早发型与晚发型重度子痫前期的临床表现及母婴结局的对比分析

目的：探讨早发型与晚发型重度子痫前期的不同临床表现及母婴结局,提高对重度予痫前期的临床认识。方法：回顾性分析重度子痫前期患者76例,按照不同的发病孕周,分为早发型（发病孕周〈32周）和晚发型（发病孕周1〉32周）,比较两组孕妇临床情况、孕妇的并发症及围产儿结局。结果：早发型孕妇与晚发型孕妇在上述方面比较,差异均具有统计学意义（P〈0．05）,早发型孕妇的各项临床表现显著差于晚发型孕妇。结论：对早发型重度子痫前期孕妇,更应加强临床各项监护措施,选择理想的终止妊娠的时机,同时加强预防措施,避免早发型重度子痫前期的发生。     

miR-19a在正常妊娠及重度子痫前期患者胎盘中的表达

目的：通过检测正常妊娠及重度子痫前期患者胎盘组织中miR-19a的表达,探讨其与子痫前期发病的关系。方法：收集10例重度子痫前期患者胎盘组织（实验组）和10例正常产妇胎盘组织（对照组）,应用荧光实时定量PCR（Real Time PCR）的方法检测两组miR-19a的表达差异。结果：重度子痫前期患者胎盘组织中miR-19a表达升高（P〈0.05）。结论：子痫前期患者胎盘组织中存在差异表达的miRNA,miR-19a在胎盘组织中的高表达可能与子痫前期的发病有关。     

闭锁卵泡中肾素—血管紧张素质系统的变化

目的：探讨卵巢局部的肾素－血管紧张素系统（RAS）在卵泡闭锁中的作用。方法：应用卵巢细胞双室培养,放射免疫测定（RIA）及免疫组化方法研究猪卵巢的健康卵泡和闭锁卵泡的颗粒细胞和卵泡内膜细胞与RAS的关系;观察了血管紧张素Ⅱ（AngⅡ)拮抗剂Saralasin及血管紧张素转换酶（ACE）抑制剂Captopril的作用。结果（1）与健康卵泡相比较,闭锁卵泡的卵泡液及卵泡内膜细胞培养液中的AngⅡ浓度明显升高,肾素浓度则明显降低;而颗粒细胞培养液中的AngⅡ和肾素浓度均无明显改变;（2）闭锁卵泡切片的AngⅡ,2型血管紧张素Ⅱ受体（AT2）染色明显强于健康卵泡;AngⅡ和AT2水平在双室培养的闭锁卵泡的卵泡内膜细胞中明显强于健康卵泡的卵泡内膜细胞;健康和闭锁卵泡的颗粒细胞中的AngⅡ,AT2水平变化不大;（3）双室培养中加入Saralasin或Captopril培养48h后,（a)与健康卵泡相比,闭锁卵泡的卵泡内膜细胞培养液中的AngⅡ浓度显降低,肾素浓度明显升高;（b)健康和闭锁卵泡的卵泡内膜细胞AngⅡ和AT2免疫组化染色均呈现下降,（c)RIA结果显示,健康和闭锁卵泡的颗粒细胞培养液中的AngⅡ和肾素浓度无明显变化;免疫组化结果显示,颗粒细胞的AngⅡ,AT2水平亦无显改变。结论：卵泡闭锁与卵巢RAS密切相关,AngⅡ和AT2是卵泡闭锁的重要相关因子;卵泡闭锁过程中卵巢局部的RAS变化主要发生在卵泡内膜细胞;Saralasin和Captopril可能通过调节卵巢RAS而具有抑制卵泡闭锁的作用。     

15-脂氧酶在子痫前期中的表达

目的：探讨15-脂氧酶（15-LO）在子痫前期的病理生理过程中的作用。方法：采用蛋白印迹法检测15-LO的两种同工酶15-LO1和15-LO2在12名正常妊娠和16名子痫前期的孕妇胎盘和脐动脉组织中的表达。结果：在子痫前期的孕妇胎盘和脐动脉组织中,15-LO1蛋白质表达明显高于其在正常妊娠中的表达（P〈0.01）;而15-LO2在正常妊娠组不表达,其在子痫前期的孕妇胎盘和脐动脉组织中的表达显著高于其在正常妊娠中的表达（P〈0.01）。结论：15-LO在子痫前期的孕妇胎盘和脐动脉组织中高表达,可能与子痫前期的发生发展密切相关。     

