Universität zu Köln

Thadhani, Ravi, Hagmann, Henning, Schaarschmidt, Wiebke, Roth, Bernhard, Cingoez, Tuelay, Karunnanchi, S. Ananth, Wenger, Julia, Lucchesi, Kathryn J., Tamez, Hector, Lindner, Tom, Fridman, Alexander, Thome, Ulrich, Kribs, Angela, Danner, Marco, Hamacher, Stefanie ORCID: 0000-0003-2158-9101, Mallmann, Peter, Stepan, Holger and Benzing, Thomas (2016). Removal of Soluble Fms-Like Tyrosine Kinase-1 by Dextran Sulfate Apheresis in Preeclampsia. J. Am. Soc. Nephrol., 27 (3). S. 903 - 914. WASHINGTON: AMER SOC NEPHROLOGY. ISSN 1533-3450

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Abstract

Preeclampsia is a devastating complication of pregnancy. Soluble Fms-like tyrosine kinase-1 (sFlt-1) is an antiangiogenic protein believed to mediate the signs and symptoms of preeclampsia. We conducted an open pilot study to evaluate the safety and potential efficacy of therapeutic apheresis with a plasma specific dextran sulfate column to remove circulating sFlt-1 in 11 pregnant women (20-38 years of age) with very preterm preeclampsia (23-32 weeks of gestation, systolic BP >= 140 mmHg or diastolic BP >= 90 mmHg, new onset protein/creatinine ratio >0.30 g/g, and sFlt-1/placental growth factor ratio >85). We evaluated the extent of sFlt-1 removal, proteinuria reduction, pregnancy continuation, and neonatal and fetal safety of apheresis after one (n=6), two (n=4), or three (n=1) apheresis treatments. Mean sFlt-1 levels were reduced by 18% (range 7%-28%) with concomitant reductions of 44% in protein/creatinine ratios. Pregnancy continued for 8 days (range 2-11) and 15 days (range 11-21) in women treated once and multiple times, respectively, compared with 3 days (range 0-14) in untreated contemporaneous preeclampsia controls (n=22). Transient maternal BP reduction during apheresis was managed by withholding pre-apheresis antihypertensive therapy, saline prehydration, and reducing blood flow through the apheresis column. Compared with infants born prematurely to untreated women with and without preeclampsia (n=22 per group), no adverse effects of apheresis were observed. In conclusion, therapeutic apheresis reduced circulating sFlt-1 and proteinuria in women with very preterm preeclampsia and appeared to prolong pregnancy without major adverse maternal or fetal consequences. A controlled trial is warranted to confirm these findings.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Thadhani, Ravi UNSPECIFIED UNSPECIFIED UNSPECIFIED Hagmann, Henning UNSPECIFIED UNSPECIFIED UNSPECIFIED Schaarschmidt, Wiebke UNSPECIFIED UNSPECIFIED UNSPECIFIED Roth, Bernhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Cingoez, Tuelay UNSPECIFIED UNSPECIFIED UNSPECIFIED Karunnanchi, S. Ananth UNSPECIFIED UNSPECIFIED UNSPECIFIED Wenger, Julia UNSPECIFIED UNSPECIFIED UNSPECIFIED Lucchesi, Kathryn J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Tamez, Hector UNSPECIFIED UNSPECIFIED UNSPECIFIED Lindner, Tom UNSPECIFIED UNSPECIFIED UNSPECIFIED Fridman, Alexander UNSPECIFIED UNSPECIFIED UNSPECIFIED Thome, Ulrich UNSPECIFIED UNSPECIFIED UNSPECIFIED Kribs, Angela UNSPECIFIED UNSPECIFIED UNSPECIFIED Danner, Marco UNSPECIFIED UNSPECIFIED UNSPECIFIED Hamacher, Stefanie UNSPECIFIED orcid.org/0000-0003-2158-9101 UNSPECIFIED Mallmann, Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Stepan, Holger UNSPECIFIED UNSPECIFIED UNSPECIFIED Benzing, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-283907
DOI:	10.1681/ASN.2015020157
Journal or Publication Title:	J. Am. Soc. Nephrol.
Volume:	27
Number:	3
Page Range:	S. 903 - 914
Date:	2016
Publisher:	AMER SOC NEPHROLOGY
Place of Publication:	WASHINGTON
ISSN:	1533-3450
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ENDOTHELIAL GROWTH-FACTOR; HOMOZYGOUS FAMILIAL HYPERCHOLESTEROLEMIA; DENSITY-LIPOPROTEIN APHERESIS; ANGIOGENIC FACTORS; EXTRACORPOREAL REMOVAL; FACTOR RECEPTOR-1; PREGNANCY; RISK; HYPERTENSION; MODEL Multiple languages Urology & Nephrology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/28390