The Underlying Molecular Mechanisms of the Placenta Accreta Spectrum: A Narrative Review

• Published in: International journal of molecular sciences Vol. 25; no. 17; p. 9722
• Main Authors: Lizárraga-Verdugo, Erik, Beltrán-Ontiveros, Saúl Armando, Gutiérrez-Grijalva, Erick Paul, Montoya-Moreno, Marisol, Gutiérrez-Arzapalo, Perla Y, Avendaño-Félix, Mariana, Gutiérrez-Castro, Karla Paola, Cuén-Lazcano, Daniel E, González-Quintero, Paul, Mora-Palazuelos, Carlos Ernesto
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.09.2024
• Subjects: Angiogenesis; Apoptosis; Biological control systems; Biomarkers; Cesarean section; Chemokines; Classification; Female; Gene expression; Genetic aspects; Humans; Insulin-like growth factors; Medical research; Medicine, Experimental; Molecular biology; Obstetrics; Physiological aspects; Placenta; Placenta accreta; Placenta Accreta - diagnosis; Placenta Accreta - genetics; Placenta Accreta - metabolism; Placenta Accreta - pathology; placenta accreta spectrum; placenta acreta; placenta increta; placenta percreta; Pregnancy; Signal Transduction; trophoblast invasion; Trophoblasts - metabolism; Trophoblasts - pathology; Womens health; Mexico; placenta increta; placenta accreta spectrum; placenta percreta; placenta acreta; trophoblast invasion
• ISSN: 1422-0067; 1661-6596; 1422-0067
• DOI: 10.3390/ijms25179722

Placenta accreta spectrum (PAS) disorders are characterized by abnormal trophoblastic invasion into the myometrium, leading to significant maternal health risks. PAS includes placenta accreta (invasion < 50% of the myometrium), increta (invasion > 50%), and percreta (invasion through the entire myometrium). The condition is most associated with previous cesarean deliveries and increases in chance with the number of prior cesarians. The increasing global cesarean rates heighten the importance of early PAS diagnosis and management. This review explores genetic expression and key regulatory processes, such as apoptosis, cell proliferation, invasion, and inflammation, focusing on signaling pathways, genetic expression, biomarkers, and non-coding RNAs involved in trophoblastic invasion. It compiles the recent scientific literature (2014-2024) from the Scopus, PubMed, Google Scholar, and Web of Science databases. Identifying new biomarkers like AFP, sFlt-1, β-hCG, PlGF, and PAPP-A aids in early detection and management. Understanding genetic expression and non-coding RNAs is crucial for unraveling PAS complexities. In addition, aberrant signaling pathways like Notch, PI3K/Akt, STAT3, and TGF-β offer potential therapeutic targets to modulate trophoblastic invasion. This review underscores the need for interdisciplinary care, early diagnosis, and ongoing research into PAS biomarkers and molecular mechanisms to improve prognosis and quality of life for affected women.