Preeclampsia: What Does the Brain Tell Us?
Can We Blame the Eclampsia Risk on a Malperfused Placenta?
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See related article, pp 219–226
In the present issue of Hypertension, Ciampa et al1 address the important topic of cerebral involvement in preeclampsia. Human biosamples of the brain are not easy to obtain in pregnancy. Therefore, the authors collected cerebrospinal fluid (CSF) during spinal anesthesia of women delivering with preeclampsia or normotensive pregnancies. The advantage of CSF is that it is in contact with neuronal tissue and thus likely to represent a good biomarker source of neural function. The authors used a proteomic platform enabling capturing >1300 proteins and performed principal component analysis. Briefly, the authors found 82 significantly altered CSF proteins in preeclampsia, among them, inflammatory and vasoactive proteins. The signaling pathways for TGF-β (transforming growth factor-β), VEGF (vascular endothelial growth factor)-A, angiotensinogen, and IL-6 (interleukin-6) were significantly involved, and ELISA confirmed upregulation of activin A and FLRG (Follistatin-related gene) in preeclamptic CSF, both proteins within the TGF-β pathway. The study by Karumanchi is one of the few studies on CSF biomarkers in preeclampsia. In another recent CSF study by van den Berg et al,2 using LC-MS/MS (liquid chromatography–mass spectrometry/mass sepctrometry) proteome profiling, 8 proteins were higher abundant and 17 proteins were lower abundant in preeclamptic CSF. In their cohort, the most significantly differentially abundant protein was protein AMBP (α1-microglobulin/bikunin precursor). AMBP is a precursor of a heme-binding protein that counteracts the damaging effects of free hemoglobin, the latter being suggested as a candidate molecule for preeclampsia development by van den Berg et al.2
At present, we lack more easily accessible biomarkers than CSF samples to study the changes of the brain in women at risk for preeclampsia and the feared complication eclampsia and their potential long-term effects and morbidity. Some recent articles, however, suggest that cerebral biomarkers of glial and neuronal origin (ie, S100B …