Circulating angiogenic factors in pregnancies complicated by pre-eclampsia.

Background: Pre-eclampsia is an inflammatory disorder characterized by diffuse endothelial dysfunction possibly secondary to impaired trophoblast invasion of the spiral arteries during implantation. It is associated with alterations in maternal serum concentrations of vascular endothelial growth factor (VEGF), placental growth factor (PIGF) and soluble fms-like tyrosine kinase-1 (sFlt-1). We did a case-control study to ascertain whether pre-eclampsia is associated with changes in serum concentrations of VEGF, PIGF and sFlt-1 in Indian patients.

Methods: Serum samples were obtained from 40 women with pre-eclampsia and 40 normotensive, non-proteinuric pregnant women. The levels of VEGF, PIGF and sFlt-1 were analysed using ELISA.

Results: In the sera of pregnant women with pre-eclampsia, the levels of sFlt-1 were significantly higher than those in the sera of normotensive, non-proteinuric pregnantwomen (median 11295.25 v. 2936.2 pg/ml, p < 0.0001), whereas there was a significant reduction in the levels of free VEGF (mean [SD] 170.53 [36.56] pg/ml v. 254.61 [47.39] pg/ml, p < 0.0001) and PIGF (mean [SD] 236.77 [93.70] pg/ml v. 744.98 [168.55] pg/ml, p < 0.0001).

Conclusion: An increase in sFlt-1 levels and a simultaneous decrease in free VEGF and PIGF levels in the sera of women with pre-eclampsia as compared with normotensive, nonproteinuric pregnant women suggest that an imbalance between the levels of these pro- and anti-angiogenic factors'may have a role to play in the pathogenesis of pre-eclampsia.