Angiogenesefaktoren in der Schwangerschaft: Indikatoren für die Präeklampsie

M. Schmidt; A. Gellhaus; S. Kasimir-Bauer; E. Winterhager; R. Kimmig

doi:10.1055/s-2007-964944

Geburtshilfe und Frauenheilkunde, Table of Contents

Geburtshilfe Frauenheilkd 2007; 67(3): 228-235
DOI: 10.1055/s-2007-964944

Übersicht

Georg Thieme Verlag KG Stuttgart · New York

Angiogenesefaktoren in der Schwangerschaft: Indikatoren für die Präeklampsie

Angiogenic Factors during Pregnancy: Indicators of PreeclampsiaM. Schmidt¹ , A. Gellhaus² , S. Kasimir-Bauer¹ , E. Winterhager² , R. Kimmig¹

¹Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Essen, Essen
²Institut für Anatomie, Universitätsklinikum Essen, Essen

Abstract

Zusammenfassung

Die Präeklampsie ist eine der Hauptursachen maternaler, fetaler und neonataler Mortalität. Trotz intensiver wissenschaftlicher Untersuchungen ist die Ätiologie der Präeklampsie weitgehend ungeklärt. Bis heute gilt die inadäquate Umwandlung der myometranen Segmente der Spiralarterien in uteroplazentare Arterien durch eine unzureichende endovaskuläre Invasion des Trophoblasten als pathogenetische Voraussetzung einer Präeklampsie. Als Folge dieser gestörten Invasion des Trophoblasten und der geringen O₂-Versorgung scheint auch die plazentare Angiogenese großen Veränderungen unterworfen und für die Entstehung einer Präeklampsie wichtig zu sein. Vascular endothelial growth factor (VEGF) und placental growth factor (PLGF) sind die wichtigsten Angiogenesefaktoren und Regulatoren einer adäquaten plazentaren Gefäßentwicklung. Diese Expression von VEGF und PLGF ist in präeklamptischen Schwangerschaften im Vergleich zu nicht präeklamptischen Schwangerschaften erniedrigt. Dagegen ist die Expression ihres Rezeptors, des löslichen fms-like tyrosine kinase receptors (sFlt-1), der anti-angiogenetische Eigenschaften besitzt, in präeklamptischen Schwangerschaften erhöht. Zusätzlich konnten wir zeigen, dass die Expression der CCN-Proteine CYR61 und NOV, die ebenfalls zu den pro-angiogenen Faktoren gehören, in der Plazenta präeklamptischer Patientinnen verringert ist. Diese Übersichtsarbeit fasst das derzeitige Verständnis der Rolle der Angiogenesefaktoren in der Entstehung einer Präeklampsie zusammen.

Abstract

Preeclampsia is a major cause of maternal, fetal and neonatal mortality worldwide. The etiology of preeclampsia is still unclear. Currently, the inadequate transformation of the smooth muscle cells of spiral arteries in the placental bed caused by an insufficient endovascular invasion of the trophoblast is considered to be the major reason for the development of preeclampsia. This insufficient invasion seems to lead to altered placental angiogenesis which thus has causal importance for the development of preeclampsia. Vascular endothelial growth factor (VEGF) and placental growth factor (PLGF) are the most important angiogenic factors with regulatory functions for placental vessel development. In preeclamptic pregnancies the expression of VEGF and PLGF was decreased. However, the expression of the corresponding receptor, the soluble fms-like tyrosine kinase receptor, which is considered to have anti-angiogenic properties, was elevated in preeclamptic pregnancies. CYR61 and NOV which belong to a group of proteins, the CCN-family, play also an important role in the regulation of placental angiogenesis. Recently, a decreased expression of both proteins in the placentae of preeclamptic women was detected. This review summarizes our current understanding of the role of angiogenic factors in the pathogenesis of preeclampsia.

Schlüsselwörter

Präeklampsie - Angiogenesefaktoren - Plazentation - CYR61 - NOV - Hypertonie

Key words

preeclampsia - angiogenic factors - placentation - CYR61 - NOV - hypertension

Full Text

References

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Dr. med. Markus Schmidt

Klinik für Frauenheilkunde und Geburtshilfe
Universitätsklinikum Essen

Hufelandstraße 55

45122 Essen

Email: markus.schmidt@uk-essen.de