Serum adrenomedullin levels in preeclamptic and normotensive pregnant women

Öz

INTRODUCTION: In spite of the assumed several mechanisms, pathogenesis of preeclampsia has not fully understood. Adrenomedullin, known as a potent vasodilator and natriuretic peptide, contributed to blood presseure regulation and related to hypertensive disorders. Nevertheless, preeclampsia related data of this peptide exhibit the divergent results. Therefore, in this study we purposed to assess whether maternal serum adrenomedullin concentrations increased in preeclamptic pregnancies. METHODS: Fourty-one preeclamptic and fourty four normotensive age and gestational age matched pregnant women prospectively included in this study. Diagnosis of preeclampsia was based on according to the American College of Obstetricians and Gynecologists (ACOG) criteria. Serum adrenomedullin concentrations were measured by using Enzyme-Linked ImmunoSorbent Assay (ELISA) technique. RESULTS: Both Systolic and diastolic blood pressure levels were higher in preeclamptic group (p>0.05). Maternal serum concentrations of adrenomedullin did not exhibited to significant difference between two groups (34.29±8.52 pmol/L vs. 33.83 ±6.21 pmol/L; p=0.29). Neither systolic nor diastolic blood pressure levels correlated with adrenomedullin (p> 0.05). DISCUSSION AND CONCLUSION: Despite fact that, preeclamptic maternal serum adrenomedullin concentrations did not elevated in this study population; It was reccomended that potential role of this vasodilator peptide in pathogenesis of preeclampsia should be more eludicated in large prospective studies.

Anahtar Kelimeler

• pregnancy
• adrenomedullin
• preeclampsia
• hypertension

Preeklamptik ve normotensiv gebe kadınlar arasında serum adrenomedullin düzeylerinin kıyaslanması

Öz

GİRİŞ ve AMAÇ: Öne sürülen çeşitli mekanizmalara rağmen, preeklampsinin patogenezi halen tam olarak anlaşılamamıştır. Adrenomedullin kan basıncı regulasyonuna katkıda bulunan güçlü vasodilatör ve natriüretik bir peptid olup hipertansif hastalıklar ile ilişkilidir. Buna karşın bu peptidin preeklampsiyle ilişkisi hakkındaki veriler farklılık göstermektedir. Bundan ötürü bu çalışmada biz maternal serum adrenomedullin konsantrasyonlarının preeklamptik gebeliklerde artış gösterip göstermediğini değerlendirmeyi amaçladık. YÖNTEM ve GEREÇLER: 41 preeklamptik ve 44 normotensiv gebe kadın yaş ve gestasyonel yaş eşleşmeli olarak prospektif şekilde çalışmaya dahil edildiler. Preeklampsi tanısı Amerikan Obstetrisyenler ve Jınekologlar Birliği (ACOG) kriterleri temel alınarak konuldu. Serum adrenomedullin konsantrasyonları ELISA (Enzyme-Linked ImmunoSorbent Assay) tekniği kullanılarak ölçüldü. BULGULAR: Hem sistolik hem de diastolik kan basıncı düzeyleri preeklamptik grupta daha yüksek saptandı. Maternal serum adrenomedullin konsantrasyonları iki grup arasında anlamlı fark göstermiyordu (34.29±8.52 pmol/L 'e karşın 33.83 ±6.21 pmol/L;p=0.29). Ne sistolik ne de diastolik kan basınçları ile adrenomedullin arasında anlamlı korelasyon saptanmadı (p>0.05) TARTIŞMA ve SONUÇ: Her ne kadar bu çalışma populasyonunda preeaklamptik maternal serum adrenomedullin konsantrasyonları artış göstermese de; bu vasodilatör peptidin preeklampsi patogenesindeki olası rolünün daha büyük prospektif çalışmalarda detaylı olarak incelenmesi gerektiği önerilir.

