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Predictors of Pregnancy Outcome In SLE and APS

SLE 和 APS 妊娠结局的预测因素

基本信息

批准号：
7931840
负责人：
Jane E Salmon
金额：
$ 47万
依托单位：
HOSPITAL FOR SPECIAL SURGERY
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-09-23 至 2011-09-22
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7931840
关键词：
Adult Angiogenesis Inhibitors Angiogenic Factor Animals Anti-DNA Antibodies Antibodies Antiphospholipid Antibodies Antiphospholipid Syndrome Autoantibodies Behavior Biological Markers Blood - brain barrier anatomy Brain Cessation of life Child Classical Complement Pathway Clinical Cognitive Cohort Studies Collection Complement Complement Activation Complement component C1 DNA Data Development Disease Endoglin Enrollment Equilibrium Etiology Event Exposure to Fetal Growth Fetal Growth Retardation Fetus Fostering Functional disorder Funding Growth Habitual Abortion Heparin Human Impaired cognition Infant Inflammation Inflammatory Injury Knowledge Laboratories Lead Learning Disabilities Literature Lupus Mediating Mediator of activation protein Medical Modeling Morbidity - disease rate Mothers Mus N-Methyl-D-Aspartate Receptors Neuraxis Neurons Observational Study Outcome PGF gene Patients Perinatal Exposure Phenotype Placental Growth Factor Placental Insufficiency Placentation Plasma Play Pre-Eclampsia Pregnancy Pregnancy Complications Pregnancy Outcome Pregnancy loss Premature Birth Research Research Infrastructure Research Personnel Resources Risk Role Sample Size Sampling Spontaneous abortion Systemic Lupus Erythematosus Testing Time Tissues Translating Urine Vascular Endothelial Growth Factor Receptor Woman Work activation product behavioral impairment cohort complement pathway effective therapy fetal in vivo injured meetings mortality mouse model neonatal morbidity neurotoxicity new therapeutic target novel offspring pregnancy immunology pregnant prevent primary outcome prospective stillbirth

项目摘要

DESCRIPTION (provided by applicant): Pregnancy complications in women with the antiphospholipid syndrome (APS) and/or SLE include recurrent miscarriage, preeclampsia, placental insufficiency, and intrauterine growth restriction (IUGR). The mechanisms leading to placental and fetal injury in vivo are incompletely understood and treatment remains sub-optimal. We have identified complement as an early effector in pregnancy loss and/or IUGR associated with placental inflammation in a mouse model of APS and shown that complement activation causes the release of anti- angiogenic factors and abnormal placental development. The PROMISSE Study (Predictors of pRegnancy Outcome: bioMarkers In antiphospholipid antibody Syndrome and Systemic lupus Erythematosus) is a first-time effort to translate our novel findings in mice to humans and determine if elevations of complement split products predict pregnancy complications in patients with antiphospholipid (aPL) antibodies and/or SLE. In the first 4 years of this prospective, observational study of pregnant patients grouped and analyzed according to the presence or absence of aPL antibodies and preexisting SLE, we have enrolled 342 pregnant patients in 7 centers, obtained detailed medical and obstetrical information monthly, and serially collected plasma, serum, DNA, RNA, and urine. Preliminary data suggest that elevated levels of complement activation products antecede and predict poor fetal outcome, consistent with our hypothesis that complement is a proximal mediator of fetal loss and IUGR. We propose to increase our target sample size from 400 to 700 pregnant patients to maintain study power given lower than expected outcome rates, and to leverage the infrastructure and rich collection of patient data and samples by expanding the array of biomarkers and scope of adverse pregnancy outcomes. Specifically, in Aim 1 we will determine whether elevations of split products generated by activation of complement pathways predict poor fetal and/or maternal outcome in patients with aPL antibodies and/or SLE and, in Aim 2, whether the balance of circulating angiogenic and antiangiogenic factors predicts preeclampsia or delivery of IUGR infants. In Aim 3, a new direction, we will use the PROMISSE cohort to affirm in humans our recent findings in mice, that certain anti-DNA antibodies cross-react with N-methyl D- aspartate receptors (NMDAR) and cause neuronal death with ensuing cognitive and behavioral impairment. We propose to quantitate anti-NMDAR antibody levels throughout pregnancy in PROMISSE SLE patients and test the hypothesis that in utero exposure to maternal anti-NMDAR antibodies alters behavior and cognitive development in offspring by evaluating cortical function tasks in 12 month and 3.5 year old children. This competitive renewal and extension of the PROMISSE Study provides an outstanding opportunity to translate knowledge from mouse models to patients, define pathogenic mechanisms, identify predictors of poor pregnancy outcome in APL and/or SLE, and define novel therapeutic targets to prevent such outcomes.Patients with systemic lupus erythematosus (SLE) and/or antiphospholipid (aPL) antibodies are at increased risk for miscarriage, preeclampsia and fetal growth restriction - major causes of maternal, fetal, and neonatal morbidity and mortality in the US and worldwide - whose etiology and mechanism remain unknown and for which therapy is limited. In addition to causing placental dysfunction, maternal autoantibodies may also directly impair fetal brain development. Identification of biomarkers that predict poor pregnancy outcome in these patients will elucidate mechanisms of disease, define targets for treating patients, and generate clinically applicable indicators to permit initiation of interventional trials in patients at greatest risk for pregnancy complications.

描述（由申请人提供）：