葡萄糖调节蛋白78在子痫前期中的表达及其意义

目的：探讨葡萄糖调节蛋白78（GRP78）mRNA及蛋白在胎盘组织的表达水平及其与子痫前期的发病关系。方法：选择2010年1月-2010年12月在南京医科大学第一附属医院江苏省人民医院产科住院的子痫前期患者35例（子痫前期组）,以同期正常孕妇35例为对照组。采用RT-PCR技术、蛋白印迹（western-blot）法和免疫组化检测两组孕妇胎盘组织中GRP78的mRNA与蛋白表达水平差异。结果：子痫前期组患者胎盘组织中GRP78mRNA与蛋白表达水平均显著高于相应孕周正常妊娠组。结论：子痫前期能够诱导GRP78表达,CHOP/GADD153表达的增高与子痫前期的发病有关。     

子痫前期患者血清对脐静脉内皮细胞CD40 和NF-kB 表达的影响

目的：研究CD40 和NF-资B 在子痫前期患者组的脐静脉内皮细胞（HUVEC）中的表达,探讨其在子痫前期发病过程中的作 用。方法：应用子痫前期患者组的血清冲击人HUVEC 株,电镜下观察HUVEC 的形态变化,流式细胞仪下测定细胞的凋亡,用 RT-PCR 方法检测HUVEC中CD40 和NF-资B 的表达情况。结果：①电镜下正常孕妇组HUVEC呈" 铺路石" 状单层镶嵌排列, 子痫前期组HUVEC形态呈典型损伤改变,细胞稀疏,细胞核与细胞浆分界模糊不清,胞浆中有暗色颗粒。②流式细胞仪测定子 痫前期组HUVEC的细胞凋亡较正常组明显升高,差异有显著意义（P<0.05）;③ RT-PCR 测定显示子痫前期患者组HUVEC 中 CD40mRNA 及NF- BmRNA 水平均较正常组明显升高,差异有显著意义（P<0.05）;④ 子痫前期组及对照组的CD40 和NF- kB表 达均呈显著性正相关。结论：CD40和NF-资B 的激活均参与了子痫前期的发病机制,并在其中发挥重要作用。     

血管紧张素II 1型受体相关蛋白研究进展

血管紧张素Ⅱ(angiotensin Ⅱ,AngⅡ)作为肾素-血管紧张素系统(renin-angiotensin system,RAS)的关键效应因子,与血管紧张素Ⅱ1型受体(angiotensin Ⅱ type 1 receptor,AT1R)结合后,在体内发挥维持体液及电解质平衡、收缩血管、调节血压,促进心肌、肾近端小管以及血管平滑肌细胞增殖,参与肿瘤的发生发展、血管形成和转移等重要作用。最新研究发现,AT1R相关蛋白特异性作用于AT1R蛋白的碳末端,通过调节受体的内化、细胞膜的再通和受体的敏感性对其表达进行控制,发挥相应的生物学作用。本文的重点在于对AT1R相关蛋白的研究进展进行综述,阐述不同AT1R相关蛋白在RAS系统中所起的作用,为RAS系统的进一步研究提供依据。     

子痫前期胰岛素抵抗相关因素研究进展

子痫前期是影响孕、产妇发病率和死亡率的重要原因,但是其发病机制目前仍未完全阐明.胰岛素抵抗在子痫前期临床表现出现之前即可被检测到,并参与其发生发展.近来,一些研究认为视黄醇结合蛋白4,同型半胱氨酸等均与胰岛素抵抗相关,并参与子痫前期的发病机制.本文就相关研究进展作一综述.     

