Investigation of Nrf2-Keap-1 pathway, Sestrin 2 and oxidative stress markers in serum of patients with placenta Accreata spectrum.

Placenta accreta spectrum (PAS) is an important disease group with risks such as maternal bleeding, hysterectomy, and death, which expresses the pathological adhesion of the placenta to the uterine myometrium, including placenta accreta, increta, and percreta, with an increased incidence with an increase in cesarean section rates. In this study, we aimed to investigate the Nuclear factor erythroid 2-related factor 2 (Nrf2)-Kelch-like ECH-related protein 1 (Keap1) pathway in these patients. Serum Sestrin 2, Nrf2, Keap1, glycogen synthase kinase 3β (GSK-3β), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) activities and malondialdehyde-modified low-density lipoprotein (MDA-LDL) levels were performed by the Enzyme-Linked Immunosorbent Assay (ELISA) method. In the findings obtained, Nrf2, Keap1, GSK-3ß, MDA-LDL levels, SOD and GSH-Px activities were statistically significantly different in the patient group compared to the control group. While MDA-LDL values were found to be high in the patient group, Nrf2, Keap1, GSK-3ß levels, SOD and GSH-Px activities were significantly lower, except for Sestrin 2 values. In addition, when grouped according to the degree of invasion, Nrf2 levels were found to be lower and Keap1 levels higher. As a result, it was determined that the Nrf2-Keap1 pathway was disrupted in PAS patients, and the oxidant/antioxidant balance was impaired in the oxidant direction. The results show that Nrf2 and Keap1 parameters can be useful in determining the degree of placental invasion.