Expresión de factores inflamatorios e incremento del grosor mediointimal en preeclampsia: evidencia de riesgo arteriosclerótico materno y neonatal

Introduction: Pre-eclampsia is a pathological condition characterized by vascular damage produced by systemic factors released from the placenta. These factors include oxygen free radicals, growth factors and inflammatory cytokines that are products released by the placenta during hypoxia cycles. Although, there is evidence of endothelial dysfunction during preeclampsia, there is no evidence of structural changes in the maternal peripheral vasculature or expression of pathological factors which could be considered as arteriosclerotic risk. Methods: We compared the plasma levels of vascular endothelial growth factor and its soluble receptor sVEGFR-1/sFlt-1 between 16 healthy pregnant women and 24 with pre-eclampsia at term, using the ELISA test. We correlated the expression of hypoxia-inducible factors and the CD40L by RT -PCR and Western blot of endothelial cells of the maternal brachial artery, and measured the Intima-Media- Thickness (IMT) and Flow- Mediated Vasodilation (FMD) by peripheral vascular ultrasound. A P value < 0.05 was considered as statistically significant. Results: The pre-eclamptic women had high levels of plasma sVEGFR-1/sFlt-1, which directly correlated with the expression of HIF-2α and CD40L in endothelial cells, whereas HIF-1α was significantly diminished. Curiously, the IMT was increased in pregnant women with pre-eclampsia, coinciding with a marked decrease in the FMD. Conclusions: Our results demonstrate that molecules involved in the pathophysiology of atherosclerosis are increased in the peripheral vasculature, with a significant thickening of the arterial intima of patients with pre-eclampsia, a condition that predisposes to maternal arteriosclerosis and could be extrapolated to a future neonatal risk.