Gebeliğin 3. Trimestrinde Plasenta Previa, Plasenta Akreata ve Normotensif Plasentalarda PLGF, sFlt-1 ekspresyonunun incelenmesi

Öz

Amaç: Normotensif, Plasenta akreata (PA) ve Plasenta previa (PP); Plasenta büyüme faktör (PLGF) ve Soluble Fms-Benzeri Tirozin Kinaz-1 (sFlt-1) proteinlerin ekspresyon düzeylerinin immünohistokimyasal olarak incelenmesini amaçladık. Materyal ve Metod: Çalışmaya 20 Nomotensif plasenta, 20 PP ve 20 PA tanısı konmuş kadına ait plasen-ta örnekleri olmak üzere 3 grup oluşturulmuştur. Plasentalardan 4-6 μm kalınlığında kesitler alındı, elde edilen kesitlere PLGF ve sFlt-1 immün boyama uygulanarak dokulardaki ekspresyon şiddetleri ve loka-lizasyonları belirlendi. Bulgular: Gözlemlerimiz sonucu normotensif plasenta grubu; hofbauer hücreler ve sinsityal nodlar sFlt-1 ve bazı tunika media bölgesindeki kas hücrelerin nukleuslarında PLGF pozitif ekspresyonu izlendi. PP ve PA grubu; desidua hücreler, hofbauer hücrelerinde ve dilate damar endotelinde sFlt-1 ekspresyonu pozitif izlendi. PP ve PA grubu; sinsityal düğümlerde negatif, hofbauer hücrelerinde ve endotel hücre-lerinde pozitif PLGF ekspresyonu izlendi. Normotensif, PP ve PA grupları arasında anlamlı bir fark vardı (p<0.05). Sonuç: PP ve PA olgularında görülen trofoblastik dejenerasyon ve apoptotik hücreler, anjiyogenezisin artmasına ve implantasyonda dengesizliğin gerçekleşmesinde sFlt-1 ve PLGF etkili olabileceğini düşün-mekteyiz.

Anahtar Kelimeler

• Plasenta akreata
• Plasenta previa
• PLGF
• sFlt-1

Investigation of PLGF, sFlt-1 Expression in Placenta Previa, Placenta Accreta and Normotensive Placentas in the 3rd Trimester of Pregnancy

Öz

Background: We aimed to immunohistochemically examine the expression level of Placental growth factor (PLGF) and Soluble FMS-like tyrosine kinase-1 (sFlt-1) proteins in normotensive, Placenta accreta (PA) and Placenta previa (PP). Materials and Methods: Three groups were created for the study: 20 Nomotensive placentas, 20 PP and 20 PA from women diagnosed with placenta samples. 4-6 μm thick sections were taken from the placentas, PLGF and sFlt-1 immunostaining were applied to the obtained sections, and their expression intensities and localizations in the tissues were determined. Results: As a result of our observations, normotensive placenta group; sFlt-1 expression was observed in hofbauer cells and syncytial nodes and PLGF positive expression was observed in nuclei of muscle cells in some tunica media region. PP and PA group; sFlt-1 expression was positive in decidua cells, hofbauer cells and dilated vascular endothelium. PP and PA group; negative PLGF expression was observed in syncytial nodes and positive PLGF expression was observed in hofbauer cells and endothelial cells. There was a significant difference between normotensive, PP and PA groups (p<0.05). Conclusions: It can be thought that sFlt-1 and PLGF may be important signal stimulators and markers in the trophoblastic degeneration, apoptotic cells, increase in angiogenesis and imbalance in implanta-tion seen in cases of PP and PA.

Anahtar Kelimeler

• Placenta accreta
• Placenta previa
• PLGF
• sFlt-1

Kaynakça

1. 1. Knöfler M, Haider S, Saleh L, Pollheimer J, Gamage T. James J. Human placenta and trophoblast development: key molecular mechanisms and model systems. Cell Mol L Sciens. 2019;76(18):3479-96.
2. 2. Napso T, Yong HEJ, Lopez-Tello J, Sferruzzi-Perri A. The role of placental hormones in mediating maternal adapta-tions to support pregnancy and lactation. Front Physiol. 2018;9:1091.
3. 3. Ahn KH, Lee EH, Cho GJ, Hong SC, Oh MJ, Kim HJ. Anterior placenta previa in the mid-trimester of pregnancy as a risk factor for neonatal respiratory distress syndrome. PloS one. 2018;13(11):e0207061.
4. 4. Silver RM. Branch DW, Placenta accreta spectrum. N Eng J Med. 2018;378(16):1529-36.
5. 5. Silver RM. Abnormal placentation: placenta previa, vasa previa, and placenta accreta. Obstet Gynecol. 2015;126(3):654-68.
6. 6. Jauniaux E, Collins S, Burton GJ. Placenta accreta spec-trum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. Am J Obstet Gynecol. 2018;218(1):75-87.
7. 7. Morlando M, Sarno L, Napolitano R, Capone A, Tessitore G, Maruotti GM, et al. Placenta accreta: incidence and risk factors in an area with a particularly high rate of cesarean section. Acta Obstet Gynecol Scandinavica. 2013;92(4):457-60.
8. 8. Fitzpatrick K, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M. The management and outcomes of placenta accreta, increta, and percreta in the UK: a population‐based descriptive study. Int J Obstet Gynecol. 2014;121(1):62-71.

