METHODS
  Determination of serum PlGF and sFlt-1 has been carried out by ELISA. Gene expression of PlGF and Flt-1 in trophoblasts was performed by RT-PCR.
  
  
  METHODS
  We investigated whether a single, combined serum measurement of the above markers could contribute to the differential diagnosis.
  
  
  RESULTS
  PlGF and sFlt-1 concentration was lower in both EP (mean, 14.60 ± 3.42/178.16 ± 76.03 pg/ml) and MA (mean, 16.25 ± 4.73/399.42 ± 337.54 pg/ml) compared to IUP (mean, 21.64 ± 5.68/1390.32 ± 655.37 pg/ml). sFlt-1 (P = 0.033) and sFlt-1/PlGF ratio (P = 0.029) but not PlGF had the ability to discriminate MA from EP. Compared to women with viable IUP, mRNA gene expression levels of PlGF and Flt-1 were considerably lower in women with MA and in women with EP.
  
  
  CONCLUSIONS
  Combined measurement of sFlt-1 and PlGF levels can differentiate normal from failed pregnancies, whereas sFlt-1 as well as sFlt-1/PlGF ratio can also discriminate EP from MA. PlGF and Flt-1 gene expression in trophoblasts from women with EP and MA appears impaired.
authors.affiliation: Department of Obstetrics and Gynecology, University of Thessalia Medical School, Larissa 41222, Greece. dapontea@otenet.gr
authors.forename: Alexandros
authors.initials: A
authors.lastname: Daponte
authors.forename: Spyros
authors.initials: S
authors.lastname: Pournaras
authors.forename: Nikolaos P
authors.initials: NP
authors.lastname: Polyzos
authors.forename: Aspasia
authors.initials: A
authors.lastname: Tsezou
authors.forename: Hara
authors.initials: H
authors.lastname: Skentou
authors.forename: Foteini
authors.initials: F
authors.lastname: Anastasiadou
authors.forename: Georgios
authors.initials: G
authors.lastname: Lialios
authors.forename: Ioannis E
authors.initials: IE
authors.lastname: Messinis
mesh_terms: D000030:Abortion, Missed / Q000097:blood / Q000175:diagnosis*; D000328:Adult; D015415:Biomarkers / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D000072483:Placenta Growth Factor; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000097:blood*; D011271:Pregnancy, Ectopic / Q000097:blood / Q000175:diagnosis*; D011446:Prospective Studies; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood*
chemical_list: D015415:Biomarkers; C000608036:PGF protein, human; D011257:Pregnancy Proteins; D000072483:Placenta Growth Factor; D040281:Vascular Endothelial Growth Factor Receptor-1