P 12 Treatment of very preterm preeclampsia by heparin-mediated extracorporeal LDL-Precipitation (H.E.L.P) apheresis results in favorable fetal outcome and weight gain without lowering soluble FMS-like Tyrosine Kinase-1 (sFlt-1) – The Freiburg preeclampsia HELP-Apheresis study

Autor: Heinrich Prömpeler, Brigitte König, Mirjam Kunze, F Markfeld-Erol, Karl Winkler, Ulrich Pecks, Dimitra Stavropoulou, Gerhard Pütz, Christiane Contini, Stefan Zschiedrich, Bärbel Krumrey
Rok vydání: 2017
Předmět:
Zdroj: Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health. 9:42
ISSN: 2210-7789
0196-7355
DOI: 10.1016/j.preghy.2017.07.090
Popis: Background Preeclampsia (PE) is a life-threatening complication of pregnancy. To date the only therapy of severe PE consists in timely delivery of the fetus. In PE a deranged lipoprotein metabolism considered to impair endothelial function is observed. Heparin-mediated extracorporeal LDL-precipitation (H.E.L.P.)-apheresis is an established method for lipoprotein removal and has already been successfully applied in PE. Recently, angiogenetic and anti-angiogenetic factors like placenta growth factor (PlGF) and soluble Fms-like tyrosine kinase-1 (sFlt-1) are discussed as risk factors and removal of sFlt-1 by dextran sulfate column (DCS) apheresis is suggested as specific cure for PE. By contrast, H.E.L.P.-apheresis does not remove sFlt-1. The present clinical trial revaluates the clinical efficacy of H.E.L.P.-apheresis in PE with focus on sFlt-1 and PlGF. Methods Open pilot study assessing the prolongation by H.E.L.P.-apheresis in 6 women (30–41 years) with very preterm PE (24 + 4 to 27 + 0 gestational weeks (GW)) (NCT01967355) compared to a historic untreated PE-group matching treated patients by GW at admission ( Results Women with PE received apheresis 2–6 times. In treated patients the average time from admission to birth was 15.0 days compared to 6.3 days in controls (p = 0.027). In treated patients the prolongation of gestation by apheresis converted to a mean fetal weight gain of 101 grams (p = 0.029). Lung maturation could be induced in all treated cases and all children could be dismissed in healthy condition. Apheresis significantly reduced levels of total cholesterol (−33%), triglycerides (−43%), and LDL-cholesterol (−44%). However, sFlt-1 was not reduced but levels significantly increased initially by H.E.L.P.-apheresis and dropped to almost pre-apheresis levels before next apheresis, with sFlt-1/PLGF ratio remaining unaffected. Conclusions H.E.L.P.-apheresis proved again to be a safe therapeutic option to prolong pregnancies in PE and results in significant fetal weight gain. However, H.E.L.P.-apheresis does not reduce circulating sFlt-1 levels. Thus, reducing lipids and other pro-inflammatory factors may be more relevant than reducing circulating sFlt-1 to improve outcome in PE.
Databáze: OpenAIRE
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