Preeclampsia is a serious complication of pregnancy affecting both the mother and fetus, and causing anestimated 14% of pregnancy-related maternal deaths worldwide. Despite its large public health impact,however, its causes are still poorly understood, and there are no known treatments that effectively alleviate therisks for both mother and fetus. Based on clinical studies in the human and experimental studies in rodents, ithas been suggested that the abnormal elevation of the circulating levels of soluble fms-like tyrosine kinase 1(sFlt-1) contributes to the systemic endothelial dysfunction and clinical manifestations of the disease throughits antagonism of vascular endothelial growth factor (VEGF) activity. As a result, it is believed that VEGFtreatment may reverse the preeclamptic phenotype caused by high sFlt-1 levels in the maternal circulation.However, in preliminary studies, we found, surprisingly, that overexpression of VEGF in pregnant mice resultsin elevated blood pressure and serum levels of sFlt-1 and soluble endoglin (sEng), and histological changes inthe kidneys, similar to the clinical findings of PE in humans and animal models. VEGF has been shown tostimulate sFlt-1 production in several cell types and placental explant cultures in multiple contexts. However,the roles of placental VEGF at different stages of pregnancy, the significance of regulation of its local activityby placental production of sFlt-1, and its potential role in regulating sFlt-1 production in the placenta, has neverbeen examined, primarily due to lack of suitable animal models to test the placenta-specific effects of VEGF.We hypothesize that VEGF activity in the placenta is regulated in a placental developmental stage-specificmanner during pregnancy through local production of sFlt-1, and placental VEGF levels may be a primarystimulus for increased production of sFlt-1 in this tissue. Studies in this proposal are designed, first, to developa novel, inducible, placenta-specific gene expression system, with the ability to monitor gene expressionthroughout pregancy by live in vivo imaging. This technique will be based on established methods for viraldelivery of genes specifically to placental tissue, effective control of consistency in gene expression levels, anda tightly controlled inducible promoter which allows expression to be rapidly switched both on and off. We willthen examine the effects of different levels of placental VEGF expression at various time points duringpregnancy using this inducible system. To define the physiological role of sFlt-1 during different stages ofpregnancy, we will selectively knock down sFlt-1 expression in the placenta using placenta-specific expressionof a short hairpin RNA (shRNA) targeted against sFlt-1. The results of these experiments will delineate, for thefirst time, the local interactions of VEGF and sFlt-1 in regulating VEGF activity in the placenta. Additionally, thisentirely novel approach, using a newly-developed, inducible, placenta-specific gene regulation system, willgreatly facilitate development of new animal models for the study of both placental disease and normalplacental development, and will greatly enable the development of therapies for complications of pregnancy.
This work addresses the fundamental causes of the pregnancy complication preeclampsia; which affects 5-7%of pregnancies worldwide and is a leading cause of maternal and fetal morbidity and mortality. It develops anew method to study the roles of different factors in placental functions and diseases; using mice as a modelsystem; specifically addressing the physiological role and mechanism of regulation of soluble fms-like tyrosinekinase 1 (sFlt-1); a soluble form of the vascular endothelial growth factor receptor 1 (Flt-1); which is found athigh levels in the blood of women with preeclampsia; and is believed to cause the maternal symptoms in thisdisease. Understanding the normal and abnormal functions of this protein will have a direct and immediateimpact on the design of clinical therapies for protecting the mother from the adverse consequences ofpreeclampsia and will provide critical understanding of how these therapies can be designed to further protectthe fetus.
| Fan, Xiujun; Rai, Anshita; Kambham, Neeraja et al. (2014) Endometrial VEGF induces placental sFLT1 and leads to pregnancy complications. J Clin Invest 124:4941-52 |
| Fan, Xiujun; Petitt, Matthew; Gamboa, Matthew et al. (2012) Transient, inducible, placenta-specific gene expression in mice. Endocrinology 153:5637-44 |
