A.A. KHASANOV^1, 2, A.V. ARZAMASTSEVA¹, I.S. RAGINOV^{1, 2}

 ¹Kazan State Medical University, Kazan

²Republic Clinical Hospital, Kazan

  Contact details:

Khasanov A.A. — MD, Professor of the Department of Obstetrics and Gynecology named after Prof. V.S. Gruzdev, Chief Specialist, Chief Researcher

Address: 49 Butlerov St., Kazan, Russian Federation, 420012, tel.: +7-917-239-15-00, e-mail: albirkhasanov@mail.ru

Preeclampsia is one of the most important problems in obstetrics. Every year, preeclampsia affects 6–8% of pregnant women in developed countries and over 20% pregnant women in developing countries. It is noted that together with obstetric bleeding and infectious complications, preeclampsia constitutes the so-called «deadly triad» and is the cause of the overwhelming number of maternal deaths. The possibilities of treating preeclampsia are limited only to symptomatic therapy, and in the absence of the desired effect, the patient is offered delivery. To date, new, pathogenetically determined, methods of treatment aimed at inhibiting the activity of membrane-attacking molecules are being considered. This literature review provides information on the role of the trophoblast in the pathogenesis of preeclampsia. The increase in the concentration of trophoblast cells in the mother’s blood leads to excessive activation of the complement system, which causes multiple endothelial damage, leading to multiple organ failure.

Key words: microchimerism, trophoblast, thrombotic microangiopathy, preeclampsia.

REFERENCES

1. Cómitre-Mariano B., Martínez-García M. Feto-maternal microchimerism: Memories from pregnancy. Science. 2022, vol. 25 (1), p. 103664.
2. O’Donoghue K., Chan J., Kennea N. et al. Microchimerism in female bone marrow and bone decades alter fetal mesenchymal Stemcell trafficking in pregnancy. Lancet, 2004, vol. 364, pp. 179–182
3. Joško O., Kumer K. Clinical, Biochemical, and Biophysical Markers of Angiogenesis in Preeclampsia. Prediction of Maternal and Fetal Syndrome of Preeclampsia, 2019.
4. James J. Pre-eclampsia: Fitting together the placental, immune and cardiovascular pieces. The Journal of Pathology, 2022, vol. 221 (4), pp. 363–378.
5. Moises Leon Juarez. Cellular and molecular mechanisms of viral infection in the human placenta. Pathogens and Disease, 2017, vol. 75 (7).
6. Saito S., Shima T., Nakashima A., Shiozaki A., Ito M., Sasaki Y. What is the role of regulatory T cells in the success of implantation and early pregnancy? J Assist Reprod Genet., 2007, Sep., vol. 24 (9), pp. 379–386. DOI: 10.1007/s10815-007-9140-y PMID: 17668314; PMCID: PMC3454956.
7. Maternal Platelets of the Human Placenta: Friend or Foe? International Journal of Molecular Sciences, 2019, Nov, vol. 20 (22), p. 5639.
8. Ruocco M.G., Chaouat G. Regulatory T-cells in pregnancy: historical perspective, state of the art, and burning questions. Immunol, 2014, vol. 5. DOI: 10.3389/fimmu.2014.00389
9. Schust D.J., Bonney E.A. The Immunology of Syncytialized Trophoblast. Int. J. Mol. Sci, 2021, vol. 22 (4), p. 1767. DOI: 10.3390/ijms22041767
10. Sánchez-Aranguren L.C., Prada C.E., Riaño-Medina C.E., Lopez M. Endothelial dysfunction and preeclampsia: role of oxidative stress. Front Physiol, 2014, Oct 10, vol. 5, p. 372. DOI: 10.3389/fphys.2014.00372 PMID: 25346691. PMCID: PMC4193194.
11. Burton G.J., Woods A.W., Jauniaux E., Kingdom J.C. Rheological and physiological consequences of conversion of the maternal spiral arteries for uteroplacental blood flow during human pregnancy. Placenta, 2009, vol. 30 (6), pp. 473–482. DOI: 10.1016/j.placenta.2009.02.009 Epub 2009 Apr 17. PMID: 19375795. PMCID: PMC2697319.
12. Pis’mo MZ RF ot 5.05.2017 no. 15-4/1560-07 “O napravlenii informatsionno-metodicheskogo pis’ma «Tromboticheskaya mikroangiopatiya v akusherstve” [Letter of the Ministry of Health of the Russian Federation dated May 5, 2017 N 15-4 / 1560-07 «On the direction of the information and methodological letter «Thrombotic microangiopathy in obstetrics»].
13. Graham J., Wood A.W. Rheological and Physiological Consequences of Conversion of the Maternal Spiral Arteries for Uteroplacental Blood Flow during Human Pregnancy. Placenta, 2009, vol. 30 (6), pp. 473–482.
14. Olivar Clemente Castejón Sandoval, Angela Josmar López González. A light and scanning electron microscopy study of placental villi associated with obesity and hypertension. Electron J Biomed, 2013, vol. 2, pp. 29–36.
15. Khosrotchrani K., Johnson K.L., Cha D.H. et al. Transfer of fetal cells with multilineage potential to maternal tissue. JAMA, 2014, vol. 292, pp. 75–80.
16. Thomas M.R., Williamson R., Craft I. et al. Y chromosome sequence DNA amplified from peripheral blood of women in early pregnancy. Lancet, 2014, vol. 343, pp. 413–414.
17. Abdullaeva N.K. The state of the compliment system in preeclampsia. Rossiyskiy vestnik akushera-ginekologa, 2014, no. 14 (6), pp. 19–23 (in Russ.).
18. Strizhakov A.N., Timokhina E.V., Ignatko I.V. et al. Thrombotic microangiopathy as a manifestation of severe preeclampsia and HELLP syndrome. Voprosy ginekologii, akusherstva i perinatologii, 2017, vol. 16, no. 6, pp. 89–92 (in Russ.).
19. Catherine B. Xie, DanJane-Wit, Jordan S. Pober. Complement Membrane Attack Complex: New Roles, Mechanisms of Action, and Therapeutic. The American Journal of Pathology, 2020, vol. 190 (6), pp. 1138–1150.
20. Fitzhugh M. Omeros touts pivotal data on HSCT-TMA candidate, shielding details, 2019.
21. Legendre C.M., Licht C., Muus P., Greenbaum L.A. et al. Terminal complement inhibitor eculizumab in atypical hemolytic-uremic syndrome. N Engl J Med, 2013, vol. 368 (23), pp. 2169–2181. DOI: 10.1056/NEJMoa1208981 PMID: 23738544.
22. Khaled S.K., Claes K., Goh Y.T., Kwong Y.L. et al. OMS721-TMA-001 Study Group Members. Narsoplimab, a Mannan-Binding Lectin-Associated Serine Protease-2 Inhibitor, for the Treatment of Adult Hematopoietic Stem-Cell Transplantation-Associated Thrombotic Microangiopathy. J Clin Oncol, 2022, vol. 40 (22), pp. 2447–2457. DOI: 10.1200/JCO.21.02389
23. Hahn S., Hasler P., Vokalova L., van Breda S.V. et al. Feto-Maternal Microchimerism: The Pre-eclampsia Conundrum. Front Immunol, 2019, vol. 10, p. 659. DOI: 10.3389/fimmu.2019.00659
24. Ariga H., Otho H., Busch M.P. et al. Kinetics of fetal cellular and cell-free DNA in the maternal circulation during and after pregnancy: implications for noninvasive prenatal diagnosis. Transfusion, 2011, vol. 41, pp. 1524–1530.