However, preeclampsia is a serious problem in industrialized countries, too. In Germany, for example, every year more than 20,000 babies are born prematurely due to preeclampsia. “In fact preeclampsia is among the leading causes of prematurely born babies,” Dr. Karumanchi stressed. As each additional week in the uterus of the mother lowers fetal morbidity and mortality, physicians strive to prolong pregnancy without compromising the safety of the mother.If the condition becomes too dangerous for the pregnant woman, they intervene and induce labor. As soon as the child is born, the mother’s symptoms disappear. But later in life the mothers can develop heart disease, hypertension and thyroid disorders due to preeclampsia. And premature babies run the risk, if they survive, of life-long disability.
Dr. Karumanchi was able to show that the placenta, the organ in the uterus which nourishes the embryo and the fetus, plays an important role in the onset of preeclampsia. It releases two different proteins. One of the proteins, the PlGF (placental growth factor) makes blood vessels grow towards the placenta. It is an angiogenisis factor which is part of the VEGF family, a large group of proteins that induces blood vessel growth. The antagonist to PlGF is sFlt-1 (soluble fms-like tyrosine kinase-1). It binds to PlGF and inhibits blood vessel growth. The levels of these two proteins in the blood of the pregnant women must be in balance for mother and unborn baby to stay healthy.
Dr. Karumanchi’s team discovered that pregnant women with preeclampsia have too much sFlt-1 circulating in their blood, and too little PlGF. As a result the placenta is no longer well supplied with blood, and the fetus does not get enough nutrients. Also, lack of PlGF constricts the blood vessels, and the expectant mother’s blood pressure becomes elevated – the main symptom of preeclampsia. As the kidneys are affected, too, the patient develops proteinuria, characterized by too much protein in the urine.Whereas formerly preeclampsia in pregnant women could only be diagnosed by these symptoms – hypertension and proteinuria – the findings of Dr. Karumanchi now make it possible to detect preeclampsia at a very early stage, even before the first symptoms appear. Researchers and clinicians measure sFlt-1 and PlGF levels and they can determine if sFLT-1 levels are too high. They can then monitor the expectant mothers at a very early stage and help prevent the disease from progressing in order to avoid seizures and liver failure.
Barbara Bachtler | Max-Delbrück-Centrum
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