Preeclampsia (PE) affects 5–7% of all pregnancies in the U.S. and is the leading cause of maternal and prenatal morbidity. PE is associated with hypertension after week 20 of gestation, decreased renal function, and small-for-gestational-age babies. Women with PE exhibit chronic inflammation and production of autoantibodies. It is hypothesized that during PE, placental ischemia occurs as a result of shallow trophoblast invasion which is associated with an immune imbalance where pro-inflammatory CD4+ T cells are increased and T regulatory cells (Tregs) are decreased. This imbalance leads to chronic inflammation characterized by oxidative stress, pro-inflammatory cytokines, and autoantibodies. Studies conducted in our laboratory have demonstrated the importance of this immune imbalance to cause hypertension in response to placental ischemia in pregnant rats. These studies confirm that increased CD4+ T cells and decreased Tregs during pregnancy leads to elevated inflammatory cytokines, endothelin (ET-1), reactive oxygen species (ROS), and agonistic autoantibodies to the Angiotensin II (Ang II), type 1 receptor (AT1-AA). All of these factors taken together play an important role in increasing the blood pressure during pregnancy. Specifically, this review focuses on the decrease in Tregs, and their associated regulatory cytokine IL-10, which is seen in response to placental ischemia during pregnancy. This study will also examine the effect of regulatory immune cell repopulation on the pathophysiology of preeclampsia. These studies show that restoring the balance of the immune system through increasing Tregs, either by adoptive transfer or by infusing IL-10, reduces the blood pressure and pathophysiology associated with placental ischemia in pregnant rats.

Placental ischemia is believed to be the initial event in the development of preeclampsia. Mitochondrial dysfunction is a cause of reactive oxygen species (ROS) generation and oxidative stress, however, there are not many studies examining the role of mitochondrial ROS in the pathology of preeclampsia. The purpose of this study was to not only examine the effect of placental ischemia on mitochondrial-mediated oxidative stress in reduced uterine perfusion pressure (RUPP) rat model of preeclampsia but to also examine the role of mitochondrial ROS in contributing to hypertension in response to placental ischemia. Female pregnant Sprague Dawley rats were used in this study. On gestational day 14, RUPP surgery was performed. On gestational day 19, blood pressure (mean arterial pressure) was measured, placentas and kidneys were collected from normal pregnant and RUPP rats and processed for mitochondrial respiration, ROS, and oxidative phosphorylation enzyme activities. Renal and placental complex activities, expressions and respiration rates were significantly reduced and mitochondrial ROS was increased in RUPP versus normal pregnant mitochondria. Mean arterial pressure was elevated in RUPP (n=6) compared with normal pregnant rats (n=5; 126±4 versus 103±4 mm Hg; P<0.05) and treatment with mitochondrial-specific antioxidants (MitoQ/MitoTEMPO) significantly reduced mean arterial pressure in RUPPs (n=5-10). Mitochondrial ROS was significantly elevated in endothelial cells incubated with RUPP serum compared from with normal pregnant rats, whereas serum from mito antioxidant-treated RUPP rats attenuated this response. Impaired mitochondrial function and vascular, placental, and renal mitochondrial ROS play an important role in hypertension and reduced fetal weight in response to placental ischemia during pregnancy.

Preeclampsia (PE) is a pregnancy-specific syndrome and one of the leading causes of preterm birth, neonatal and maternal morbidity and mortality. This disease is characterized by new onset hypertension usually in the third trimester of pregnancy and is sometimes associated with proteinuria, although proteinuria is not a requirement for the diagnosis of PE. In developing countries, women have a higher risk of death due to PE than more affluent countries and one of the most frequent causes of death is high blood pressure and stroke. Although PE only affects approximately 2%–8% of pregnancies worldwide it is associated with severe complications such as eclampsia, hemorrhagic stroke, hemolysis, elevated liver enzymes and low platelets (HELLP syndrome), renal failure and pulmonary edema. Importantly, there is no “cure” for the disease except for early delivery of the baby and placenta, leaving PE a health care risk for babies born from PE moms. In addition, PE is linked to the development of cardiovascular disease and stroke in women after reproductive age, leaving PE a risk factor for long-term health in women. This review will highlight factors implicated in the pathophysiology of PE that may contribute to long-term effects in women with preeclamptic pregnancies.

