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Preeclampsia: the role of persistent endothelial cells in uteroplacental arteries.
Am J Obstet Gynecol 2019; 221(3):219-226AJ

Abstract

We explore the potential role of the endothelial lining of uteroplacental arteries in the pathogenesis of preeclampsia, a severe pregnancy disorder characterized by incomplete invasion of the uterine vasculature by extravillous trophoblast and angiogenic imbalance. In normal pregnancy, the endothelium disappears progressively from the uteroplacental arteries and is replaced by trophoblast and deposition of fibrofibrinoid structure, underpinning the so-called physiological transformation of uterine spiral arteries. We hypothesize that partial persistence of the endothelium, albeit injured, initiates a chain of events leading to the emergence of preeclampsia in 3 sequential stages. The first stage results in retention of the endothelium in uteroplacental arteries secondary to incomplete physiological transformation of the vessels. Consequently, the uteroplacental vessels are reactive to pathological cues, which drives local arteriopathy. The second stage starts with progressive reduction in uteroplacental blood flow, generating oxidative stress in the whole placenta, and heightened maternal inflammation in response to circulating trophoblastic debris. In the third stage, generalized endotheliosis causes systemic angiogenic imbalance, hypertension, and other clinical manifestation of preeclampsia.

Authors+Show Affiliations

Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium. Electronic address: Ivo.brosens@med.kuleuven.be.Division of Biomedical Sciences, Warwick Medical School, Coventry, United Kingdom.Division of Biomedical Sciences, Warwick Medical School, Coventry, United Kingdom.Life Institute for Fertility and Embryology, Leuven, Belgium.Department of Gynecology, Obstetrics, and Urology, Sapienza, University of Rome, Rome, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30738027

Citation

Brosens, Ivo, et al. "Preeclampsia: the Role of Persistent Endothelial Cells in Uteroplacental Arteries." American Journal of Obstetrics and Gynecology, vol. 221, no. 3, 2019, pp. 219-226.
Brosens I, Brosens JJ, Muter J, et al. Preeclampsia: the role of persistent endothelial cells in uteroplacental arteries. Am J Obstet Gynecol. 2019;221(3):219-226.
Brosens, I., Brosens, J. J., Muter, J., Puttemans, P., & Benagiano, G. (2019). Preeclampsia: the role of persistent endothelial cells in uteroplacental arteries. American Journal of Obstetrics and Gynecology, 221(3), pp. 219-226. doi:10.1016/j.ajog.2019.01.239.
Brosens I, et al. Preeclampsia: the Role of Persistent Endothelial Cells in Uteroplacental Arteries. Am J Obstet Gynecol. 2019;221(3):219-226. PubMed PMID: 30738027.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preeclampsia: the role of persistent endothelial cells in uteroplacental arteries. AU - Brosens,Ivo, AU - Brosens,Jan J, AU - Muter,Joanne, AU - Puttemans,Patrick, AU - Benagiano,Giuseppe, Y1 - 2019/02/06/ PY - 2018/08/26/received PY - 2019/01/11/revised PY - 2019/01/31/accepted PY - 2019/2/10/pubmed PY - 2019/2/10/medline PY - 2019/2/10/entrez KW - endothelium KW - fetal growth restriction KW - hypoxia KW - oxidative stress KW - preeclampsia KW - trophoblast KW - uteroplacental arteries KW - vasoconstriction SP - 219 EP - 226 JF - American journal of obstetrics and gynecology JO - Am. J. Obstet. Gynecol. VL - 221 IS - 3 N2 - We explore the potential role of the endothelial lining of uteroplacental arteries in the pathogenesis of preeclampsia, a severe pregnancy disorder characterized by incomplete invasion of the uterine vasculature by extravillous trophoblast and angiogenic imbalance. In normal pregnancy, the endothelium disappears progressively from the uteroplacental arteries and is replaced by trophoblast and deposition of fibrofibrinoid structure, underpinning the so-called physiological transformation of uterine spiral arteries. We hypothesize that partial persistence of the endothelium, albeit injured, initiates a chain of events leading to the emergence of preeclampsia in 3 sequential stages. The first stage results in retention of the endothelium in uteroplacental arteries secondary to incomplete physiological transformation of the vessels. Consequently, the uteroplacental vessels are reactive to pathological cues, which drives local arteriopathy. The second stage starts with progressive reduction in uteroplacental blood flow, generating oxidative stress in the whole placenta, and heightened maternal inflammation in response to circulating trophoblastic debris. In the third stage, generalized endotheliosis causes systemic angiogenic imbalance, hypertension, and other clinical manifestation of preeclampsia. SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/30738027/Preeclampsia:_the_role_of_persistent_endothelial_cells_in_uteroplacental_arteries L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9378(19)30323-0 DB - PRIME DP - Unbound Medicine ER -