Abstract
Aim: With this review we try to unravel if placenta-derived factors are able to initiate liver sinusoidal endothelial cells (LSEC) decay in HELLP syndrome and eventually cause the development of sinusoidal obstruction syndrome (SOS).
Background: Haemolysis, Elevated Liver enzymes and Low Platelets (HELLP) syndrome is a severe complication of pregnancy. It is characterized by elevated liver enzymes, low platelet count and haemolytic anaemia. The risk of developing HELLP syndrome within a pregnancy is 0.1-0.8%. The mortality rate among women with HELLP syndrome is 0-24% and the perinatal death goes up to 37%. The aetiology of HELLP syndrome is not fully understood but the pathogenesis of the liver pathology in the HELLP syndrome resembles that of a SOS with endothelial damage of the LSECs which ultimately leads to liver failure.
Objectives: We hypothesize that placenta derived factors cause LSEC damage and thereby liver dysfunction.
Methods: We searched in the PubMed database for relevant articles about placenta derived factors involved in endothelial activation especially in the liver. We yielded eventually 55 relevant articles.
Results: Based on this literature search we associate that in HELLP syndrome there is an increase of soluble fmslike tyrosine kinase (sFlt1), vascular endothelial growth factor (VEGFR), soluble endoglin (sEng), galectin-1 (Gall), endothelin-1 (ET-1), Angiopoietin 2 (Angs-2), Asymmetric dimethylarginine (ADMA), activin B, inhibin A, Fas ligand (FasL) and heat shock protein 70 (Hsp70).
Conclusion: We assume that these eleven increased placenta derived factors are responsible for LSEC damage which eventually leads to liver failure. This concept shows a possible design of the complicated pathophysiology in HELLP syndrome. However further research is required.
Original language | English |
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Pages (from-to) | 42-48 |
Number of pages | 7 |
Journal | Pregnancy Hypertension: an international journal of women's cardiovascular health |
Volume | 18 |
DOIs | |
Publication status | Published - Oct 2019 |
Keywords
- HELLP syndrome
- Haemolysis elevated liver enzymes and low platelets syndrome
- Etiology
- Pathophysiology
- Pathogenesis
- SOS
- Sinusoidal obstruction syndrome
- Placenta derived factors
- Liver function
- LSEC
- Liver sinusoidal endothelial cells
- Endothelial activation
- FAS LIGAND
- ACTIVIN-A
- BETA-B
- EXPRESSION
- PREECLAMPSIA
- GALECTIN-1
- ANGIOGENESIS
- BIOLOGY
- HEAT-SHOCK-PROTEIN-70
- DIMETHYLARGININE