Estrategias terapéuticas futuras para la preeclampsia basadas en la reducción del estrés oxidativo
DOI:
https://doi.org/10.55204/scc.v2i2.e36Palabras clave:
drogas en investigación, estrés oxidativo, preeclampsia, terapéuticaResumen
Introducción: la preeclampsia (PE) es una condición que ocurre después de la semana 20 de gestación, con hipertensión y proteinuria, con prevalencia global del 4.6%.
Objetivo: describir las estrategias terapéuticas futuras para la preeclampsia basadas en la reducción del estrés oxidativo
Desarrollo: los antioxidantes y compuestos antiinflamatorios ofrecen promesas en la PE, pero necesitan validación en ensayos clínicos. Personalización, riesgos y beneficios, mecanismos, interacciones y efectos secundarios requieren atención. La N-acetilcisteína reduce significativamente los niveles de malondialdehído (MDA), IL-8 y homocisteína en pacientes con preeclampsia. Sin embargo, no tiene un efecto significativo en los niveles de PCR, TNF-α e IL-6. En cuanto a la aspirina, se observa un efecto positivo en la prevención de la preeclampsia, especialmente cuando se administra en dosis bajas. La pravastatina reduce la incidencia de preeclampsia en un 61%. La terapia combinada de Danshen y sulfato de magnesio mejora la tensión arterial, la proteína urinaria, los niveles de TNF-α, el estrés oxidativo y eficacia terapéutica en la preeclampsia grave.
Conclusiones: estos hallazgos sugieren diversas intervenciones prometedoras en la preeclampsia, pero se necesita más investigación.
Descargas
Citas
Rana S, Lemoine E, Granger J, Karumanchi SA. Preeclampsia: Pathophysiology, Challenges, and Perspectives. Circ Res. 2019 Mar 29;124(7):1094–112.
Dimitriadis E, Rolnik D, Zhou W. Pre-eclampsia. Nat Rev Dis Primers. 2023;9(1):6–14.
Selek S, Gul A, Atakul N. Investigation of serum enzyme activities and oxidative stress markers in preeclampsia: a multiparameter analysis. Ginekol Pol. 2022;94(6):9–14.
Taysi S, Tascan AS, Ugur MG, Demir M. Radicals, Oxidative/Nitrosative Stress and Preeclampsia. Mini-Reviews in Medicinal Chemistry. 2019;19(3):178–93.
Ishihara N, Matsuo H, Murakoshi H. Increased apoptosis in the syncytiotrophoblast in human term placentas complicated by either preeclampsia or intrauterine growth retardation. Am J Obstet Gynecol. 2002;186(1):158–66.
Hung T, Skepper J, Charnock D. Hypoxia-reoxygenation: A potent inducer of apoptotic changes in the human placenta and possible etiological factor in preeclampsia. Circ Res. 2002;90(12):1274–81.
Schoots M, Bourgonje M, Bourgonje A. Oxidative stress biomarkers in fetal growth restriction with and without preeclampsia. Placenta. 2021;115(8):87–96.
Matsubara K, Higaki T, Matsubara Y. Nitric oxide and reactive oxygen species in the pathogenesis of preeclampsia. Int J Mol Sci. 2015;16(3):4600–14.
Khan K, Wojdyla D, Say L. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367(9516):1066–74.
Say L, Chou D, Gemmill A. Global causes of maternal death: A WHO systematic analysis. Lancet Glob Health. 2014;2(6):9–15.
Abalos E, Cuesta C, Carroli G. Pre-eclampsia, eclampsia and adverse maternal and perinatal outcomes: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG. 2014;121(8):14–24.
Bisson C, Dautel S, Patel E. Preeclampsia pathophysiology and adverse outcomes during pregnancy and postpartum. Front Med (Lausanne). 2023;10(3):1–10.
Abalos E, Cuesta C, Grosso AL, Chou D, Say L. Global and regional estimates of preeclampsia and eclampsia: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2013;170(1):1–7.
