title: The role of albumin and endoplasmic reticulum in pathogenesis Preeclampsia. Changes of GRP78 and placental VEGF in preeclampsia.
abstract: Preeclampsia remains the highest causes of maternal mortality in Indonesia. This disease is known as "the disease of theories" since the etiology of this disease still obscure, but it is clearly accepted that this disease is correlated with placenta. The incidence of this disease increased in dr. Soetomo General Hospital during economic crisis in Indonesia, as nutritional problem occurred, but correlation between nutrition to preeclampsia still unclear. This study was conducted to find out the influence of hypoalbuminemia caused by alteration of amino acids and changes of GRP78 and placental VEGF in preeclampsia.
  
  
  METHODS
  It was cross-sectional study among 10 patients with preeclampsia albumin ⩽ gram/dL and 9 patients with preeclampsia albumin >3g/dL. Placenta collected was homogenized and blood was separated from the cells. Placental lysat, serum and plasma were stored -87°C until laboratory analysis for GRP78 and VEGF. Data were analyzed using student t test, Manova. Pearson correlation, simple and multiple regressions.
  
  
  RESULTS
  There were alterations of amino acid's profile among albumin ⩽3g/dL compare with albumin >3g/dL. GRP78 concentration on albumin ⩽3g/dL group was higher, but were not significant. Weak negative correlation between albumins to GRP78 was found. Negative correlation were found in the groups of albumin ⩽3g/dL - GRP⩽425μg/dL, but significant result only on albumin ⩽3g/dL - GRP⩽425μg/dL. Positive correlation were found in the group of albumin >3g/dL - GRP>425μg/dL. Response of Endoplasmic Reticulum Stress appeared different depends on levels of albumin (stressor) and GRP78 (stress response protein). Placental VEGF were significantly lower in albumin ⩽3g/dL (p<0.05). Correlation between GRP78 on placental VEGF was negative with coefficient correlation was 3.8%. Placental VEGF profoundly decreased as correlation between albumin and GRP78 stronger.
  
  
  CONCLUSIONS
  Alteration of amino acids profile influenced Albumin concentration. Hypoalbuminemia was a stressor that induced reticulum endoplasmic response by increasing GRP78, decreasing placental VEGF. Responses of Endoplasmic Reticulum Stress depend on levels of stressor (albumin) and stress response protein (GRP78).
authors.affiliation: Feto maternal Division, Department Obstetrics and Gynecology, Airlangga University, Indonesia.
authors.lastname: Aditiawarman
keywords: Albumin; Amino Acids; Angiogenesis; GRP78; Placental VEGF; Plasma VEGF; Reticulum Endoplasmic Stress Response