A pilot study in the Journal of the American Society of Nephrology outlines one of the first therapeutic interventions for preeclampsia that could allow women to safely prolong their pregnancy via removal of soluble Fms-like tyrosine kinase-1 (sFlt-1) from the blood via apheresis.
Ravi Thadhani, MD, MPH, from Massachusetts General Hospital in Boston, MA, and colleagues designed the open pilot study to evaluate the safety and efficacy of the process apheresis in treating preeclampsia. In apheresis, blood is removed and passed through a column lined with a material that binds to sFIt-1; the material retains sFIt-1 and the remainder of the blood is returned to the body. sFIt-1 is believed to play a role in preeclampsia and has been linked to altered blood vessel growth.
The procedure was tested in 11 women aged 20–38 with very preterm preeclampsia (23–32 weeks of gestation, systolic BP ≥140mmHg or diastolic BP ≥90mmHg, new onset protein/creatinine ratio >0.30g/g, and sFlt-1/placental growth factor ratio >85). A significant reduction in protein excreted in the urine (mean reduction 18%) with concomitant reductions of 44% in protein/creatinine ratios was observed after the procedure. Pregnancy continued for 8 days (range 2–11) and 15 days (range 11–21) in women treated once and multiple times, respectively, vs. three days (range 0–14) in untreated contemporaneous preeclampsia controls (n=22). Treatment also transiently reduced blood pressure and no major adverse effects of apheresis were reported.
The authors hope to further test this intervention in randomized clinical trials.
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