肿瘤坏死因子alpha与子痫前期的关系

子痫前期是妊娠期特有疾病,是导致孕产妇及围生儿病死率的重要原因,其病因和发病机理仍未完全明确。目前,已被提出 和子痫前期的发生相关的因素包括遗传、氧化应激、异常滋养层细胞侵入、血管内皮细胞功能紊乱、营养缺乏、免疫缺陷等,其中 内皮细胞损伤导致的内皮细胞生理功能紊乱已经成为子痫前期病因学研究的热点。肿瘤坏死因子-alpha(tumor necrosis factor-alpha, TNF-alpha)在内皮细胞损害中发挥着重要作用,可能通过诱导炎性因子和血管内皮细胞黏附分子-1(VCAM-1)生成、抑制基质金属蛋 白酶(MMP)、影响血管活性物质、脂联素、瘦素和血管因子生成,介导子痫前期的发生。本文就TNF-琢与子痫前期发生的关系进行 综述。     

辅酶Q10 对子痫前期中氧化应激的防治作用的研究进展

子痫前期是导致全球孕产妇和围生儿发病和死亡的主要原因之一.子痫前期的病因至今尚未明确,但是大量研究已证实多系统的氧化应激与子痫前期发病机制有关.辅酶Q10是目前受到广泛关注的一种抗氧化剂,并且已有辅酶Q10药品制剂问世.本文从细胞水平简要总结了氧化应激与子痫前期发病机制的关系,并讨论了辅酶Q10对予痫前期中氧化应激的防治作用.希望为子痫前期的早期治疗及改善预后提供新的思路.     

AT2R − 1332 G:A polymorphism and its interaction with AT1R 1166 A:C,ACE I/D and MMP-9 − 1562 C:T polymorphisms: Risk factors for susceptibility to preeclampsia

The possible association of angiotensin type 2 receptor (AT2R) − 1332 G:A polymorphism with susceptibility to preeclampsia was studied in 252 women consisted of 155 women with preeclampsia and 97 healthy pregnant women. Also, the interaction of this polymorphism with angiotensin type 1 receptor (AT1R) 1166 A:C, angiotensin converting enzyme insertion/deletion (ACE I/D) and also with matrix metalloproteinase-9 (MMP-9) − 1562 C:T polymorphism was investigated. The AT2R − 1332 G:A polymorphism was detected using PCR–RFLP method. Significantly higher frequencies of GG+GA genotype and G allele of AT2R were observed in mild (80.2%, p = 0.003 and 47.5%, p = 0.012, respectively) and severe (77.8%, p = 0.034 and 48.1%, p = 0.026, respectively) preeclampsia compared to controls (60.8% and 35.1%, respectively). The presence of G allele was associated with 1.69-fold increased risk of preeclampsia (p = 0.005). In severe preeclamptic women, systolic and diastolic blood pressures in the presence of GG+GA genotype were significantly higher compared to those in the presence of AA genotype. The concomitant presence of both alleles of AT2R G and AT1R C was associated with 1.3 times increased risk of mild preeclampsia (p = 0.03). There was an interaction between AT2R G and ACE D alleles that significantly increased the risk of mild and severe preeclampsia by 1.38- and 1.3-fold, respectively. Also, interaction between MMP-9 T and AT2R G alleles increased the risk of severe preeclampsia 1.39-fold (p = 0.028). Our study demonstrated that the G allele of AT2R − 1332 G:A polymorphism is associated with an increased risk of preeclampsia. Also, epistatic interaction of G allele and each allele of the AT1R C, ACE D and MMP-9 T was associated with the risk of preeclampsia. Our findings suggest that the renin–angiotensin system (RAS) variants and gene–gene interactions affect the risk of preeclampsia.     

The effect of hypothalamo-pituitary disconnection on the renin-angiotensin system in the late-gestation fetal sheep

