ABSTRACT
Hypertensive disorders of pregnancies remain a central public health concern throughout the world, and are a major cause of maternal mortality in the developing world. Although treatment options have not significantly changed in recent years, insight on the pathogenesis of preeclampsia/eclampsia has been remarkable. With improved animal models of preeclampsia and large-scale human trials, we have embarked upon a new era where angiogenic biomarkers based on mechanism of disease can be designed to assist in early diagnosis and treatment. There is also a growing recognition of how elusive the diagnosis of eclampsia can be, especially in the postpartum period. Proper treatment of these patients depends heavily on the correct diagnosis, especially by the emergency physician. Finally, large epidemiologic studies have revealed that preeclampsia, once thought to be a self-limited entity, now appears to portend real damage to the cardiovascular and other organ systems in the long term. This review will present the latest update on our understanding of the various hypertensive disorders of pregnancies and their treatment options.
Subject(s)
Hypertension/diagnosis , Hypertension/therapy , Pregnancy Complications, Cardiovascular/diagnosis , Pregnancy Complications, Cardiovascular/therapy , Antihypertensive Agents/therapeutic use , Biomarkers/metabolism , Chronic Disease , Delivery, Obstetric/methods , Dietary Supplements , Female , Humans , Hypertension/classification , Hypertension/metabolism , Hypertension/physiopathology , Hypertension, Pregnancy-Induced/diagnosis , Hypertension, Pregnancy-Induced/metabolism , Hypertension, Pregnancy-Induced/physiopathology , Hypertension, Pregnancy-Induced/therapy , Podocytes/metabolism , Postpartum Period , Pregnancy , Pregnancy Complications, Cardiovascular/classification , Pregnancy Complications, Cardiovascular/metabolism , Pregnancy Complications, Cardiovascular/physiopathology , Treatment OutcomeABSTRACT
PROBLEM: There is a lack of validated marker(s) for the diagnosis of early-stage ovarian cancer (OVCA). The objective was to determine if women with OVCA had antibodies, to assess their potential as markers of ovarian cancer. The secondary objective was to compare the prevalence of antibodies to proteins from normal ovary and ovarian tumors to determine if antibodies primarily recognize tumor antigens, as many antigens are common to tumor and normal ovary. METHOD OF STUDY: Serum samples from patients with OVCA, borderline or benign ovarian tumors, endometrial cancer and healthy women were examined for anti-ovarian and anti-tumor antibodies by immunoassay. Immunoreactive proteins were characterized by one- and two-dimensional Western blot. RESULTS: Ovarian (81%, P < or = 0.001) and anti-tumor (69%, P < or = 0.001) autoantibodies in OVCA were significantly different from those of control sera. A majority of OVCA serum samples reacted with proteins at about 50 kDa from normal ovary or ovarian tumors in one-dimensional Western blot. While there were similar reactions in two-dimensional Western blots, there are differences between reactions to normal and tumor antigens and between reactions to autologous and allogeneic tumors. CONCLUSION: Serum autoantibodies are significantly associated with OVCA. Anti-tumor antibodies may provide a useful marker for the detection of ovarian cancer.
Subject(s)
Antibodies, Neoplasm/blood , Antigens, Neoplasm/immunology , Autoantibodies/blood , Biomarkers, Tumor/blood , Ovarian Neoplasms/immunology , Adult , Aged , Aged, 80 and over , Blotting, Western , Female , Humans , Immunoassay , Middle Aged , Ovarian Neoplasms/bloodABSTRACT
Anti-tumor antibodies have potential as cancer biomarkers. There is relatively limited identification of anti-tumor antibodies in response to ovarian cancer, compared with studies for other cancers. There is also very limited information on the prevalence of anti-tumor antibodies among ovarian cancer patients. Although most anti-tumor antibodies react with antigens common to both tumor and normal tissue, the anti-tumor response tends to be confined to individuals with ovarian cancer, similar to other cancers. Antibodies to HOXA7, a differentiation antigen, have the highest reported prevalence in ovarian cancer (67%). Antibodies to other ubiquitous antigens including NY-ESO-1, Ep-CAM (epithelial cell adhesion molecule), HSP-90 (heat shock protein 90), and mutated p53 have been identified in ovarian cancer. Anti-tumor antibody specificity reflects the heterogeneity of antigen expression in tumors. Tests based on panels of a combination of anti-tumor antibodies may be more predictive for ovarian cancer, as no single specificity accounts for ovarian tumors. In addition to characterization of anti-tumor antibodies as diagnostic markers, study of anti-tumor antibodies is likely to provide insights into mechanisms of tumor development. There is evidence of antibodies to tumor antigens and of activated T cells, suggesting immune recognition of tumor antigens occurred. Nonetheless, as tumors are not 'rejected', it is likely that there are alterations in the immune system. The basis for tumor growth in the face of immune activity remains to be determined.
