[Angiogenic factors and their role in pathogenesis and prediction of preeclampsia]

Abstract

Angiogenic factors like placental growth factor (PlGF) and its anti-angiogenic antagonists soluble fms-like tyrosine kinase 1 (sFlt1) and soluble endoglin (sEng) are closely related to the pathogenesis of preeclampsia and intrauterine growth restriction (IUGR). The discovery and investigation of these angiogenic factors could characterize important pathogenetic mediators of preeclampsia or even the cause for placental dysfunctions. These anti-angiogenic proteins are dramatically elevated in maternal circulation weeks prior to the onset of the syndrome preeclampsia. Since it is known that altered maternal sFlt1, sEng and PlGF levels are detectable weeks prior to the onset of these pregnancy complications, it was the aim of the study to investigate the predictive value of these markers in high-risk second trimester pregnancies characterized by abnormal uterine perfusion. Using both factors, sFlt1 and PlGF, early-onset preeclampsia can be predicted with 83% sensitivity and 95% specificity. Combined analysis of sEng and sFlt1 is able to predict early-onset PE even with a sensitivity of 100% and a specificity of 93.3%. This shows, that the concurrent measurement of uterine perfusion and angiogenic factors allows an efficient prediction of early-onset pregnancy complications, particularly preeclampsia. The next step will be the development of therapeutic tools that have positive impact on the clinical symptoms via the inhibition of sFlt1 and or sEng.