Pathophysiological Mechanisms and Biomarkers in Preeclampsia

Preeclampsia is a multisystem hypertensive disorder of pregnancy characterised by new-onset hypertension and organ dysfunction after 20 weeks of gestation. Central to its development is abnormal placentation, in which inadequate trophoblast invasion and defective spiral artery remodelling result in placental hypoxia and the release of anti-angiogenic and pro-inflammatory mediators into the maternal circulation. An imbalance between soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) precipitates widespread endothelial dysfunction, leading to hypertension, proteinuria and end-organ damage. Oxidative stress and immune dysregulation further exacerbate vascular injury, while emerging data implicate extracellular vesicles and non-coding RNAs in modulating maternal vasculature and trophoblast survival. Early detection of molecular biomarkers and a deeper understanding of underlying pathways are vital for risk stratification and the development of targeted interventions that may avert severe complications for mother and child.

Research from Nature Portfolio

Recent studies have explored non-invasive diagnostic approaches by analysing maternal urine and urinary exosomes for soluble proteins and vesicular markers. Advanced separation techniques have revealed that urinary levels of sFlt-1 and PlGF closely mirror those in blood, while exosomal markers such as TSG101 and CD63 provide additional sensitivity. Compared with conventional blood tests, the urinary sFlt-1/PlGF ratio demonstrates up to a four-fold increase in detection sensitivity, and exosome-based assays enhance early identification of high-risk pregnancies. These findings point to a practical, non-invasive platform for early screening and real-time monitoring of preeclampsia progression.

Pathophysiological Mechanisms and Biomarkers in Preeclampsia publication trend

The graph below shows the total number of articles in pathophysiological mechanisms and biomarkers in preeclampsia across all publications each year (not limited to Nature Index journals).

Technical terms

Trophoblast: cells originating from the embryo that invade the uterine lining to establish and maintain the placenta.

Exosome: nanoscale extracellular vesicle carrying proteins and nucleic acids that mediates intercellular communication.

sFlt-1: a soluble form of VEGF receptor 1 that binds vascular endothelial growth factor, reducing angiogenic signalling.

PlGF: placental growth factor, a pro-angiogenic protein essential for placental vascular development.

Circular RNA (circRNA): a covalently closed non-coding RNA that regulates gene expression by sequestering microRNAs.

References

1. Understanding the role of soluble proteins and exosomes in non-invasive urine-based diagnosis of preeclampsia. Scientific Reports (2024).
2. Preeclampsia: Novel Mechanisms and Potential Therapeutic Approaches. Frontiers in Physiology (2018).
3. Hsa_circ_0002348 regulates trophoblast proliferation and apoptosis through miR-126-3p/BAK1 axis in preeclampsia. Journal of Translational Medicine (2023).