Removal of Soluble Fms-Like Tyrosine Kinase-1 by Dextran Sulfate Apheresis in Preeclampsia
| Autor: | S. Ananth Karumanchi, Bernhard Roth, Stefanie Hamacher, Ulrich Thome, Peter Mallmann, Marco Danner, Tom H. Lindner, Thomas Benzing, Ravi Thadhani, Holger Stepan, Tuelay Cingoez, Alexander Fridman, Angela Kribs, W Schaarschmidt, Kathryn J. Lucchesi, Julia Wenger, Hector Tamez, Henning Hagmann |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
medicine.medical_specialty Blood Pressure Gestational Age Pilot Projects 030204 cardiovascular system & hematology Gastroenterology Pregnancy Maintenance Preeclampsia 03 medical and health sciences chemistry.chemical_compound Young Adult 0302 clinical medicine Pre-Eclampsia Pregnancy Internal medicine Up Front Matters Medicine Birth Weight Humans Creatinine 030219 obstetrics & reproductive medicine Proteinuria Vascular Endothelial Growth Factor Receptor-1 business.industry Dextran Sulfate Infant Newborn Oxygen Inhalation Therapy Gestational age General Medicine Heart Rate Fetal medicine.disease Surgery Apheresis chemistry Nephrology embryonic structures Blood Component Removal Gestation Premature Birth Female medicine.symptom business Soluble fms-like tyrosine kinase-1 |
| Zdroj: | Journal of the American Society of Nephrology : JASN. 27(3) |
| ISSN: | 1533-3450 |
| Popis: | Preeclampsia is a devastating complication of pregnancy. Soluble Fms-like tyrosine kinase-1 (sFlt-1) is an antiangiogenic protein believed to mediate the signs and symptoms of preeclampsia. We conducted an open pilot study to evaluate the safety and potential efficacy of therapeutic apheresis with a plasma-specific dextran sulfate column to remove circulating sFlt-1 in 11 pregnant women (20-38 years of age) with very preterm preeclampsia (23-32 weeks of gestation, systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, new onset protein/creatinine ratio >0.30 g/g, and sFlt-1/placental growth factor ratio >85). We evaluated the extent of sFlt-1 removal, proteinuria reduction, pregnancy continuation, and neonatal and fetal safety of apheresis after one (n=6), two (n=4), or three (n=1) apheresis treatments. Mean sFlt-1 levels were reduced by 18% (range 7%-28%) with concomitant reductions of 44% in protein/creatinine ratios. Pregnancy continued for 8 days (range 2-11) and 15 days (range 11-21) in women treated once and multiple times, respectively, compared with 3 days (range 0-14) in untreated contemporaneous preeclampsia controls (n=22). Transient maternal BP reduction during apheresis was managed by withholding pre-apheresis antihypertensive therapy, saline prehydration, and reducing blood flow through the apheresis column. Compared with infants born prematurely to untreated women with and without preeclampsia (n=22 per group), no adverse effects of apheresis were observed. In conclusion, therapeutic apheresis reduced circulating sFlt-1 and proteinuria in women with very preterm preeclampsia and appeared to prolong pregnancy without major adverse maternal or fetal consequences. A controlled trial is warranted to confirm these findings. |
| Databáze: | OpenAIRE |
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