9. 9. Jauniaux E, Bhide A. Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean deliv-ery: a systematic review and meta-analysis. Am J Obstet Gynecol. 2017;217(1):27-36.
10. 10. Lecarpentier É, Vieillefosse S, Haddad B, Fournier T, Leguy MC, Guibourdenche J, et al. Placental growth factor (PlGF) and sFlt-1 during pregnancy: physiology, as-say and interest in preeclampsia. Annal Bio Clin. 2016;74(3):259-67.
11. 11. Liao L, Zhao X, Zhou M, Deng Y, Li Y, Peng C. sFlt-1: A Double Regulator in Angiogenesis-related Diseases. Cur-rent Pharmaceutical Design. 2021;27(40):4160-70.
12. 12. Chau K, Hennessy A, Makris A. Placental growth factor and pre-eclampsia. J Hum Hypert. 2017;31(12):782-6.
13. 13. Cai SN, Wu YT, Zeng L, Ding YQ. Value of 3D ultrasound flow imaging combined with serum AFP, β-hCG, sFlt-1 and CK in the diagnosis of placenta accreta. BMC Wom-en's Health. 2022;22(1):556.
14. 14. Alessandrini L, Aryananda R, Ariani G, Agustina B, Akbar MİA Dachlan EG, et al. The correlation between serum levels and placental tissue expression of PLGF and sFLT-1 and the FIGO grading of the placenta accreta spectrum disorders. J Matern Fetal Neonatal Med. 2023;36(1):2183744.
15. 15. Seker U, Aktas A, Nergiz Y, Zincircioglu S.B, Ketani M.A. Investigation of the protective effects of melatonin, amifostine (WR-2721), and N-acetylcysteine on radio-therapy-induced uterine tissue injury in rats. Int. J. Radia-tion Research. 2020;18(4): 791-8.
16. 16. Seker U, Kavak D.E, Dokumaci F.Z, Kizildag S, Irtegun-Kandemir S. The nephroprotective effect of Quercetin in Cyclophosphamide-induced renal toxicity might be associ-ated with MAPK/ERK and NF-κB signal modulation activi-ty. Drug and Chemical Toxicology. 2024;1-10.
17. 17. Sur E, Oznurlu Y, Ozaydın T. The determination of Ghrelin immunoreactivity in gastric mucosa of fundus during pregnancy in mice. Int J Bio Res. 2017;8(12):672-6.
18. 18. Lecarpentier E, Zsengellér ZK, Salahuddin S, Covarrubias AE, Lo A, Haddad B, et al. Total versus free placental growth factor levels in the pathogenesis of preeclampsia. Hypertension. 2020;76(3):875-83.
19. 19. Stepan H, Hund M, Andraczek T. Combining biomarkers to predict pregnancy complications and redefine preeclamp-sia: the angiogenic-placental syndrome. Hypertension. 2020;75(4):918-26.
20. 20. Huhn EA, Kreienbühl A, Hoffmann I, Schoetzau A, Lange S, Martinez de Tejada B, et al. Diagnostic accuracy of differ-ent soluble fms-like tyrosine kinase 1 and placental growth factor cut-off values in the assessment of preterm and term preeclampsia: a gestational age matched case-control study. Frontiers in medicine. 2018;5:325.
21. 21. Öztaş E, Özler S, Ergin M, Erel Ö, Güler B, Çağlar AT, et al. Decreased oxidative stress may contribute to the disease process in placenta accreta. Turk J Med Sci. 2017;47(4):1180-4.
22. 22. Andraweera P, Dekker G, Roberts C. The vascular endothe-lial growth factor family in adverse pregnancy outcomes. Human reproduction update. 2012;18(4):436-57.
23. 23. Yamashita M, Kumasawa K, Nakamura H, Kimura T. Solu-ble FLT-1 rules placental destiny. Biochemical and bio-physical research communications. 2018;496(4):1243-9.
24. 24. McMahon K, Karumanchi SA, Stillman IE, Cummings BSP, Patton D, Easterling T. Does soluble fms-like tyrosine ki-nase-1 regulate placental invasion? Insight from the inva-sive placenta. Am J Obstet Gynecol. 2014;210(1):68.e1-4.
25. 25. Lumbanraja S, Yaznil MZ, Siahaan AM, Bancin BEP. Pla-cental Growth Factor-soluble FMS-like Tyrosine Kinase-1 Ratio in Placenta Accreta Spectrum Disorder: Case Control Study. Open Access Macedonian J Med Sci. 2022;10(B):848-52.
26. 26. Seval Y, Korgun ET, Demir R. Hofbauer cells in early hu-man placenta: possible implications in vasculogenesis and angiogenesis. Placenta. 2007;28(8-9):841-5.
27. 27. Ciğercioğullari E, Filinte D, Toz E, Avci İ, Erdem B, Eminli İ, et al., The determination of normal percentages of syn-cytiotrophoblastic knots in various regions of placenta: where to count the syncytial knots. Turk Patoloji Derg. 2015; 31(1):1-8.
28. 28. Özgökçe Ç, Öcal A, Ermiş I.S. Expression of NF-κB and VEGF in normal placenta and placenta previa patients. Advance in Clin. and Exp.Med. 2023;32(3):297-306.