The Role of Abnormal Placentation in Congenital Heart Disease; Cause, Correlate, or Consequence?

The Role of Abnormal Placentation in Congenital Heart Disease; Cause, Correlate, or Consequence?
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DOI:
10.3389/fphys.2018.01045
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发表时间:
2018
影响因子:
4
通讯作者:
Jones HN
Jones HN
中科院分区:
医学2区
文献类型:
--
作者:
Courtney JA;Cnota JF;Jones HN

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先天性心脏病(CHD)是最常见的出生缺陷,约占所有活产婴儿的1%(货车der Linde等人)。尽管临床护理有所改善,但它仍是与出生缺陷相关的婴儿死亡率的主要原因(Yang等人,)并使幸存者负担显著的发病率(吉尔博亚等人,)。此外,CHD占出生缺陷相关住院费用的最大比例(26.7%),2013年高达61亿美元(阿尔斯等人)。然而,经过几十年的研究,主要集中在遗传病因学,这些缺陷的根本原因仍然是未知的,在大多数情况下(扎伊迪和Brueckner,)。原因不明的CHD可能继发于未发现的非编码遗传、表观遗传和环境因素等的作用(Russell et al.,)。最近的人群研究表明,妊娠合并CHD也具有发生与异常胎盘相关的病理学的较高风险,包括生长障碍(Puri等人,),先兆子痫(Auger等,; Brodwall等人,),早产(Laas等人,),和死产(Jorgensen等人,)。心脏和胎盘都是血管器官,同时发育;因此,几乎可以肯定,共同的途径指导两者的发育。胎盘异常参与先天性心脏病,无论是因果关系,相称或反应,正在调查中,并考虑到共同的发展窗口和共同的发展途径的心脏和胎盘和并发血管系统的发展,我们建议进一步调查结合临床数据,在体外,在体内,和计算机建模是我们的理解和潜力,开发治疗。
Congenital heart disease (CHD) is the most common birth defect, affecting ~1% of all live births (van der Linde et al.,). Despite improvements in clinical care, it is the leading cause of infant mortality related to birth defects (Yang et al.,) and burdens survivors with significant morbidity (Gilboa et al.,). Furthermore, CHD accounts for the largest proportion (26.7%) of birth defect-associated hospitalization costs—up to $6.1 billion in 2013 (Arth et al.,). Yet after decades of research with a primary focus on genetic etiology, the underlying cause of these defects remains unknown in the majority of cases (Zaidi and Brueckner,). Unexplained CHD may be secondary to undiscovered roles of noncoding genetic, epigenetic, and environmental factors, among others (Russell et al.,). Population studies have recently demonstrated that pregnancies complicated by CHD also carry a higher risk of developing pathologies associated with an abnormal placenta including growth disturbances (Puri et al.,), preeclampsia (Auger et al.,; Brodwall et al.,), preterm birth (Laas et al.,), and stillbirth (Jorgensen et al.,). Both the heart and placenta are vascular organs and develop concurrently; therefore, shared pathways almost certainly direct the development of both. The involvement of placental abnormalities in congenital heart disease, whether causal, commensurate or reactive, is under investigated and given the common developmental window and shared developmental pathways of the heart and placenta and concurrent vasculature development, we propose that further investigation combining clinical data, in vitro, in vivo, and computer modeling is fundamental to our understanding and the potential to develop therapeutics.
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