The activity of the renin-angiotensin system (RAS) increases significantly in the late-gestation fetal sheep. Fetal cortisol is also increased during this time, and it is thought that the increase in cortisol may modulate the RAS changes. Previous studies have examined the effects of cortisol infusion on RAS activity, but the effects of blocking the peripartum increase in cortisol concentrations on the developmental changes in the RAS are not known. Therefore, we utilized the technique of hypothalamic-pituitary disconnection (HPD), which prevents the cortisol surge from occurring, to investigate the importance of the late-gestation increase in cortisol on the ontogenic changes in RAS activity. HPD of fetal sheep was performed at 120 days of gestational age (dGA), and fetuses were delivered between 135 and 139 dGA. Control fetuses were sham operated. HPD blocked the late-gestation cortisol increase but did not alter renal renin mRNA, renal renin or prorenin protein content, nor plasma renin levels compared with sham operated. However, HPD fetuses had increased ANG II receptor subtype 1 (AT1) mRNA and protein expression in the kidney and lungs. ANG II receptor subtype 2 (AT2) expression was not altered in these tissues at either mRNA or protein level. HPD did not change AT1 or AT2 mRNA in the left ventricle but did result in decreased protein levels for both receptors. These studies demonstrate that blockade of the naturally occurring increase in fetal cortisol concentration in late gestation is associated with tissue-specific alterations in expression of AT1 and AT2 receptors. These changes may impact on fetal tissue maturation and hence have consequences in postnatal life.     

Influence of myocardial infarction on changes in the expression of angiotensin type 1 receptor in the rat prostate

Angiotensin II (AngII) is the biologically active peptide of the renin-angiotensin system (RAS). Tissue- based, local RAS has been identified in the prostate, testis, epididymis and coagulating glands. Experimental and clinical studies have consistently shown that myocardial infarction (MI) is associated with activation of the systemic RAS with increased concentration of angiotensin peptides in the blood and changes in expression of angiotensin receptors (AT). Changes in angiotensin receptors in the renal and cardiovascular system after MI are well recognized, but the effects of MI influence on changes in other tissue like the prostate gland are unknown. In the present study, we investigated the effect of myocardial infarction on angiotensin receptor protein and mRNA expression in the rat prostate gland. MI model was established in Wistar rats by ligating the left coronary artery (modified Selye method). The levels of AT1a-b and AT2 receptor mRNAs and proteins were measured in the rat prostate. Our study demonstrates tissue-specific changes in AT1a-b and AT2 receptor expression after myocardial infarction. The results show that MI has a strong influence on the expression of angiotensin receptor type AT1 in the prostate at the protein and mRNA level.     

Renin-angiotensin system in the carotid body

Research studies have been done on the influence of the renin-angiotensin system (RAS) on numerous tissues and organs. The local RAS, which is frequently of paracrine/autocrine origin, caters to specific organ and tissue needs through actions that add to, or differ from, the circulating RAS. Recent data have demonstrated a functional expression of RAS in the carotid body, wherein the carotid chemoreceptors play a major physiological role in the regulation of autonomic responses to changes in arterial chemical content. However, the angiotensin II and other vasoactive substances can directly modulate the excitability of the chemoreceptor. Long-term hypoxia modifies the level of gene expression in the carotid body by increasing the expression of AT(1) receptors along with sensitivity of the chemoreceptor to angiotensin II. Even though these findings support a physiological role of RAS in the carotid body, it has yet to be clearly defined. As a result this review will present current information about expression and localization of AT(1) receptors, and show that local RAS exists in the carotid body. The regulation of RAS by chronic hypoxia, the significance of its changes and clinical relevance in the carotid body, are also addressed.     

Angiotensinogen and angiotensin-converting enzyme mRNA decrease and AT1 receptor mRNA and protein increase in epididymal fat tissue accompany age-induced elevation of adiposity and reductions in expression of GLUT4 and peroxisome proliferator-activated receptor (PPARγ)

Elevated adiposity is one of the accompanying features of increased age in humans and animals. Angiotensin II (Ang II) is considered as growth promoting peptide to be involved in hypertrophic enlargement of adipose tissue. However, systemic renin-angiotensin system (RAS) seems to decrease with increased age of rats. Local adipose tissue RAS might be independent of the systemic one. Therefore we performed a comprehensive study using rats with increased age from 9 to 26 weeks and evaluated angiotensinogen, angiotensin-converting enzyme (ACE) and AT(1) receptor mRNA in epididymal adipose tissue by RT-PCR. In addition, we determined AT(1) receptor protein by Western blotting and Ang II binding. These RAS parameters were correlated with expression of selected adiposity-dependent proteins such as leptin, adiponectin, insulin-dependent glucose transporter (GLUT4) and PPARgamma. Angiotensinogen and ACE expression decreased with increased age and adiposity. On the contrary, AT(1) receptor mRNA and protein was significantly elevated in 26-week-old rats though the Ang II binding was not different between 9 and 26-week-old animals. These results suggest dynamic adaptation of local adipose tissue RAS components to increased age and adiposity most likely by decreasing local Ang II formation which is thereafter compensated by increased expression of AT(1) receptor. However, this increase in AT(1) receptor mRNA and protein is not reflected in increased receptor binding. We believe that this complex regulation of adipose tissue RAS slows down the negative age and adiposity related changes in adipose tissue leptin, adiponectin, GLUT4 and PPARgamma.     

