Our understanding of how microRNAs (miRNAs) regulate gene networks and affect different molecular pathways leading to various human pathologies has significantly improved over the years. In contrary, the role of miRNAs in pregnancy-related hypertensive disorders such as preeclampsia (PE) is only beginning to emerge. Recent papers highlight that adverse pregnancy outcomes are associated with aberrant expression of several miRNAs. Presently, efforts are underway to determine the biologic function of these placental miRNAs which can shed light on their contribution to these pregnancy-related disease conditions. The discovery that miRNAs are stable in circulation coupled with the fact that the placenta is capable of releasing them to the circulation in exosomes generates a lot of enthusiasm to use them as biomarkers. In this review, we will summarize the recent findings of our understanding of miRNA regulation in relation to PE, a hypertensive disorder of pregnancy. Particular emphasis will be given to the role of key miRNA molecules such as miR-210 and miR-155 that are known to be consistently dysregulated in women with PE.

Treatment of pregnancy-related hypertensive disorders, such as preeclampsia (PE), remain a challenging problem in obstetrics. Typically, aggressive antihypertensive drug treatment options are avoided to prevent pharmacological-induced hypotension. Another major concern of administering antihypertensive drugs during pregnancy is possible adverse fetal outcome. In addition, management of hypertension during pregnancy in chronic hypertensive patients or in patients with prior kidney problems are carefully considered. Recent studies suggest that PE patients are at increased cardiovascular risk postpartum. Therefore, these patients need to be monitored postpartum for the subsequent development of other cardiovascular diseases. In this review article, we review the antihypertensive drugs currently being used to treat patients with PE and the advantages or disadvantages of using these drugs during pregnancy.

Preeclampsia (PE) is a pregnancy-related hypertensive disorder that affects 5-8% of all pregnancies worldwide. Placental microRNA (miRNA) expression is known to be dysregulated during PE which includes miR-210. However, the role of miR-210 in the development of PE is still unknown. We have previously demonstrated STAT6, a transcription factor, to be a direct target of miR-210. In addition, STAT6 modulates levels of IL-4, an anti-inflammatory cytokine which is known to be beneficial during pregnancy. Given that the STAT6/IL-4 pathway is important for normal pregnancy, we hypothesized that an overexpression of miR-210 in mice will contribute to PE-like symptoms by inhibiting the STAT6/IL-4 pathway. Systolic blood pressures (SBP) were measured using the tail-cuff method on both WT (C57Bl/6J) and miR-210 TG mice. The miR-210 TG mice exhibited increased SBP compared to the WT mice (WT: 95±2 mmHg, miR-210 TG: 115±2.4 mmHg, p<0.05). The miR-210 TG mice also displayed endothelial dysfunction measured by aortic vascular reactivity using wire myography (WT: 93% miR-210 TG: 68% relaxation, p<0.05 vs. WT) and a significant increase in proteinuria (4 fold, p<0.05 vs. WT). Furthermore, the miR-210 TG mice exhibit placental necrosis and a significant increase in the number of malformed pups. Placental STAT6 levels decreased in miR-210 TG compared to WT mice (2.6 fold, p<0.05 vs. WT) as determined by immunoblotting. In addition, qRT-PCR analysis of the miR-210 TG placentas exhibited a (4.8 fold, p<0.05 vs. WT) decrease in IL-4 expression. Immunoblotting and immunohistochemistry (IHC) studies showed a decrease in IL-4 levels (2.4 fold, p<0.05 vs. WT) and immunoreactivity in the miR-210 TG placentas as well as. IHC studies in human placentas also showed a decrease in both IL-4 and STAT6. Based on our results, miR-210 overexpression induces PE-like symptoms including hypertension, endothelial dysfunction, proteinuria, and malformed pups in pregnant mice. In addition, miR-210 overexpression attenuated the STAT6/IL-4 anti-inflammatory pathway. Our data suggests that either targeting miR-210 or the STAT6/1L-4 pathway could be a potential therapeutic in mitigating the symptoms of PE.