| Autor: |
Duan L; Department of Gynecology and Obstetrics, University of Duisburg-Essen, 45147 Essen, Germany., Ma Y; Department of Gynecology and Obstetrics, University of Duisburg-Essen, 45147 Essen, Germany., Reisch B; Department of Gynecology and Obstetrics, University of Duisburg-Essen, 45147 Essen, Germany., Hadrovic E; Department of Gynecology and Obstetrics, University of Duisburg-Essen, 45147 Essen, Germany., Mach P; Department of Gynecology and Obstetrics, University of Duisburg-Essen, 45147 Essen, Germany., Kimmig R; Department of Gynecology and Obstetrics, University of Duisburg-Essen, 45147 Essen, Germany., Jahn M; Department of Nephrology, University of Duisburg-Essen, University Hospital Essen, 45147 Essen, Germany., Köninger A; Department of Gynecology and Obstetrics, University of Duisburg-Essen, 45147 Essen, Germany.; Department of Gynecology and Obstetrics, University Clinic St. Hedwig of the Order of St. John, 93049 Regensburg, Germany., Iannaccone A; Department of Gynecology and Obstetrics, University of Duisburg-Essen, 45147 Essen, Germany., Gellhaus A; Department of Gynecology and Obstetrics, University of Duisburg-Essen, 45147 Essen, Germany. |
| Abstrakt: |
Therapeutic plasma exchange (TPE) is a widely used treatment for numerous diseases including pregnancy-related conditions. Our prior study on 20 early-onset preeclampsia patients undergoing TPE revealed a significant extension in pregnancy duration and reduced serum levels of sFlt-1, sFlt-1/PlGF, and sEndoglin. Here, we investigated the impact of TPE on serum sB7-H4, an immunological checkpoint molecule, and placental proteins (Flt-1, Eng, B7-H4, iNOS, TNF-α) in TPE-treated early-onset preeclampsia patients (N = 12, 23 + 2-28 + 5 weeks), conventionally treated counterparts (N = 12, 23 + 5-30 weeks), and gestational age-matched controls (N = 8, 22 + 4-31 + 6 weeks). Immunoblotting, ELISA, and co-immunohistochemistry were used for biomarker analysis, including placental inflammation factors (iNOS, TNF-α). The results showed that TPE extended pregnancy by a median of 6.5 days in this cohort of early-onset preeclampsia. Serum sB7-H4, sFlt-1, and sEndoglin levels decreased, along with reduced expression of their membrane-bound proteins in placental tissue upon TPE treatment. Moreover, TPE-treated patients displayed reduced placental inflammation compared to preeclampsia patients receiving standard-of-care treatment. In conclusion, TPE may improve pregnancy outcomes in early-onset preeclampsia by lowering circulating levels of sB7-H4, sFlt-1, and sEndoglin, as well as reducing placental inflammation. This translational approach holds promise for enhancing placental function and extending gestation in high-risk pregnancies including very preterm PE or HELLP cases. |
