Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Canada.
Women and Children's Health Research Institute, University of Alberta, Edmonton, Canada.
Clin Sci (Lond). 2024 Feb 21;138(4):137-151. doi: 10.1042/CS20231442.
Hypercholesterolemia in pregnancy is a physiological process required for normal fetal development. In contrast, excessive pregnancy-specific hypercholesterolemia increases the risk of complications, such as preeclampsia. However, the underlying mechanisms are unclear. Toll-like receptor 4 (TLR4) is a membrane receptor modulated by high cholesterol levels, leading to endothelial dysfunction; but whether excessive hypercholesterolemia in pregnancy activates TLR4 is not known. We hypothesized that a high cholesterol diet (HCD) during pregnancy increases TLR4 activity in uterine arteries, leading to uterine artery dysfunction. Sprague Dawley rats were fed a control diet (n=12) or HCD (n=12) during pregnancy (gestational day 6-20). Vascular function was assessed in main uterine arteries using wire myography (vasodilation to methacholine and vasoconstriction to phenylephrine; with and without inhibitors for mechanistic pathways) and pressure myography (biomechanical properties). Exposure to a HCD during pregnancy increased maternal blood pressure, induced proteinuria, and reduced the fetal-to-placental weight ratio for both sexes. Excessive hypercholesterolemia in pregnancy also impaired vasodilation to methacholine in uterine arteries, whereby at higher doses, methacholine caused vasoconstriction instead of vasodilation in only the HCD group, which was prevented by inhibition of TLR4 or prostaglandin H synthase 1. Endothelial nitric oxide synthase expression and nitric oxide levels were reduced in HCD compared with control dams. Vasoconstriction to phenylephrine and biomechanical properties were similar between groups. In summary, excessive hypercholesterolemia in pregnancy impairs uterine artery function, with TLR4 activation as a key mechanism. Thus, TLR4 may be a target for therapy development to prevent adverse perinatal outcomes in complicated pregnancies.
妊娠期间的高胆固醇血症是胎儿正常发育所必需的生理过程。相反,妊娠特异性的高胆固醇血症过度增加了并发症的风险,如先兆子痫。然而,其潜在机制尚不清楚。Toll 样受体 4(TLR4)是一种受高胆固醇水平调节的膜受体,导致内皮功能障碍;但是妊娠期间是否过度高胆固醇血症激活 TLR4尚不清楚。我们假设妊娠期间高胆固醇饮食(HCD)会增加子宫动脉中的 TLR4 活性,导致子宫动脉功能障碍。妊娠期间(妊娠第 6-20 天),给予 Sprague Dawley 大鼠对照饮食(n=12)或 HCD(n=12)。使用线描记法(乙酰甲胆碱引起的血管舒张和苯肾上腺素引起的血管收缩;有和没有用于机制途径的抑制剂)和压力描记法(生物力学特性)评估主子宫动脉的血管功能。妊娠期间暴露于 HCD 会增加母体血压,诱导蛋白尿,并降低雌雄胎儿-胎盘重量比。妊娠期间过度高胆固醇血症也会损害子宫动脉对乙酰甲胆碱的血管舒张作用,在较高剂量下,乙酰甲胆碱引起血管收缩而不是仅在 HCD 组中引起血管舒张,这可以通过抑制 TLR4 或前列腺素 H 合酶 1 来预防。与对照组相比,HCD 中的内皮型一氧化氮合酶表达和一氧化氮水平降低。对苯肾上腺素的血管收缩和生物力学特性在两组之间相似。总之,妊娠期间过度高胆固醇血症会损害子宫动脉功能,TLR4 激活是一个关键机制。因此,TLR4 可能是治疗开发的靶点,以预防复杂妊娠中的不良围产期结局。