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作为子痫前期治疗策略的心脏保护β受体阻滞剂的临床前研究。

Pre-Clinical Investigation of Cardioprotective Beta-Blockers as a Therapeutic Strategy for Preeclampsia.

作者信息

Binder Natalie K, MacDonald Teresa M, Beard Sally A, de Alwis Natasha, Tong Stephen, Kaitu'u-Lino Tu'uhevaha J, Hannan Natalie J

机构信息

Translational Obstetrics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg 3084, Australia.

Therapeutics Discovery and Vascular Function Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Heidelberg 3084, Australia.

出版信息

J Clin Med. 2021 Jul 30;10(15):3384. doi: 10.3390/jcm10153384.

Abstract

Despite significant maternal and fetal morbidity, a treatment for preeclampsia currently remains an unmet need in clinical care. As too does the lifelong cardiovascular risks imparted on preeclampsia sufferers. Endothelial dysfunction and end-organ injury are synonymous with both preeclampsia and cardiovascular disease, including heart failure. We propose that beta-blockers, known to improve endothelial dysfunction in the treatment of cardiovascular disease, and specifically known to reduce mortality in the treatment of heart failure, may be beneficial in the treatment of preeclampsia. Here, we assessed whether the beta-blockers carvedilol, bisoprolol, and metoprolol could quench the release of anti-angiogenic factors, promote production of pro-angiogenic factors, reduce markers of inflammation, and reduce endothelial dysfunction using our in vitro pre-clinical preeclampsia models encompassing primary placental tissue and endothelial cells. Here, we show beta-blockers effected a modest reduction in secretion of anti-angiogenic soluble fms-like tyrosine kinase-1 and soluble endoglin and increased expression of pro-angiogenic placental growth factor, vascular endothelial growth factor and adrenomedullin in endothelial cells. Beta-blocker treatment mitigated inflammatory changes occurring after endothelial dysfunction and promoted cytoprotective antioxidant heme oxygenase-1. The positive effects of the beta-blockers were predominantly seen in endothelial cells, with a less consistent response seen in placental cells/tissue. In conclusion, beta-blockers show potential as a novel therapeutic approach in the treatment of preeclampsia and warrant further investigation.

摘要

尽管存在显著的母婴发病率,但子痫前期的治疗目前仍是临床护理中未满足的需求。子痫前期患者所面临的终身心血管风险也是如此。内皮功能障碍和终末器官损伤是子痫前期和心血管疾病(包括心力衰竭)的共同特征。我们提出,已知在心血管疾病治疗中可改善内皮功能障碍,且特别已知在心力衰竭治疗中可降低死亡率的β受体阻滞剂,可能对子痫前期的治疗有益。在此,我们使用包含原代胎盘组织和内皮细胞的体外临床前子痫前期模型,评估了卡维地洛、比索洛尔和美托洛尔这三种β受体阻滞剂是否能抑制抗血管生成因子的释放、促进促血管生成因子的产生、降低炎症标志物并减轻内皮功能障碍。在此,我们发现β受体阻滞剂可适度减少抗血管生成可溶性fms样酪氨酸激酶-1和可溶性内皮糖蛋白的分泌,并增加内皮细胞中促血管生成胎盘生长因子、血管内皮生长因子和肾上腺髓质素的表达。β受体阻滞剂治疗减轻了内皮功能障碍后发生的炎症变化,并促进了具有细胞保护作用的抗氧化血红素加氧酶-1的生成。β受体阻滞剂的积极作用主要在内皮细胞中观察到,在胎盘细胞/组织中的反应则不太一致。总之,β受体阻滞剂显示出作为子痫前期治疗新方法的潜力,值得进一步研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b979/8348612/142e7c10a2ed/jcm-10-03384-g001a.jpg

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