Endothelium-Dependent Relaxation and Angiotensin II Sensitivity in Experimental Preeclampsia

Objective

We investigated endothelial dysfunction and the role of angiotensin (Ang)-II type I (AT1-R) and type II (AT2-R) receptor in the changes in the Ang-II sensitivity in experimental preeclampsia in the rat.

Methods

Aortic rings were isolated from low dose lipopolysaccharide (LPS) infused pregnant rats (experimental preeclampsia; n=9), saline-infused pregnant rats (n=8), and saline (n=8) and LPS (n=8) infused non-pregnant rats. Endothelium-dependent acetylcholine--mediated relaxation was studied in phenylephrine-preconstricted aortic rings in the presence of vehicle, N^G-nitro-L-arginine methyl ester and/or indomethacin. To evaluate the role for AT1-R and AT2-R in Ang-II sensitivity, full concentration response curves were obtained for Ang-II in the presence of losartan or PD123319. mRNA expression of the AT1-R and AT2-R, eNOS and iNOS, COX1 and COX2 in aorta were evaluated using real-time RT-PCR.

Results

The role of vasodilator prostaglandins in the aorta was increased and the role of endothelium-derived hyperpolarizing factor and response of the AT1-R and AT2-R to Ang-II was decreased in pregnant saline infused rats as compared with non-pregnant rats. These changes were not observed during preeclampsia.

Conclusion

Pregnancy induced adaptations in endothelial function, which were not observed in the rat model for preeclampsia. This role of lack of pregnancy induced endothelial adaptation in the pathophysiology of experimental preeclampsia needs further investigation.     

Angiotensin 1-7 and its analogue decrease blood pressure but aggravate renal damage in preeclamptic mice

Preeclampsia (PE) is a multisystem disease that affects the health of both the pregnant women and the fetus during pregnancy. Agonistic autoantibodies to the angiotensin II type I receptor (AT1-AA) play a significant role in the pathogenesis of PE. This study aimed to determine the effects of Angiotensin 1-7 (Ang 1-7) and its analogue AVE0991 on AT1-AA-induced PE model. Pregnant mice were divided into five groups: the normal pregnant group, AT1-AA-induced preeclampsia group, and AT1-AA-induced preeclampsia group treated with Losartan, Ang 1-7, and AVE0991, respectively. AT1-AA-induced PE model was established on gestational day 13 by tail intravenous injection of purified AT1-AA polyclonal antibody from serum of guinea pigs. Blood urea nitrogen (BUN), urine albumin and urinary creatinine were measured on day 18 of pregnancy. The systolic blood pressure (SBP) was measured from gestational day 13 to day 18. Renal structure changes were observed via light and electron microscopy. Compared with the normal pregnant group (NP group), AT1-AA-induced preeclampsia group (PE group) exhibited elevated blood pressure and proteinuria, consistent with the characteristics of PE. Ang 1-7 or AVE0991 treatment decreased blood pressure without showing renoprotective effects. The findings indicated that Ang 1-7 and its analogue reduced blood pressure but aggravated renal damage in AT1-AA-induced PE mice.     

