Preeclampsia usually occurs after week 20 of gestation and features hypertension and an increased peripheral vascular resistance. The mechanisms are unknown (1). Several lines of evidence implicate angiotensin II (Ang II) and its binding site, the AT 1 receptor. Preeclamptic patients manifest exaggerated pressor responses to Ang II. Gant et al. (2) infused Ang II into pregnant patients from week 10 of pregnancy onward and observed that those who later developed sustained hypertension required diminishing amounts of Ang II to obtain a similar pressor response. One possible explanation for this phenomenon might be increased expression of the AT 1 receptor. Baker et al. (3) also performed Ang II infusion experiments in pregnant patients and identified five patients who subsequently developed hypertension after week 20. These women were compared with seven who did not develop hypertension. The platelets of the preeclamptic women exhibited increased calcium signaling and increased binding sites for Ang II. The authors suggested increased stimulus-effect coupling in terms of Ang II responses in preeclamptic patients. We also observed increased cytosolic calcium responses in the platelets of preeclamptic patients in response to Ang II (4). However, circulating levels of Ang II are not increased in preeclampsia (5-7). In an earlier study of patients with essential hypertension, we observed a remarkably high incidence of circulating antibodies that cross-reacted with the α1-adrenoceptor and stimulated its signaling mechanism (8). In the present study, we tested the hypothesis that circulating antibodies to a vascular receptor might be responsible for the hypertension observed in preeclampsia. We employed a bioassay of beating neonatal rat cardiomyocytes, as well as Western blotting and confocal microscopy. We found that immunoglobulin from preeclamptic women contains a factor that binds to, and stimulates, the AT 1 receptor. MethodsCell culture. Isolation and cultivation of neonatal heart cells were performed as described previously (9). Briefly, single cells were dissociated from the minced ventricles of Wistar rats (1-2 days old) with a 0.25% solution of crude trypsin and were cultured as monolayers with a density of 800 cells/mm 2 in Halle SM 20-I medium equilibrated with humidified air. The medium contained 10% heat-inactivated FCS and 2 µmol/l fluorodeoxyuridine (Serva, Heidelberg, Germany) the latter to prevent proliferation of nonmuscle cells. On the third or fourth days, the cells were incubated for 2 h in 2 ml fresh serum-containing medium. Seven to 10 selected cells or synchronously contracting cell clusters per flask were counted for 15 s. This procedure was Immune mechanisms and the renin-angiotensin system are implicated in preeclampsia. We investigated 25 preeclamptic patients and compared them with 12 normotensive pregnant women and 10 pregnant patients with essential hypertension. Antibodies were detected by the chronotropic responses to AT 1 receptor-mediated stimulation of cultured neonatal rat cardio...

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Sensitivity and resistance to the effects of sodium were evaluated in normotensive and hypertensive humans by two approaches. Blood pressure was measured after an intravenous infusion of 2 L of normal (0.9%) saline and after sodium and volume depletion induced by a low sodium diet and furosemide administration in 378 normal volunteers and 198 subjects with essential hypertension. Those in whom mean arterial blood pressure decreased by at least 10 mm Hg after sodium and volume depletion were considered sodium-sensitive, and those with a decrease of 5 mm Hg or less (including an increase in pressure) were considered sodium-resistant. The second study utilized the blood pressure response to modest dietary sodium restriction in 74 normotensive subjects to identify sodium sensitivity and resistance. In both studies the responses were heterogeneous. In the first study significantly more hypertensive subjects were sodium-sensitive, as compared with those in the normotensive group (p less than 0.001). Plasma renin activity (low, normal, or high) did not predict sodium responses. In both groups sodium-sensitive individuals were significantly older (p less than 0.001) and had lower baseline renin values than sodium-resistant subjects. Factors related to the change in mean arterial blood pressure after sodium and volume depletion included baseline pressure (r = -0.54, p less than 0.001) and age (r = -0.16, p = 0.002 in the normotensive group; r = -0.28, p less than 0.001 in the hypertensive group). The response to dietary sodium restriction was also correlated with baseline pressure (r = 0.61, p less than 0.001) and the initial urinary sodium excretion (r = 0.27, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)