Anahtar Kelimeler

• gebelik
• adrenomedullin
• preeklampsi
• hipertansiyon

Kaynakça

1. Craici IM, Wagner SJ, Bailey KR, Fitz-Gibbon PD, Wood-Wentz CM, Turner ST, et al. Podocyturia predates proteinuria and clinical features of preeclampsia: longitudinal prospective study. Hypertension. 2013;61:1289-96
2. Warrington JP, George EM, Palei AC, Spradley FT, Granger JP. Recent advances in the understanding of the pathophysiology of preeclampsia.Hypertension. 2013;62:666-73
3. George EM, Bidwell GL.STOX1: a new player in preeclampsia? Hypertension. 2013;61:561-63.
4. Hu W, Zhou PH, Zhang XB, Xu CG, Wang W. Plasma concentrations of adrenomedullin and natriuretic peptides in patients with essential hypertension. Exp Ther Med. 2015;9:1901-8.
5. Dikensoy E, Balat O, Pence S, Balat A, Cekmen M, Yurekli M. The changes of plasma malondialdehyde, nitric oxide, and adrenomedullin levels in patients with preeclampsia. Hypertens Pregnancy. 2009;28:383-9.
6. Lauria MR, Standley CA, Sorokin Y, Yelian FD, Cotton DB. Adrenomedullin levels in normal and preeclamptic pregnancy at term. J Soc Gynecol Investig. 1999;6:318–21.
7. Di Iorio R, Marinoni E, Letizia C, Alò P, Villaccio B, Cosmi EV. Adrenomedullin, a new vasoactive peptide, is increased in preeclampsia. Hypertension. 1998;32:758–63.
8. Minegishi T, Nakamura M, Abe K, Tano M, Andoh A, Yoshida M, et al. Adrenomedullin and atrial natriuretic peptide concentrations in normal pregnancy and preeclampsia. Mol Hum Reprod. 1999;5:767–70.

9. [No authors listed]. ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia.Obstet Gynecol. 2019;133:e1-e25.
10. Noori M, Donald AE, Angelakopoulou A, Hingorani AD, Williams DJ. Prospective study of placental angiogenic factors and maternal vascular function before and after preeclampsia and gestational hypertension. Circulation. 2010;122:478-87.
11. Zhu L, Sui L, Wu S, Wang L, Fu J, Wang X. Association between essential hypertension and three vasoactive peptides, urotensin II, endothelin and adrenomedullin.Clin Exp Hypertens. 2015;37:604-8.
12. Hu W, Zhou PH, Zhang XB, Xu CG, Wang W. Plasma concentrations of adrenomedullin and natriuretic peptides in patients with essential hypertension.Exp Ther Med. 2015;9:1901-8.
13. Ishihara T, Yokota N, Hisanaga S, Fujimoto S, Hirayama N, Kato J, et al. Increased plasma levels of mature form of adrenomedullin in patients with chronic renal failure. Clin Nephrol. 1999;52:119-22.
14. Hu W, Zhou PH, Zhang XB, Xu CG, Wang W. Pathophysiological functions of adrenomedullin and natriuretic peptides in patients with primary aldosteronism. Endocrine. 2015;48:661-8.
15. Jerat S, Morrish DW, Davidge ST, Kaufman S. Effect of adrenomedullin on placental arteries in normal and preeclamptic pregnancies. Hypertension. 2001;37:227-31.
16. Di Iorio R, Marinoni E, Scavo D, Letizia C, Cosmi EV. Adrenomedullin in pregnancy. Lancet. 1997;349:328.
17. Di Iorio R, Marinomi E, Letizia C, Villaccio B, Alberini A, Cosmi EV. Adrenomedullin production is increased in normal human pregnancy. Eur J Endocrinol. 1999;140:201–206.
18. Marinoni E, Di Iorio R, Letizia C, Villaccio B, Scucchi L, Cosmi EV. Immunoreactive adrenomedullin in human fetoplacental tissues. Am J Obstet Gynecol. 1998;179:784 –7.
19. Whigham CA, MacDonald TM, Walker SP, Pritchard N, Hannan NJ, Hastie R, et al. Circulating adrenomedullin mRNA is decreased in women destined to develop term preeclampsia. Pregnancy Hypertens. 2019;16:16-25.
20. Joosen AMCP, van der Linden IJM, Schrauwen L, Theeuwes A, de Groot MJM, Ermens AAM. Reference intervals and longitudinal changes in copeptin and MR-proADM concentrations during pregnancy. Clin Chem Lab Med. 2017;56:113-119
21. Alma LJ, Bokslag A, Maas AHEM, Franx A, Paulus WJ, de Groot CJM.Shared biomarkers between female diastolic heart failure and pre-eclampsia: a systematic review and meta-analysis. ESC Heart Fail. 2017;4:88-98.