Erythropoietin and Soluble Erythropoietin Receptor: A Role for Maternal Vascular Adaptation to High Altitude Pregnancy.

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Erythropoietin and Soluble Erythropoietin Receptor: A Role for Maternal Vascular Adaptation to High Altitude Pregnancy.

J Clin Endocrinol Metab. 2016 Nov 3;:jc20161767

Authors: Wolfson G, Vargas E, Browne VA, Moore LG, Julian CG

Abstract
CONTEXT: An imbalance of pro- and anti-angiogenic factors is thought to be central to the widespread vascular dysfunction characteristic to preeclampsia (PreE). Erythropoietin (Epo), a pleiotrophic cytokine known for its erythropoietic effects, has important angiogenic and vasoactive properties, however its contribution to impaired maternal vascular responses in PreE is unknown.
OBJECTIVE(S): Since chronic hypoxia raises the incidence of PreE we asked whether the chronic hypoxia of high altitude (HA) increased maternal Epo and soluble Epo receptor (sEpoR) levels, and whether such effects differed between PreE cases and normotensive controls at HA.
DESIGN, SETTING AND PARTICIPANTS: Longitudinal studies were conducted in pregnant, Andean HA (n=28; 3600 m) or sea level (SL, n=16; 300 m) residents. Cross-sectional studies included 34 gestational-age matched Andean PreE cases (n=17) and controls (n=17) in La Paz-El Alto, Bolivia (3600m - 4100m).
RESULTS: HA augmented the pregnancy-associated rise in Epo relative to SL (P=0.002), despite a similar reduction of Hb concentration across pregnancy at each altitude (7-9%, both P<0.001). HA PreE cases had equivalent circulating Epo levels compared to normotensive controls, but greater sEpoR values (P<0.05) and reduced hemoglobin (P=0.06, trend).
CONCLUSION(S): Chronic hypoxia augments the pregnancy-associated rise in Epo but has no effect on maternal sEpoR, an effect that may be important for successful vascular adaptation to pregnancy at HA. In contrast, we speculate that elevated sEpoR observed in PreE cases vs. controls at HA impedes Epo-stimulated angiogenesis, vasodilation and the maintenance of endothelial function and may thereby be of pathophysiological relevance for increased incidence of PreE at HA.

PMID: 27809650 [PubMed - as supplied by publisher]

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