Year: 2020
Type: dissertation
Study design: Observational Study
Abstract: Background: The prevalence of preeclampsia (PE) and human immunodeficiency virus (HIV) \ninfection in pregnant women remains a concern to the South African healthcare system. The conflicting \nangiogenic roles of osteopontin (OPN) and soluble neuropilin-1 (sNRP-1) has been highlighted in many \ndiseases. However, there is a dire paucity of data on the influence of OPN and sNRP-1 in PE. Moreover, \nthere is an absence of information of OPN and sNRP-1 in HIV-associated PE. In light of the \naforementioned criteria, it was important to study the influence of OPN and sNRP-1 in the synergy of \nHIV-infection and PE. Therefore, this study evaluated the concentration of angiogenic proteins, OPN \nand sNRP-1, in the synergy of HIV infection and PE. Additionally, in light of the coronavirus disease \n2019 (COVID-19) pandemic, we reviewed maternal endothelial dysfunction in HIV-associated PE \ncomorbid with COVID-19. In this review article, we also explored the potential of antiretroviral therapy \n(ART) in the therapeutic intervention of COVID-19. \nStudy design: A Bio-plex multiplex immunoassay was used to quantify serum OPN and sNRP-1 \nconcentrations in preeclamptic vs normotensive pregnancy type stratified by HIV status (n=19 per \nsubgroup). \nResults: Significant differences across all groups, i.e., HIV-negative normotensive (n = 19), HIV-negative \npreeclamptic (n = 19), HIV-positive normotensive (n = 19) and HIV-positive preeclamptic (n = 19), were \nreported in maternal age (p = 0.0211), gestational age (p = 0.0004), parity (p = 0.0042), systolic blood \npressure (p < 0.0001) and diastolic blood pressure (p < 0.0001). The concentration of OPN was \nsignificantly downregulated by pregnancy type (preeclamptic vs normotensive; p = 0.0033) and showed \na non-significant elevation when stratified by HIV status (HIV-positive vs HIV-negative; p = 0.5099). \nIn addition, there was a significant upregulation in sNRP-1 concentration by pregnancy type \n(preeclamptic vs normotensive; p = 0.0054) and by HIV status (HIV-positive vs HIV-negative; (p = \n0.0005). In comparison to the normotensive HIV-negative group, there was a significant difference in \nsNRP-1 concentrations between the sub-groups normotensive HIV-positive (p = 0.0049), preeclamptic \nHIV-negative (p = 0.0244), and preeclamptic HIV-positive (p < 0.001), respectively. \nConclusion: This innovative study validates a significant systemic downregulation of OPN in PE \ncompared to normotensive pregnancies in contrast to an upregulation of sNRP-1, conforming to the \nanti-angiogenic milieu of PE. Moreover, based on HIV-status, both the systemic OPN and sNRP-1 \nlevels were upregulated in HIV-positive pregnancies. This may be attributed to the HIV trans-activator \nof transcription protein mimicry of VEGF and/or the immune reconstitution following ART as well as \n \nto integrin expression that mediates endothelial cell tube formation during angiogenesis. Additionally, \nadverse effects associated with HIV infection and ART promote endothelial dysfunction predisposing \nPE development; however, higher prevalence and mortality rates among PE cases are still associated \nwith ART use. Pregnancies complicated by the COVID-19 exploitation of angiotensin-converting \nenzyme 2 have a strong correlation with PE-like symptoms such as endothelial injury, implicating \nCOVID-19 in PE onset. Inconsistent data on the potential effectiveness of ART in COVID-19 and their \nsafety in pregnancy warrants further investigations.
Author: Nitalia Naidoo
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W3196047221