The role of soluble e-selectin and thrombospondin-2 in HIV associated preeclampsia.

Abstract

Objective: HIV infection and hypertensive disorders of pregnancy are common causes of maternal mortality in South Africa. Preeclampsia (PE) is a pregnancy-specific disorder that contributes to the majority of maternal deaths caused by hypertension in pregnancy. Reduced placentation, endothelial dysfunction of multiple organs and inflammation occur during PE. Endothelial cells express the adhesion molecule soluble E-selectin (sE-selectin) in response to inflammation. This molecule facilitates the cohesion of leukocytes to endothelial cells. In PE, endothelial cell activation and dysfunction cause endothelial cells to secrete the glycoprotein thrombospondin-2 (TSP-2). TSP-2 affects cellular functions, plays a regulatory role in the extracellular matrix and is an inhibitor of angiogenesis. In PE, an imbalance of angiogenic and anti-angiogenic factors result in dysregulation of angiogenesis. Considering the high rate of maternal mortality in South Africa due to HIV infection and PE, the aim of this study was to investigate the role of sE-selectin and TSP-2 in HIV-associated preeclamptic and normotensive pregnancies. Method: The study population (n = 72) comprised of normotensive pregnant (n = 36) and preeclamptic (n = 36) groups. These groups were further stratified by HIV status (negative vs. positive). The Bio-Plex immunoassay technique was used to measure serum concentrations of sE-selectin and TSP-2. Results: There was a statistical difference observed in gestational age, systolic blood pressure, diastolic blood pressure and baby weight across the study groups (p < 0.0001). sE-selectin: Based on pregnancy type and HIV status, levels of serum sE-selectin were significantly increased in preeclamptic HIV-negative compared to normotensive HIV-negative groups (p = 0.0070). TSP-2: Regardless of HIV status and based on pregnancy type, TSP-2 levels were significantly elevated (p = 0.0429) in preeclamptic compared to normotensive groups. Based on HIV status, a significant upregulation (p = 0.0095) of TSP-2 was noted in HIV-positive compared to HIV-negative groups. Furthermore, based on pregnancy type and HIV status, levels of TSP-2 were statistically significant across all study groups (p = 0.0229). Conclusion: This study highlights the role of sE-selectin and TSP-2 in preeclamptic women compromised by HIV infection and demonstrates the potential biomarker value of sE-selectin and TSP-2 in the early diagnosis of preeclampsia.