Document Detail


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.
MedLine Citation:
PMID:  21316642     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Mark J Wehrum; Irina A Buhimschi; Carolyn Salafia; Stephen Thung; Mert O Bahtiyar; Erica F Werner; Katherine H Campbell; Christine Laky; Anna K Sfakianaki; Guomao Zhao; Edmund F Funai; Catalin S Buhimschi
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2011-02-12
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  204     ISSN:  1097-6868     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-07-26     Completed Date:  2011-10-07     Revised Date:  2012-10-09    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  411.e1-411.e11     Citation Subset:  AIM; IM    
Copyright Information:
Published by Mosby, Inc.
Affiliation:
Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA. mark.j.wehrum@us.army.mil
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MeSH Terms
Descriptor/Qualifier:
Adult
Case-Control Studies
Epithelial-Mesenchymal Transition
Female
Humans
Keratin-7 / metabolism
Phosphotyrosine / metabolism
Placenta Accreta / metabolism*,  pathology
Placenta Previa / metabolism*,  pathology
Pregnancy
Pregnancy Proteins / blood
Trophoblasts / metabolism*,  pathology
Vascular Endothelial Growth Factor A / metabolism*
Vascular Endothelial Growth Factor Receptor-1 / blood
Vimentin / metabolism
Grant Support
ID/Acronym/Agency:
K12 HD 1027766/HD/NICHD NIH HHS; R01 HD 047321/HD/NICHD NIH HHS; R01 HD047321-05/HD/NICHD NIH HHS; R03 HD 50249/HD/NICHD NIH HHS; R03 HD050249-02/HD/NICHD NIH HHS
Chemical
Reg. No./Substance:
0/Keratin-7; 0/Pregnancy Proteins; 0/Vascular Endothelial Growth Factor A; 0/Vimentin; 144589-93-5/placenta growth factor; 21820-51-9/Phosphotyrosine; EC 2.7.10.1/Vascular Endothelial Growth Factor Receptor-1
Comments/Corrections

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