Wertaschnigg D, Selvaratnam RJ, Rolnik DL, Davey MA, Anil S, Mol BWJ, et al. Hypertensive disorders in pregnancy – Trends over eight years: A population-based cohort study. Pregnancy Hypertens. 2022 Jun 1;28:60–5.
Lokken EM, Mathur A, Bunge KE, Fairlie L, Makanani B, Beigi R, et al. Pooled Prevalence of Adverse Pregnancy and Neonatal Outcomes in Malawi, South Africa, Uganda, and Zimbabwe: Results From a Systematic Review and Meta-Analyses to Inform Trials of Novel HIV Prevention Interventions During Pregnancy. Frontiers in reproductive health. 2021 Nov 26;3:672446.
Hodgins S, Tielsch J, Rankin K, Robinson A, Kearns A, Caglia J. A New Look at Care in Pregnancy: Simple, Effective Interventions for Neglected Populations. Gebhardt G, editor. PLoS One. 2016 Aug 18;11(8):e0160562.
Magee LA, Brown MA, Hall DR, Gupte S, Hennessy A, Karumanchi SA, et al. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens. 2022 Mar 1;27:148–69.
Tomimatsu T, Mimura K, Matsuzaki S. Preeclampsia: Maternal Systemic Vascular Disorder Caused by Generalized Endothelial Dysfunction Due to Placental Antiangiogenic Factors. Int J Mol Sci. 2019;20(17):42–6.
Roberts JM, Rich-Edwards JW, McElrath TF, Garmire L, Myatt L. Subtypes of Preeclampsia: Recognition and Determining Clinical Usefulness. Hypertension. 2021 May 1;77(5):1430–41.
Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, et al. Hypertensive Disorders of Pregnancy. Hypertension. 2018 Jul 1;72(1):24–43.
Redman CWG, Staff AC, Roberts JM. Syncytiotrophoblast stress in preeclampsia: the convergence point for multiple pathways. Am J Obstet Gynecol. 2022 Feb 1;226(2):S907–27.
Ridder A, Giorgione V, Khalil A, Thilaganathan B. Preeclampsia: The Relationship between Uterine Artery Blood Flow and Trophoblast Function. Int J Mol Sci. 2019 Jul 1;20(13).
De Wolf F, Robertson WB, Brosens I. The ultrastructure of acute atherosis in hypertensive pregnancy. Am J Obstet Gynecol. 1975 Sep 15;123(2):164–74.
Amaral LM, Wallace K, Owens M, LaMarca B. Pathophysiology and Current Clinical Management of Preeclampsia. Curr Hypertens Rep. 2017 Aug 1;19(8):1–6.
Kendall RL, Thomas KA. Inhibition of vascular endothelial cell growth factor activity by an endogenously encoded soluble receptor. Proceedings of the National Academy of Sciences. 1993 Nov 15;90(22):10705–9.
Maynard SE, Min JY, Merchan J, Lim KH, Li J, Mondal S, et al. Excess placental soluble fms-like tyrosine kinase 1 (sFlt1) may contribute to endothelial dysfunction, hypertension, and proteinuria in preeclampsia. J Clin Invest. 2003 Mar 1;111(5):649–58.
Rana S, Burke SD, Karumanchi SA. Imbalances in circulating angiogenic factors in the pathophysiology of preeclampsia and related disorders. Am J Obstet Gynecol. 2022 Feb 1;226(2):S1019–34.
Chappell LC, Cluver CA, Kingdom J, Tong S. Pre-eclampsia. The Lancet. 2021;398(10297):341–54.
Townsend R, Khalil A, Premakumar Y, Allotey J, Snell KIE, Chan C, et al. Prediction of pre-eclampsia: review of reviews. Ultrasound Obstet Gynecol. 2019 Jul 1;54(1):16–27.
Tan MY, Wright D, Syngelaki A, Akolekar R, Cicero S, Janga D, et al. Comparison of diagnostic accuracy of early screening for pre-eclampsia by NICE guidelines and a method combining maternal factors and biomarkers: results of SPREE. Ultrasound Obstet Gynecol. 2018 Jun 1;51(6):743–50.