Angiotensin II receptor type 1 (AT1) selective nonpeptidic antagonists--a perspective

Hypertension is a major risk factor for human morbidity and mortality through its effects on target organs like heart, brain and kidneys. More intensive treatment for the effective control of blood pressure significantly reduces the morbidity and mortality. The renin angiotensin system (RAS) is a coordinated hormonal cascade of major clinical importance in the regulation of blood pressure. The principal effector peptide of RAS is angiotensin II, which acts by binding to one of the two major angiotensin II receptors AT(1) and AT(2). Angiotensin II through AT(1) receptor mediates vast majority of biologically detrimental actions. Nonpeptidic angiotensin II (AT(1)) antagonists are the most specific means to block the renin angiotensin enzymatic cascade available presently. Majority of AT(1) antagonists are based on modifications of losartan structure, the first clinically used AT(1) antagonist. In this review, a comprehensive presentation of the literature on AT(1) receptor antagonists has been given.     

High Na intake increases renal angiotensin II levels and reduces expression of the ACE2-AT(2)R-MasR axis in obese Zucker rats

High sodium intake is known to regulate the renal renin-angiotensin system (RAS) and is a risk factor for the pathogenesis of obesity-related hypertension. The complex nature of the RAS reveals that its various components may have opposing effects on natriuresis and blood pressure regulation. We hypothesized that high sodium intake differentially regulates and shifts a balance between opposing components of the renal RAS, namely, angiotensin-converting enzyme (ACE)-ANG II-type 1 ANG II receptor (AT(1)R) vs. AT(2)-ACE2-angiotensinogen (Ang) (1-7)-Mas receptor (MasR), in obesity. In the present study, we evaluated protein and/or mRNA expression of angiotensinogen, renin, AT(1A/B)R, ACE, AT(2)R, ACE2, and MasR in the kidney cortex following 2 wk of a 8% high-sodium (HS) diet in lean and obese Zucker rats. The expression data showed that the relative expression pattern of ACE and AT(1B)R increased, renin decreased, and ACE2, AT(2)R, and MasR remained unaltered in HS-fed lean rats. On the other hand, HS intake in obese rats caused an increase in the cortical expression of ACE, a decrease in ACE2, AT(2)R, and MasR, and no changes in renin and AT(1)R. The cortical levels of ANG II increased by threefold in obese rats on HS compared with obese rats on normal salt (NS), which was not different than in lean rats. The HS intake elevated mean arterial pressure in obese rats (27 mmHg) more than in lean rats (16 mmHg). This study suggests that HS intake causes a pronounced increase in ANG II levels and a reduction in the expression of the ACE2-AT(2)R-MasR axis in the kidney cortex of obese rats. We conclude that such changes may lead to the potentially unopposed function of AT(1)R, with its various cellular and physiological roles, including the contribution to the pathogenesis of obesity-related hypertension.     

Increases in brain and cardiac AT1 receptor and ACE densities after myocardial infarct in rats

In the brain, ouabain-like compounds (OLC) and the reninangiotensin system (RAS) contribute to sympathetic hyperactivity in rats after myocardial infarction (MI). This study aimed to evaluate changes in components of the central vs. the peripheral RAS. Angiotensin-converting enzyme (ACE) and angiotensin type 1 (AT1) receptor binding densities were determined by measuring 125I-labeled 351A and 125I-labeled ANG II binding 4 and 8 wk after MI. In the brain, ACE and AT1 receptor binding increased 8-15% in the subfornical organ, 14-22% in the organum vasculosum laminae terminalis, 20-34% in the paraventricular nucleus, and 13-15% in the median preoptic nucleus. In the heart, the greatest increase in ACE and AT1 receptor binding occurred at the infarct scar (approximately 10-fold) and the least in the right ventricle (2-fold). In kidneys, ACE and AT1 receptor binding decreased 10-15%. After intracerebroventricular infusion of Fab fragments to block brain OLC from 0.5 to 4 wk after MI, increases in ACE and AT1 receptors in the subfornical organ, organum vasculosum laminae terminalis, paraventricular nucleus, and medial preoptic nucleus were markedly inhibited, and ACE and AT1 receptor densities in the heart increased less (6-fold in the infarct scar). In kidneys, decreases in ACE and AT1 receptor binding were absent after treatment with Fab fragments. These results demonstrate that ACE and AT1 receptor binding densities increase not only in the heart but also in relevant areas of the brain of rats after MI. Brain OLC appears to play a major role in activation of brain RAS in rats after MI and, to a modest degree, in activation of the cardiac RAS.