Escudero Carlos, Vatish Manu
Vascular Physiology Laboratory, Department of Basic Sciences, Universidad del Bío-Bío, Chillán, Chile; Nuffield Department of Women's & Reproductive Health. University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom; Group of Research and Innovation in Vascular Health (GRIVAS Health), Chillan, Chile.
Nuffield Department of Women's & Reproductive Health. University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom.
Placenta. 2025 Apr 10. doi: 10.1016/j.placenta.2025.04.001.
Preeclampsia is a complex pregnancy disorder characterized by hypertension and multisystem organ damage, notably affecting the liver, kidneys, and brain. Eclampsia, a severe form of preeclampsia, is marked by the sudden onset of generalized tonic-clonic seizures. Brain complications, including eclampsia, are responsible for 60-70 % of preeclampsia-related maternal deaths, particularly in low-income regions. Despite the significant impact of brain complications in preeclampsia, their underlying pathophysiology remains unclear. Evidence suggests that brain edema in preeclampsia and eclampsia results from disruption of the blood-brain barrier (BBB). Although direct analysis of the BBB is challenging, in vitro studies indicate that plasma from women with preeclampsia can compromise the BBB, with the specific circulating factors involved still unidentified. Among the potential culprits, recent findings highlight placental-derived small extracellular vesicles (PDsEVs) as key players in BBB disruption observed in preeclampsia. This review examines the role of PDsEVs in the pathophysiology of brain edema associated with preeclampsia, emphasizing areas for future research, including neuroinflammation and neuron dysfunction. Additionally, we discuss the protective role of magnesium sulfate in these processes.
子痫前期是一种复杂的妊娠疾病，其特征为高血压和多系统器官损害，尤其会影响肝脏、肾脏和大脑。子痫是子痫前期的一种严重形式，其特点是突然出现全身性强直阵挛性惊厥。包括子痫在内的脑部并发症导致了60%至70%的子痫前期相关孕产妇死亡，在低收入地区尤为如此。尽管脑部并发症在子痫前期中具有重大影响，但其潜在的病理生理学仍不清楚。有证据表明，子痫前期和子痫中的脑水肿是由血脑屏障（BBB）破坏所致。虽然直接分析血脑屏障具有挑战性，但体外研究表明，子痫前期女性的血浆会损害血脑屏障，其中涉及的具体循环因子仍未确定。在潜在的罪魁祸首中，最近的研究结果突出了胎盘来源的小细胞外囊泡（PDsEVs）是子痫前期中观察到的血脑屏障破坏的关键因素。本综述探讨了PDsEVs在子痫前期相关脑水肿病理生理学中的作用，强调了未来研究的领域，包括神经炎症和神经元功能障碍。此外，我们还讨论了硫酸镁在这些过程中的保护作用。
