PREECLAMPSIA AS A NEUROIMMUNE PROCESS: POTENTIAL DIAGNOSTIC EFFICACY OF NEUROGENIC AND ANGIOGENIC MARKERS

Abstract

Background. Preeclampsia (PE) is a multisystem pregnancy complication arising from the 20nd week of gestation, coinciding with fetal neurocorticogenesis – formation of the cerebral cortex and higher CNS structures, accompanied by expression of foreign neuron-specific proteins (NSPs). Current obstetric practice lacks effective methods for prevention, early diagnosis and therapy of PE, determining the relevance of studying markers of neurocorticogenesis and angiogenic imbalance as diagnostic targets. Objective. To compare levels of neurogenic markers – NSE, S100B, angiogenic factors sFlt, PlGF and their ratio, as well as C5 complement component in blood serum of pregnant women with PE, high risk of its development and physiological pregnancy. Materials and methods. A single-center cross-sectional study of 82 patients at 22–40 weeks was conducted: main group – 38 with PE; risk group – 22 with risk factors; control – 22 healthy pregnant women. Levels of NSE, S100B, sFlt-1, PlGF and C5 were determined by ELISA. Statistical analysis was performed using Kruskal–Wallis and Mann–Whitney tests with Bonferroni correction, and ROC analysis. The study was approved by the local ethics committee of Sechenov University. Results. NSE and S100B levels were significantly elevated in the PE group compared to control and risk group (p 0.001). ROC analysis showed high diagnostic efficacy of NSE and S100B (AUC0.8), moderate value of sFlt-1/PlGF ratio (AUC = 0.71). sFlt, PlGF and C5 showed low diagnostic efficacy. Conclusions. Our study indicates high significance of neurogenic markers with prospect of clinical implementation for early detection of high-risk pregnant women, improving diagnosis and stratification of PE severity, which will change management principles and provide timely, effective medical care to patients with preeclampsia.