Recognition of double-stranded RNA by Toll-like receptor 3 (TLR3) will increase the production of cytokines and chemokines through transcriptional activation by the NF-B protein.Over 136 single-nucleotide polymorphisms (SNPs) in TLR3 have been identified in the human population. Of these, four alter the sequence of the TLR3 protein. Molecular modeling suggests that two of the SNPs, N284I and L412F, could affect the packing of the leucine-rich repeating units in TLR3. Notably, L412F is reported to be present in 20% of the population and is higher in the asthmatic population. To examine whether the four SNPs affect TLR3 function, each were cloned and tested for their ability to activate the expression of TLR3-dependent reporter constructs. SNP N284I was nearly completely defective for activating reporter activity, and L412F was reduced in activity. These two SNPs did not obviously affect the level of TLR3 expression or their intracellular location in vesicles. However, N284I and L412F were underrepresented on the cell surface, as determined by flow cytometry analysis, and were not efficiently secreted into the culture medium when expressed as the soluble ectodomain. They were also reduced in their ability to act in a dominant negative fashion on the wild type TLR3 allele. These observations suggest that N284I and L412F affect the activities of TLR3 needed for proper signaling.

Proteins that recognize pathogen-associated molecular patterns are key factors in the cascade of events from the detection to the elimination of an invading organism. This form of innate immunity is conserved in eukaryotes. For example, the Drosophila melanogaster Toll protein is responsible for resistance to fungal and bacterial infections (3, 4), and plants can encode disease-resistance proteins that are important in determining the outcome of infection (5). The vertebrate pathogendetecting proteins called Toll-like receptors (TLRs) 5 are key players in the activation of both the innate and adaptive arms of the immune system (6 -9).The TLRs and related pathogen sensors contain leucine-rich repeat motifs that form docking sites for pathogen ligands or adaptors that bind pathogen ligands, the binding of which will activate signal transduction pathway(s) (10 -12). TLR3 recognizes double-stranded RNA and may be a part of a redundant sensor system to detect viral infections (13-15). Although specific features in the ligands required to interact with TLR3 remain to be identified, TLR3 is activated by polyinosinepolycytidylic acid (poly(I:C)) and has been reported to be activated by RNAs extracted from necrotic cells (16).A number of issues concerning TLR3 structure and function remain to be elucidated. For example, TLR3 can apparently act both on the surface of the plasma membrane, as it does in fibroblasts, and by attaching to the membranes of intracellular vacuoles, where it is proposed to act in immature dendritic cells (17,18). The trafficking of TLRs should be influenced by glycosylation in general, and N-linked glycosylation of TLR2 and TLR4 has been shown to play essential roles in its localization (19,20). A significant recent advance in TLR3 was the elucidation of a 2.1 Å structure of the soluble ectodomain by Choe et al. (1). Bell et al. (2) independently elucidated a highly similar structure. In both studies, the crystallized ectodomains were produced in a baculovirus expression system and formed a horseshoe-shaped solenoid structure that was extensively decorated with glycosyl modifications, some of which were partially resolved in the structure. Whether the glycosylations are important in TLR3 localization and/or function were not directly addressed in these works (1, 2). However, de Bouteiller et al. (21) showed that a change of Asn-247 to an arginine in TLR3 negatively affected TLR3 activity.We expressed the extracellular domain (ECD) of the human TLR3 in human embryonic kidney cells (HEK 293T) and demonstrated that it was modified with N-linked glycosylations. Using the GlcNAc-transferase inhibitor tunicamycin, a concentration-dependent inhibition of TLR3 activity was observed. Systematic mutational analysis of the predicted N-linked glycosylation sites identified two asparagine residues in leucine-rich repeats 8 and 15 that are important for TLR3 activity. The mutant proteins remain expressed at levels similar to wild type. In addition, because our ectodomain was produced in human cells as opp...