Вивчення рівня експресії гена eNOS у плацентарній тканині при залізодефіцитній анемії

Abstract

Метою дослідження була оцінка експресії гена eNOS у плацентарній тканині при залізодефіцитній анемії. Показано, що у пацієнток із ЗДА рівень експресії гена eNOS більший в 1,4 раза, ніж у здорових вагітних, а при поєднанні ЗДА та дисфункції плаценти рівень експресії гена eNOS менший у 10 разів, ніж у здорових вагітних. Обговорюється адаптивний характер змін експресії гена eNOS при залізодефіциті у вагітних. Проведене зіставлення генетичних та фенотипічних характеристик активності ферменту ендотеліальної нітроксидази у децидуальній тканині.

Introduction. One of the most urgent problems of modern obstetrics is the occurrence of iron deficiency in pregnant women. The experts assess its prevalence in 20–30 % of cases in economically developed countries and 50–80 % – in developing countries. In Ukraine in the recent years, the incidence of iron deficiency anemia during pregnancy increased from 15.0 to 22.6 %. The interest of researchers to the problem of IDA due to the fact that in this pathological condition incidence of preeclampsia, preterm labor, polyhydramnios, premature rupture of membranes, weakness of labor forces and other pregnancy complications significantly increased. According to experts, the increase in the amount of blood loss during labor is in 10 % of pregnant women with IDA. This population of pregnant women has also postpartum septic complications and hypogalactia. Iron deficiency significantly worsens overall condition of mother and fetus. Our aim was to evaluate the gene expression of eNOS in placental tissue of the pregnant women with iron deficiency anemia. Material and Methods. Research performed at the maternity hospital № 2 (Odessa), Genetic Laboratories "Nadiaya" and pathomorphological department of State Institution "IPOG NAMSU" (Head, Professor, MD Zadorozhna TD, Kyiv). The study involved 100 women in labor; we took placenta samples from them. Thus, the following clinical groups were designed: group 1 – the placenta samples of women with physiological pregnancy and childbirth (n = 20), group 2 – the placenta samples of pregnant women with a history of anemia (n = 40), group 3 – the placenta of women with placental dysfunction and a history of anemia (n = 40). In addition to the general clinical research methods, we used current clinical protocol approved by the order № 782 dated 29.12.2005 “On approval of clinical protocols for obstetric and gynecological care”, further research was conducted analysis of immunohistochemical expression of endothelial nitric synthase (eNOS) in placental tissue. Age of pregnant women ranged from 20 to 35 years (28.5 ± 2.8 years). Discussion. As a result the level of eNOS gene expression increased by 1.4 folds in patients with IDA, while the combination of IDA and placental dysfunction eNOS gene expression level reduced by 10 folds. We discuss the adaptive nature of changes in eNOS gene expression in iron deficiency amongst pregnant women. There were compared genetic and phenotypic characteristics of the enzyme activity of endothelial nitric oxide synthase in decidual tissue. When comparing detected changes of eNOS gene expression with the phenotypic manifestations we found that the expression of endothelial nitric oxide synthase in patients with dysfunction of the placenta in the cytoplasm synticia villi and fetal capillary endothelium and vascular decidua reduced, and the presence of a combination of placental dysfunction and iron deficiency anemia occured with the paradoxical increase expression of the enzyme. Thus, inhibition of eNOS gene expression is a reflection of the exhaustion of the adaptive capacity of the organism. This circumstance suggests that routine administration of nitric oxide precursor (L-arginine medication) in women with gestational endoteliopatiyi manifestations may not give the desired effect due to the presence of a genetically determined deficiency of endothelial nitric oxide synthase and its products. Besides, when isolated iron deficiency anemia occurs than changes in eNOS gene expression is less evident.

Целью исследования была оценка экспрессии гена eNOS в плацентарной ткани при железодефицитной анемии. Показано, что у пациенток с ЖДА уровень экспрессии гена eNOS больше в 1,4 раза, чем у здоровых беременных, а при сочетании ЖДА и дисфункции плаценты уровень экспрессии гена eNOS меньше в 10 раз, чем у здоровых беременных. Обсуждается адаптивный характер изменений экспрессии гена eNOS при железодефиците у беременных. Проведено сопоставление генетических и фенотипических характеристик активности фермента эндотелиальной нитроксидазы в децидуальной ткани.