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Substance in Urine Predicts Development of Preeclampsia

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Updated January 07, 2005

This study builds upon earlier findings by the last author, S. Ananth Karumanchi, M.D., of the Renal Division at the Beth Israel Deaconess Medical Center and Harvard Medical School in Boston. Dr. Karumanchi and his coworkers had previously discovered that a substance called soluble fms- like tyrosine kinase 1 (sFlt-1) circulates in large quantities in the bloodstreams of women with preeclampsia and that sFlt-1 injected into the bloodstream of pregnant rats caused a preeclampsia-like illness.

Last year, Drs. Levine, Karumanchi and their coworkers reported that high levels of sFlt-1 likely influenced the development of preeclampsia, by binding to PlGF and VEGF. Because they were bound to sFlt-1, the two substances could not be used by the blood vessel cells that required them. A release describing that study is available at http://www.nichd.nih.gov/new/releases/preeclampsia.cfm.

Dr. Levine noted that a screening test for PlGF would probably need to be used in conjunction with other measures. He explained that a few of the 118 women who did not develop preeclampsia also had low levels of PlGF. To confirm that preeclampsia is present, women with low levels of PlGF could be referred for a blood test to measure their blood levels of sFlt-1.

A urinary test for PlGF could probably be performed less expensively than could a blood test for sFlt-1, because it wouldn't require the services of a medical professional to draw blood. Moreover, a urine sample could conceivably be collected at home, and then brought into a medical lab for testing. This would be an advantage over a blood test, especially in countries lacking trained medical staff to draw blood.

Currently, Dr. Levine is planning an additional study to more accurately predict the development of preeclampsia by measuring urinary levels of PlGF. The current study obtained urine samples from pregnant women only on 3 occasions during their pregnancies. In the planned study, researchers would measure urinary PlGF levels throughout pregnancy, in an effort to pinpoint precisely when levels of PlGF begin to drop. Similarly, another study is measuring urinary PlGF levels in a much larger number of women, to gain a better understanding of individual variations in PlGF levels. Dr. Levine estimates that, pending the results of these studies, a urine test to screen for preeclampsia could be available in 4 to 5 years.

He added that it also might be possible to develop a treatment for preeclampsia, by supplying at risk women with additional PlGF and VEGF. Theoretically, these substances would bind to sFlt-1, allowing the PlGF and VEGF made by the body to be used by the blood vessel cells that require them.

Since the early 1990's, the NIH has funded numerous studies of preeclampsia. In addition to the study that tested calcium to prevent the condition, other studies have tested aspirin, magnesium, and fish oil, with no success.

The NICHD is part of the National Institutes of Health (NIH), the biomedical research arm of the federal government. NIH is an agency of the U.S. Department of Health and Human Services. The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation.

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