Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Angiogenesis. 2020 May;23(2):105-117. doi: 10.1007/s10456-019-09694-w. Epub 2019 Nov 9.
A branched vascular network is crucial to placental development and is dependent on factors such as vascular endothelial growth factor (VEGF), placental growth factor (PlGF), angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2), soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng) to regulate blood vessel growth. Imbalances in these factors can lead to aberrant placental vascular development. Throughout pregnancy, these factors are also released into the maternal circulation to aid in adapting the maternal cardiovascular system to pregnancy. Increased secretion of anti-angiogenic factors can lead to the development of an anti-angiogenic state in the mother and contribute to the development of pregnancy pathologies such as pre-eclampsia and foetal growth restriction (FGR). Thus, what are commonly referred to as 'angiogenic factors' have distinct functions in the maternal and placental circulations making this a misnomer. Indeed, technical issues in this field such as assay methodology and lack of data considering different placental cell types mean that the physiological roles of these factors in the maternal and placental circulations are frequently muddled in the literature. This review aims to (1) unpick the distinct roles of factors that influence placental vascular development and separate these from the roles of the same factors within the maternal circulation in normal pregnancy and (2) critically assess how imbalances may contribute to the distinct pathophysiological mechanisms underlying pregnancy disorders. Together, this critical assessment of the field endeavours to improve our ability to accurately use these factors as predictive/diagnostic biomarkers in the future.
分支血管网络对于胎盘发育至关重要，并且依赖于血管内皮生长因子 (VEGF)、胎盘生长因子 (PlGF)、血管生成素-1 (Ang-1)、血管生成素-2 (Ang-2)、可溶性 fms 样酪氨酸激酶-1 (sFlt-1) 和可溶性内皮糖蛋白 (sEng) 等因素来调节血管生长。这些因素的失衡可能导致胎盘血管发育异常。在整个怀孕期间，这些因素也会释放到母体循环中，以帮助母体心血管系统适应怀孕。抗血管生成因子的分泌增加可导致母体中抗血管生成状态的发展，并有助于妊娠病理的发展，如子痫前期和胎儿生长受限 (FGR)。因此，通常被称为“血管生成因子”的因子在母体和胎盘循环中具有不同的功能，这是一个错误的说法。事实上，该领域的技术问题，如测定方法和缺乏考虑不同胎盘细胞类型的数据，意味着这些因子在母体和胎盘循环中的生理作用在文献中经常混淆。本综述旨在 (1) 剖析影响胎盘血管发育的因子的独特作用，并将其与正常妊娠中母体循环中相同因子的作用区分开来，以及 (2) 批判性评估失衡如何可能导致妊娠疾病的独特病理生理机制。总的来说，对该领域的批判性评估旨在提高我们未来准确将这些因子用作预测/诊断生物标志物的能力。
