Altered Endothelial Nitric Oxide Signaling as a Paradigm for Maternal Vascular Maladaptation in Preeclampsia

• Published in: Current hypertension reports Vol. 19; no. 10; p. 82
• Main Authors: Osol, George, Ko, Nga Ling, Mandalà, Maurizio
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2017; Springer Nature B.V
• Subjects: Cardiology; Endothelium, Vascular - metabolism; Endothelium, Vascular - physiopathology; Family Medicine; Female; General Practice; Humans; Hypertension; Internal Medicine; Medicine; Medicine & Public Health; Metabolic Diseases; Nephrology; Nitric oxide; Nitric Oxide - metabolism; Nitric Oxide Synthase Type III - metabolism; Oxidative Stress; Placenta - blood supply; Placenta Growth Factor - metabolism; Pre-Eclampsia - physiopathology; Preeclampsia; Preeclampsia (VD Garovic; Pregnancy; Primary Care Medicine; Section Editor; Signal Transduction; Topical Collection on Preeclampsia; Vascular Endothelial Growth Factor A - metabolism; Endothelial dysfunction; Nitric oxide synthase; Vascular tone; Preeclampsia; Nitric oxide; Vasodilation
• ISSN: 1522-6417; 1534-3111
• DOI: 10.1007/s11906-017-0774-6

Purpose of Review The goal of this review is to present the newest insights into what we view as a central failure of cardiovascular adaptation in preeclampsia (PE) by focusing on one clinically significant manifestation of maternal endothelial dysfunction: nitric oxide signaling. The etiology, symptoms, and current theories of the PE syndrome are described first, followed by a review of the available evidence, and underlying causes of reduced endothelial nitric oxide (NO) signaling in PE. Recent Findings PE maladaptations include, but are not limited to, altered physiological stimulatory inputs (e.g., estrogen; VEGF/PlGF; shear stress) and substrates (L-Arg; ADMA), augmented placental secretion of anti-angiogenic and inflammatory factors such as sFlt-1 and Eng, changes in eNOS (polymorphisms, expression), and reduced bioavailability of NO secondary to oxidative stress. Summary PE is a complex obstetrical syndrome that is associated with maternal vascular dysfunction. Diminished peripheral endothelial vasodilator influence in general, and of NO signaling specifically, are key in driving disease progression and severity.