Accreta complicating complete placenta previa is characterized by reduced systemic levels of vascular endothelial growth factor and by epithelial-to-mesenchymal transition of the invasive trophoblast - 19/08/11
, Irina A. Buhimschi, MD a, Carolyn Salafia, MD b, Stephen Thung, MD a, Mert O. Bahtiyar, MD a, Erica F. Werner, MD a, Katherine H. Campbell, MD a, Christine Laky, MD a, Anna K. Sfakianaki, MD a, Guomao Zhao, BSc a, Edmund F. Funai, MD a, Catalin S. Buhimschi, MD a
Reprints: Mark J. Wehrum, DO, Womack Army Medical Center, Department of Obstetrics/Gynecology, WAMC Stop A, 2817 Reilly Rd., Fort Bragg, NC 28310Résumé |
Objective |
We sought to characterize serum angiogenic factor profile of women with complete placenta previa and determine if invasive trophoblast differentiation characteristic of accreta, increta, or percreta shares features of epithelial-to-mesenchymal transition.
Study Design |
We analyzed gestational age-matched serum samples from 90 pregnant women with either complete placenta previa (n = 45) or uncomplicated pregnancies (n = 45). Vascular endothelial growth factor (VEGF), placental growth factor, and soluble form of fms-like-tyrosine-kinase-1 were immunoassayed. VEGF and phosphotyrosine immunoreactivity was surveyed in histological specimens relative to expression of vimentin and cytokeratin-7.
Results |
Women with previa and invasive placentation (accreta, n = 5; increta, n = 6; percreta, n = 2) had lower systemic VEGF (invasive previa: median 0.8 [0.02-3.4] vs control 6.5 [2.7-10.5] pg/mL, P = .02). VEGF and phosphotyrosine immunostaining predominated in the invasive extravillous trophoblasts that coexpressed vimentin and cytokeratin-7, an epithelial-to-mesenchymal transition feature and tumorlike cell phenotype.
Conclusion |
Lower systemic free VEGF and a switch of the interstitial extravillous trophoblasts to a metastable cell phenotype characterize placenta previa with excessive myometrial invasion.
Le texte complet de cet article est disponible en PDF.Key words : angiogenesis, invasion, myometrium, trophoblast, vascular endothelial growth factor
Plan
| This work was supported by National Institutes of Health Grant no. R01 HD 047321 (I.A.B.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine. C.S.B. was supported by the Yale Women's Reproductive Health Research Career Development Center (K12 HD 1027766) and NIH RO3 HD 50249. |
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| The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government. |
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| Cite this article as: Wehrum MJ, Buhimschi IA, Salafia C, et al. Accreta complicating complete placenta previa is characterized by reduced systemic levels of vascular endothelial growth factor and by epithelial-to-mesenchymal transition of the invasive trophoblast. Am J Obstet Gynecol 2011;204:411.e1-11. |
Vol 204 - N° 5
P. 411.e1-411.e11 - mai 2011 Retour au numéro
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