Angiogenic factors in preeclampsia: potential for diagnosis and treatment

Abstract

Purpose of review: The review summarizes new observations of key roles for circulating angiogenic factors in diagnosing, managing, and treating preeclampsia.

Recent findings: Alterations in circulating angiogenic factors (soluble fms-like tyrosine kinase-1 and placental growth factor) in preeclampsia correlate with the diagnosis and adverse outcomes, particularly when the disease presents prematurely (<34 weeks). Measurement of these angiogenic biomarkers further helps differentiate preeclampsia and its complications from other disorders that present with similar clinical profiles. A ratio of soluble fms-like tyrosine kinase-1/placental growth factor greater than 85 appears ideal as the cut-off for both diagnosis and prognosis. There is also evidence that modulating these factors has therapeutic effects, suggesting a future role for angiogenic factors in treatment and prevention of preeclampsia.

Summary: Circulating angiogenic biomarkers help in diagnostic and prognostic profiling of preeclampsia and may facilitate better management of these patients.

FIGURE 1

Predictive accuracy and correlation with duration of pregnancy of the sFlt1/PlGF ratio. (a) Shows receiver operating characteristic curves for prediction of adverse outcomes using the sFlt1/PlGF ratio, alanine aminotransferase (ALT), uric acid, SBP (highest SBP measured in triage), and creatinine, in patients presenting less than 34 weeks’ gestation. All laboratory values were measured in blood collected at the time of presentation. The area under the curve (AUC) is given for each potential predictor in the legend. All AUCs were significantly different from that of the sFlt1/PlGF ratio alone (P <0.01). (b) Shows the Kaplan–Meier survival function for time to delivery in participants presenting less than 34 weeks’ gestation. Patients were censored at delivery or at 34 weeks’ gestation [26^▪]. PlGF, placental growth factor; sFlt1, soluble fms-like tyrosine kinase-1.