The Potential Benefit of Hydroxychloroquine in Chronic Placental Inflammation of Unknown Etiology Associated with Adverse Pregnancy Outcomes

Bouariu, Alexandra; Gică, Nicolae; Ciobanu, Anca Marina; Scutelnicu, Ana Maria; Popescu, M; Panaitescu, Anca Maria

doi:10.3390/healthcare10010168

Cited by 7 publications

(3 citation statements)

References 75 publications

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“…In a study performed on 37 patients presenting SLE or APS, it was proven that this technique is safe, and 70% of them delivered at least one child [ 58 ]. A factor for this success could be represented by the treatment of patients with SLE with hydroxychloroquine, which is suspected to have a protective effect on chronic inflammatory lesions of the placenta [ 59 ].…”

Section: Resultsmentioning

confidence: 99%

Preparing for Pregnancy in Women with Systemic Lupus Erythematosus—A Multidisciplinary Approach

et al. 2022

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Pregnancy is one of the most challenging processes the human body is exposed to: the healthy mother can carry to term a genetically different new-born, while her immune system adapts to tolerate this new status and avoids rejection. In autoimmune disorders, motherhood is even more challenging, with additional medical counselling, mother care, and foetus development checks being necessary. While the aspects of supplementary mother care and pregnancy progress tracking are associated with well-established medical procedures and protocols, counselling, be it pre- or post-conception, is still underestimated and scarcely applied. Indeed, over the past decades, medical counselling for this particular population has changed significantly, but from a healthcare’s provider point of view, more is required to ensure a smooth, controllable pregnancy evolution. One of the most frequent autoimmune diseases affecting young females during their fertile years is Systemic Lupus Erythematosus (SLE). Like other heterogenous diseases, it exposes the mother to severe, organ-threatening complications and unpredictable evolution. Both the disease and its treatment can significantly affect the mother’s willingness to engage in a potentially risky pregnancy, as well as the likeliness to carry it to term without any impairments. A good collaboration between the patient’s rheumatologist and obstetrician is therefore mandatory in order to: (a) allow the mother to make an informed decision on pursuing with the pregnancy; (b) ensure a perfect synchronization between pregnancy terms and treatment; and (c) avoid or minimize potential complications. The best approach to achieve these outcomes is pregnancy planning. Moreover, knowing one desired prerequisite for a successful pregnancy evolution in SLE mothers is a stable, inactive, quiescent disease for at least six months prior to conception, planning becomes more than a recommended procedure. One particular aspect that requires attention before conception is the treatment scheme applied before delivery as autoantibodies can influence significantly the course of pregnancy. In this view, future SLE mothers should ideally benefit from preconception counselling within their agreed care pathway. A multidisciplinary team including at least the rheumatologist and obstetrician should be employed throughout the pregnancy, to decide on the appropriate timing of conception and compatible medication with respect to disease activity, as well as to monitor organ involvement and foetus development progress.

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Section: Resultsmentioning

confidence: 99%

Preparing for Pregnancy in Women with Systemic Lupus Erythematosus—A Multidisciplinary Approach

et al. 2022

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“…Hydroxychloroquine has a good oral absorption, long plasma elimination, and slow renal clearance and crosses the placental barrier, being found at similar concentrations in both the umbilical cord blood and maternal blood 14 . The therapeutic range for SLE was 500–2000 ng/ml (1.15–4.61 μM) , and above 2000 ng/ml were considered supratherapeutic 15 .…”

Section: Discussionmentioning

confidence: 99%

Toxicology evaluation of overdose hydroxychloroquine on zebrafish (Danio rerio) embryos

Luo

Xie

Lin

et al. 2022

Sci Rep

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Potential risks of treatment with hydroxychloroquine (HCQ) include QT interval prolongation, hypoglycemia, a wide range of neuropsychiatric manifestations, hematotoxicity, and potential genetic defects. HCQ is extremely toxic when used in overdose and can lead to tachycardia, hypotension, known central nervous system, transmission defects, hypokalemia and other manifestations in individuals. The mechanism of excessive HCQ leading to these manifestations is still unclear. In this paper, overdose HCQ at different concentrations was used to treat zebrafish embryos, and the phenomena like human beings were obtained, such as increased heart rate and nervous system inhibition. With the increase of concentration to 100 μM, embryo mortality and malformation rate increased and hatching rate decreased, in situ hybridization showed abnormal differentiation of embryo germ layers and formation of vital organs. We selected embryos treated with 50 μM HCQ, in which concentration the mortality rate, hatching rate and malformation rate of the embryos were like those of the control group, for transcriptome analysis. Although the above indexes did not change significantly, the molecular changes related to the development of the heart, eye, nerve and other important organs were significant. This study provides useful information for further research on the toxicity mechanism of HCQ overdose, and provides some insight that can guide future studies in humans.

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“…The promising results observed with the use of HCQ to treat autoimmunity in pregnancy have laid the foundation for its use in chronic placental inflammation, a condition characterized by the disruption of healthy placental tissue. They can only be confirmed by a post-delivery histopathological examination[ 14 ]. Chronic placental inflammation has been linked to severe complications of pregnancy, such as fetal growth restriction, premature labor, and miscarriage[ 15 ].…”

Section: To the Editormentioning

confidence: 99%

Update on hydroxychloroquine use in pregnancy

Nori,

Akram,

Al-Ani

2023

World J Exp Med

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Orphan diseases are rare diseases that affect less than 200000 individuals within the United States. Most orphan diseases are of neurologic and genetic origin. With the current advances in technology, more funding has been devoted to developing therapeutic agents for patients with these conditions. In our review, we highlight emerging options for patients with neurologic orphan diseases, specifically including diseases resulting in muscular deterioration, epilepsy, seizures, neurodegenerative movement disorders, inhibited cognitive development, neuron deterioration, and tumors. After extensive literature review, gene therapy offers a promising route for the treatment of neurologic orphan diseases. The use of clustered regularly interspaced palindromic repeats/Cas9 has demonstrated positive results in experiments investigating its role in several diseases. Additionally, the use of adeno-associated viral vectors has shown improvement in survival, motor function, and developmental milestones, while also demonstrating reversal of sensory ataxia and cardiomyopathy in Friedreich ataxia patients. Antisense oligonucleotides have also been used in some neurologic orphan diseases with positive outcomes. Mammalian target of rapamycin inhibitors are currently being investigated and have reduced abnormal cell growth, proliferation, and angiogenesis. Emerging innovations and the role of genetic treatments open a new window of opportunity for the treatment of neurologic orphan diseases.

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The Potential Benefit of Hydroxychloroquine in Chronic Placental Inflammation of Unknown Etiology Associated with Adverse Pregnancy Outcomes

Cited by 7 publications

References 75 publications

Preparing for Pregnancy in Women with Systemic Lupus Erythematosus—A Multidisciplinary Approach

Preparing for Pregnancy in Women with Systemic Lupus Erythematosus—A Multidisciplinary Approach

Toxicology evaluation of overdose hydroxychloroquine on zebrafish (Danio rerio) embryos

Update on hydroxychloroquine use in pregnancy

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