Widmer M, Cuesta C, Khan KS, Conde-Agudelo A, Carroli G, Fusey S, et al. Accuracy of angiogenic biomarkers at ⩽20weeks’ gestation in predicting the risk of pre-eclampsia: A WHO multicentre study. Pregnancy Hypertens. 2015 Oct 1;5(4):330–8.
Levine RJ, Maynard SE, Qian C, Lim KH, England LJ, Yu KF, et al. Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med. 2004 Feb 12;350(7):672–83.
Saffer C, Olson G, Boggess KA, Beyerlein R, Eubank C, Sibai BM. Determination of placental growth factor (PlGF) levels in healthy pregnant women without signs or symptoms of preeclampsia. Pregnancy Hypertens. 2013 Apr;3(2):124–32.
Chappell LC, Duckworth S, Seed PT, Griffin M, Myers J, Mackillop L, et al. Diagnostic accuracy of placental growth factor in women with suspected preeclampsia: a prospective multicenter study. Circulation. 2013 Nov 5;128(19):2121–31.
Zeisler H, Llurba E, Chantraine F, Vatish M, Staff AC, Sennström M, et al. Predictive Value of the sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia. N Engl J Med. 2016 Jan 7;374(1):13–22.
Castro-García SZ, Chamorro-Cevallos G, Quevedo-Corona L, McCarty MF, Bobadilla-Lugo RA. Beneficial effects of phycobiliproteins from Spirulina maxima in a preeclampsia model. Life Sci. 2018 Oct;211(4):17–24.
Wang H, Li M, Chen P, Shi X. Anti-inflammatory and Antioxidant Effects of Pyrroloquinoline Quinone in L-NAME-Induced Preeclampsia-Like Rat Model. Reproductive Sciences. 2022;29(2):578–85.
Indriyani W, Mestika LCD, Nurseta T, Norahmawati E. Effect of Soybean Extract on sFlt-1 LEVELS in Huvecs Cultures Induced by Preeclampsia Plasma. Medical Laboratory Technology Journal. 2023 Aug 2;1(5069):508–508.
Soetrisno S, Arinekso B, Sulistyowati S. The effect of L-arginine therapy on hepatocyte cells damage in mice ( Mus musculus ) model of preeclampsia. Journal of thee Medical Sciences (Berkala Ilmu Kedokteran). 2019;51(04):316–24.
Nunes PR, Bueno Pereira TO, Bertozzi Matheus M, Grandini NA, Siqueira JS, Correa CR, et al. Glibenclamide Increases Nitric Oxide Levels and Decreases Oxidative Stress in an In Vitro Model of Preeclampsia. Antioxidants (Basel). 2022 Aug 1;11(8).
Jiang L, Gong Y, Rao J, Yang Q, Gao N, Li G, et al. 1-O-Hexyl-2,3,5-Trimethylhydroquinone Ameliorates the Development of Preeclampsia through Suppression of Oxidative Stress and Endothelial Cell Apoptosis. Oxid Med Cell Longev. 2021;2021.
Yang Y, Xu P, Zhu F, Liao J, Wu Y, Hu M, et al. The Potent Antioxidant MitoQ Protects against Preeclampsia during Late Gestation but Increases the Risk of Preeclampsia When Administered in Early Pregnancy. Antioxid Redox Signal. 2021;34(2):118–36.
Mahdy ZA, Chin KY, Nik-Ahmad-zuky NL, Kalok A, Rahman RA. Tocotrienol in Pre-Eclampsia Prevention: A Mechanistic Analysis in Relation to the Pathophysiological Framework. Cells. 2022;11(4).
Kohan HR, Armistead B, Berg M, Drewlo S. Irisin protects the human placenta from oxidative stress and apoptosis via activation of the akt signaling pathway. Int J Mol Sci. 2021;22(20).
Liu M, Wang R bo, Xing J hong, Tang Y xue. Atractylenolide inhibits apoptosis and oxidative stress of HTR-8/SVneo cells by activating MAPK/ERK signalling in preeclampsia. Phytomedicine. 2021;93:8–9.
