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Stéroidogénèse anormale et statut anti-angiogénique au cours de la prééclampsie, utilisation potentielle comme biomarqueurs

Abstract : Abstract : sFlt1 appears to be a good biomarker of preeclampsia (PE). The impact on pregnancy outcomes of close monitoring of women identified as "at risk" at 24 and 29 weeks of gestation (weeks) by a high level of plasma sFlt1, was evaluated in a randomized controlled trial (MOMA). 939 nulliparous women were included in 2 arms (sFlt1 known or unknown). Our results do not show any improvement of pregnancy outcomes and suggest that the inefficiency of the intervention (close follow-up) is the most likely cause. Thus, routine sFlt1 screening to predict the occurrence of PE does not seem useful until effective treatment is available. Abnormalities of placental steroidogenesis have been associated with PE. 90 samples from the MOMA cohort divided into three groups (25 intra-uterine growth retardation (IUGR) without PE, 25 PE and 40 controls) were used to assess by the reliable GC / MS technique, the steroid profile (between 24 and 29 weeks)before the development of clinical signs. In the PE group, we showed abnormal androgen aromatization, by calculating the estradiol/Δ4-Dione ratio (blood), and a lack of expression of placental aromatase. Similarly to the significantly low levels of pregnenolone sulfate found, this lack of aromatization seems specific to PE as they are not found in the IUGR group. These modifications are part of a deregulation of the overall steroid profile. In the PE and IUGR groups, we observed an excess of 20α-dihydroprogesterone (20α-DHP) and a significantly high 20α-DHP/Progesterone ratio. Sex steroids share common signaling pathways with angiogenic factors which easily integrate the "steroidogenesis abnormalities" hypothesis in the current concepts in the pathophysiology of PE. Links between disturbances of steroidogenesis and preeclampsia are discussed.
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Nadia Berkane. Stéroidogénèse anormale et statut anti-angiogénique au cours de la prééclampsie, utilisation potentielle comme biomarqueurs. Cardiologie et système cardiovasculaire. Université Paris Saclay (COmUE), 2019. Français. ⟨NNT : 2019SACLS069⟩. ⟨tel-02909697⟩

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