Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
8675034 | Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health | 2018 | 8 Pages |
Abstract
Objective: Soluble Fms-like tyrosine kinase-1 (sFlt-1) is thought to be causative in the pathogenesis of preeclampsia (PE) and specific removal of sFlt-1 via dextran sulfate cellulose (DSC)-apheresis was suggested as cure to allow prolongation of pregnancy in preterm PE. However, in addition a deranged lipoprotein metabolism may impact endothelial and placental function in PE. Lipoprotein-apheresis by heparin-mediated extracorporeal LDL-precipitation (H.E.L.P.) was previously applied and has been shown to alleviate symptoms in PE. This clinical trial reevaluates the clinical efficacy of H.E.L.P.-apheresis in PE considering sFlt-1. Study design: Open pilot study assessing the prolongation by H.E.L.P.-apheresis in 6 women (30-41â¯years) with very preterm PE (24+4 to 27+0 gestational weeks (GW)) (NCT01967355) compared to a historic control-group matched for GW at admission (<28â¯GW; nâ¯=â¯6). Clinical outcome of mothers and babies, and pre- and post H.E.L.P.-apheresis levels of sFlt-1 and PlGF were monitored. Main outcome measures: In apheresis patients (2-6 treatments), average time from admission to birth was 15.0â¯days (6.3â¯days in controls; pâ¯=â¯0.027). Lung maturation was induced in all treated cases, and all children were released in healthy condition. Apheresis reduced triglycerides and LDL-cholesterol by more than 40%. Although H.E.L.P.-apheresis induced a transient peak baseline levels did not change and rather stabilized sFlt-1 levels at pre-apheresis levels throughout treatments, with sFlt-1/PLGF ratio remaining unaffected. Conclusions: H.E.L.P.-apheresis proved again to be safe and prolongs pregnancies in PE. However, without changing sFlt-1 levels below baseline lowering lipids or other yet undefined factors appear to be of more relevance than reducing sFlt-1.
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Authors
K. Winkler, C. Contini, B. König, B. Krumrey, G. Pütz, S. Zschiedrich, U. Pecks, D. Stavropoulou, H. Prömpeler, M. Kunze, F. Markfeld-Erol,