The role of the circulating placental angiogenic factors SFLT-1/PLGF ratio in patients with preeclampsia-a review

Abstract

Preeclampsia (PE), a progressive, multisystem disease of pregnant women, is the leading cause of maternal and fetal / neonatal morbidity and mortality with an incidence of 3-8% at a global level. PE is defined as de novo occurrence of hypertension and proteinuria after the 20th gestation week of pregnancy. The diagnosis of PE has long been based on the measurement of those two non-specific signs the diagnostic value of which is often insufficient given the clinical diversity of the disease as well as the different impact on the mother and the fetus. In the absence of specific preeclampsia therapy, clinical management consists of symptomatic / substitution therapy and monitoring for the detection of worsening of the maternal or fetal state and delivery as the ultimate remedy. The fact that only the delivery, or more precisely, the removal of the placenta leads to a definitive stop of PE, puts the placenta at a central place in the pathogenesis of the disease. More and more studies have suggested the connection of placental angiogenic factors with preeclampsia. These factors include circulating angiogenic proteins such as soluble fms-like tyrosine kinase-1 (sFlt-1), the anti-angiogene responsible for vasoconstriction, and the placental growth factor (PLGF) pro-angiogene responsible for placental pseudo-vasculogenesis and vasodilatation. In preeclampsia patients, the anti-angiogene sFlt-1 predominates due to increased production in the placenta, which reduces the effect of pro-angiogene PLGF whose concentrations in the serum are significantly reduced. All this leads to the clinical expression of PE with hypertension due to vasoconstriction and multisystemic involvement due to systemic endotheliosis, i.e. microvasculopathy. The determination of the serum sFlt-1 / PLGF rate is recommended as a possible useful test for diagnosis of PE and the determination of the severity of the clinical picture, and as a useful tool in its management.