Automated assays for sVEGF R1 and PlGF as an aid in the diagnosis of preterm preeclampsia: a prospective clinical study

Sunderji, Shiraz; Gaziano, Emanuel P.; Wothe, Donald; Rogers, Linda C.; Sibai, Bahaeddine M; Karumanchi, S. Ananth; Hodges-Savola, Cheryl

doi:10.1016/j.ajog.2009.07.025

Cited by 115 publications

(73 citation statements)

References 18 publications

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“…5,13,23,[35][36][37] In some women there appeared to be a rebound following apheresis (see Figures 2, 4, and 5). Given that the volume of distribution of sFlt-1 is large, with significant quantities bound to the interstitial matrix and ,20% of total body sFlt-1 circulating, 38 rebound following equilibration with the interstitial matrix compartment is not surprising.…”

Section: Discussionmentioning

confidence: 94%

Removal of Soluble Fms-Like Tyrosine Kinase-1 by Dextran Sulfate Apheresis in Preeclampsia

Thadhani¹,

Hagmann²,

Schaarschmidt³

et al. 2016

Journal of the American Society of Nephrology

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Preeclampsia is a devastating complication of pregnancy. Soluble Fms-like tyrosine kinase-1 (sFlt-1) is an antiangiogenic protein believed to mediate the signs and symptoms of preeclampsia. We conducted an open pilot study to evaluate the safety and potential efficacy of therapeutic apheresis with a plasmaspecific dextran sulfate column to remove circulating sFlt-1 in 11 pregnant women (20-38 years of age) with very preterm preeclampsia (23-32 weeks of gestation, systolic BP $140 mmHg or diastolic BP $90 mmHg, new onset protein/creatinine ratio .0.30 g/g, and sFlt-1/placental growth factor ratio .85). We evaluated the extent of sFlt-1 removal, proteinuria reduction, pregnancy continuation, and neonatal and fetal safety of apheresis after one (n=6), two (n=4), or three (n=1) apheresis treatments. Mean sFlt-1 levels were reduced by 18% (range 7%-28%) with concomitant reductions of 44% in protein/creatinine ratios. Pregnancy continued for 8 days (range 2-11) and 15 days (range 11-21) in women treated once and multiple times, respectively, compared with 3 days (range 0-14) in untreated contemporaneous preeclampsia controls (n=22). Transient maternal BP reduction during apheresis was managed by withholding pre-apheresis antihypertensive therapy, saline prehydration, and reducing blood flow through the apheresis column. Compared with infants born prematurely to untreated women with and without preeclampsia (n=22 per group), no adverse effects of apheresis were observed. In conclusion, therapeutic apheresis reduced circulating sFlt-1 and proteinuria in women with very preterm preeclampsia and appeared to prolong pregnancy without major adverse maternal or fetal consequences. A controlled trial is warranted to confirm these findings.

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Section: Discussionmentioning

confidence: 94%

Removal of Soluble Fms-Like Tyrosine Kinase-1 by Dextran Sulfate Apheresis in Preeclampsia

Thadhani¹,

Hagmann²,

Schaarschmidt³

et al. 2016

Journal of the American Society of Nephrology

Self Cite

227

145

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“…7 Meanwhile fast and accurate assays working on existing diagnostic platforms, including a point-of-care assay, have been developed. 7,11,12,26,27 The diagnostic performance of the sFlt-1/PlGF ratio is better than that of the individual values of sFlt-1 and PlGF. 7,11 With a cutoff value of 85, the reported sensitivity and specificity of the sFlt-1/PlGF ratio are 89% and 97% (area under the receiver operating characteristic curve, 0.97) for preterm preeclampsia and 74% and 89% (area under the receiver operating characteristic curve, 0.87) for late-onset preeclampsia.…”

Section: Sflt-1/plgf Ratio As a Diagnostic Testmentioning

confidence: 96%

“…4,[6][7][8][9][10] Because of the reciprocal changes of these markers, the ratio of sFlt-1/PlGF appears to be a superior marker of (early onset) preeclampsia compared with the individual values of these markers. 7,11 In the 3 complicated pregnancies of this grand round, we used the sFlt-1/PlGF ratio as a biomarker to differentiate among superimposed preeclampsia, activation of the underlying disease, or the combined occurrence of these 2 conditions. For all 3 of the patients, sFlt-1 and PlGF were measured by precise ELISA on a fully automated Elecsys system (Roche Diagnostics).…”

mentioning

confidence: 99%

Differential Diagnosis of Preeclampsia

et al. 2012

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“…However, the levels noted are significantly lower than those seen during active preeclampsia. 20,21 The mechanism of injury, sFlt1-mediated VEGF depletion, was demonstrated through the use of the well established chicken chorioallantoic membrane in vitro angiogenesis assay. Sera from patients with acute PR3-AAV (but not anti-MPO) led to the near-complete disruption of the microvasculature in the treated area, an effect that was completely reversed by the addition of human VEGF.…”

mentioning

confidence: 99%