Lang X, Liu W, Chen Q, Yang X, Chen D, Cheng W. Resveratrol inhibits multiple organ injury in preeclampsia rat model. Acta Biochim Pol. 2023;70(1):131–5.
Chen D, Yang S, Ding J, Liu A. Natural Flavonoid Quercetin Enhances the Anti-inflammatory Effects of Aspirin in a Preeclampsia-like Rat Model Induced by Lipopolysaccharide. Curr Mol Med. 2022;23(5):425–32.
Erlandsson L, Ducat A, Castille J, Zia I, Kalapotharakos G, Hedström E, et al. Alpha-1 microglobulin as a potential therapeutic candidate for treatment of hypertension and oxidative stress in the STOX1 preeclampsia mouse model. Sci Rep. 2019 Dec 1;9(1).
Zhang Y, Liu W, Zhong Y, Li Q, Wu M, Yang L, et al. Metformin Corrects Glucose Metabolism Reprogramming and NLRP3 Inflammasome-Induced Pyroptosis via Inhibiting the TLR4/NF- κ B/PFKFB3 Signaling in Trophoblasts: Implication for a Potential Therapy of Preeclampsia. Oxid Med Cell Longev. 2021;2021.
Gomes VJ, Rezeck Nunes P, Haworth SMC, Sandrim VC, Peraçoli JC, Peraçoli MTS, et al. Monocytes from preeclamptic women previously treated with silibinin attenuate oxidative stress in human endothelial cells. Hypertens Pregnancy. 2021;40(2):124–32.
Huang J, Zheng L, Wang F, Su Y, Kong H, Xin H. Mangiferin ameliorates placental oxidative stress and activates PI3K/Akt/mTOR pathway in mouse model of preeclampsia. Arch Pharm Res. 2020;43(2):233–41.
Lang Q, Wei J, Tian M, Wei S, Yu X, Zhao C, et al. Attenuated effect of zinc gluconate on oxidative stress, inflammation, and angiogenic imbalance in pre-eclampsia rats. Life Sci. 2022;310:1–2.
Rangel H, Abad C, Chiarello DI, Rojas D, Proverbio F. Can magnesium gluconate be used as an alternative therapy for preeclampsia ? 2022;15:39–48.
Faghfouri AH, Zarezadeh M, Tavakoli-Rouzbehani OM, Radkhah N, Faghfuri E, Kord-Varkaneh H, et al. The effects of N-acetylcysteine on inflammatory and oxidative stress biomarkers: A systematic review and meta-analysis of controlled clinical trials. Eur J Pharmacol. 2020;884(July):173368.
Fakari FR, Rousta R, Fakari FR, Ghazanfarpour M, Kariman N. The Effect of Aspirin on Preeclampsia: A Systematic Review. International journal of pediatrics-mashhad. 2020;8(8):11803–11.
Hirsch A, Rotem R, Ternovsky N, Hirsh Raccah B. Pravastatin and placental insufficiency associated disorders: A systematic review and meta-analysis. Front Pharmacol. 2022;13(11):1–14.
Zhou Y, Wang J, Wang L, Tang J, Zhang C. Effect of Compound Danshen Injection Combined with Magnesium Sulfate on Oxidative Stress, TNF- α, NO, and Therapeutic Efficacy in Severe Preeclampsia. Comput Intell Neurosci. 2022;2022.
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2023 Stefany Salomé Calle Criollo, Freddy Rosendo Cárdenas Heredia
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
Los autores conservan los derechos morales y patrimoniales de sus obras. Puesto que Salud ConCiencia es una publicación de acceso abierto, los lectores pueden reproducir total o parcialmente su contenido siempre y cuando proporcionen adecuadamente el crédito a los autores correspondientes y a la revista misma.
Nuestra revista se rige por las políticas internacionales SHERPA/RoMEO: Revista verde: Permiten el autoarchivo tanto del pre-print (borrador de un trabajo) como del post-print (la versión corregida y revisada por pares) y hasta de la versión final (maquetada tal como saldrá publicada en la revista).
Véase también "Derechos de autor y licencias".
