1Ramadan M, 1Khamis Y, 2Kuhn W, 3El-Kaffash DM, 1Azab HI.
Departments of 1Obstetric and Gynecology and 3Clinical Pathology, Alexandria University, Egypt, and 2Department of Obstetric and Gynecology, Göttingen University, Germany.
Endothelial cell dysfunction is widely accepted as a primary cause in the pathogenesis of pre-eclampsia. A number of cellular molecules is altered in women with pre-eclampsia including endothelial cell adhesion molecules. The aim of this study is to determine the maternal as well as fetal levels of some endothelial cell adhesion molecules namely ICAM-1, VCAM-1, E-Selectin, P-Selectin in pre-eclampsia and eclampsia, in order to compare their levels with that of normal pregnancy, and to determine to what extent the fetal circulation is involved in the systemic changes that occur in pre-eclampsia and eclampsia. and Peripheral maternal plasma were collected from normal pregnant women (n=40), pre-eclamptic women (n=33), and eclamptic women (n=18). Fetal plasma samples from the umbilical vein from the corresponding foetuses (normal=40, pre-eclampsia=28, eclampsia=13) were collected at delivery. A sandwich ELISA technique was employed to quantitate concentrations of soluble(s) ICAM-1, VCAM-1, E-Selectin and P-Selectin. In maternal blood, the values of endothelial cell adhesion molecules were 288.38±70.10, 336.70±159.42, 493.17±170.05 for sICAM-1, 750.80±199.03, 929.64±196.82, 1249.67±585.30 for sVCAM-1, 41.08±15.05, 51.70±19.13, 63.89±41.70 for sE-selectin, 69.55±29.33, 93.61±51.64, 70.56±24.45 for sP-selectin in normal, pre-eclamptic, and eclamptic pregnant women respectively. In fetal blood sICAM-1 was 160.90±42.75, 130.96±42.96, and 138.15±37.65 for normal, pre-eclampsia and eclampsia. The corresponding sVCAM-1 values were 1663.58±588.22, 1680.54±549.83, 1795.46±396.09. sE-selectin was 148.25±57.29, 156.21±65.95, 110.31±44.85, while sP-selectin was 75.80±29.18, 82.96±33.39, 69.54±27.65 in fetuses of normal, pre-eclamptic and eclamptic mothers respectively. The concentrations of sICAM-1, sVCAM-1, and sE-Selectin were significantly elevated in women with pre-eclampsia and eclampsia compared to healthy control pregnant women. The fetal concentrations of these molecules were found to be markedly different from the corresponding maternal values. However, there was no difference in the fetal concentration of these molecules between normal pregnancies and pregnancies complicated with eclampsia or pre-eclampsia. sP-selectin in maternal blood correlated with platelet count and with sP-selectin of the fetal blood. In conclusion, eclampsia and pre-eclampsia show signs of endothelial cell dysfunction manifested by the increased endothelial cell adhesion molecules . The fetal circulation may not be affected by the factor(s) that lead to disturbed endothelial cell function in women with eclampsia or pre-eclampsia. P-selectin seems not to be involved in these conditions suggesting a selective dysregulation of some molecules rather than damage of the endothelial cells.