Table 1.
Placental factors involved in pathogenesis of liver in HELLP women.
| Factors | HELLP | Role | References |
|---|---|---|---|
| Factors influencing the vasculature | |||
| VEGF | ↑ | Proangiogenic, prevents hypertension | Abildgaard et al. [6], Bussen et al. [20], Purwosunu et al. [21] |
| sFlt1 | ↑↑ | Antiangiogenic, ⊖ vasodilation, ⊕ ET-1 | Abildgaard et al. [6], Zhou et al. [22], Tache et al. [23], Whitehead et al. [24], Schaarschmidt et al. [25], Venkatesha et al. [26], Purwosunu et al. [21] |
| sEng | ↑↑ | ⊖ TGFβ signaling, ⊖ vasodilation, antiangiogenic, influences vascular permeability | Abildgaard et al. [6], Venkatesha et al. [26], Purwosunu et al. [21] |
| Gal-1 | ↑ | Proangiogenic, matrix remodeling, procoagulant | Freitag et al. [27], Schnabel et al. [28], Pacienza et al. [29] |
| ET-1 | ↑↑ | Promotes hypertension, increases hemolysis, liver enzymes, CD4+ and CD8+, decreases platelets | Morris et al. [30], Karakus et al. [31] |
| Angs-2 | ↑↑ | Activates endothelial cells | Karakus et al. [31], Torry et al. [32] |
| ADMA | ↑ | ⊖ NO synthase | Siroen et al. [33], Savvidou et al. [34] |
| Growth factors | |||
| Inhibin A | ↑ | Antagonise activin A | Mylonas et al. [35], Muttukrishna et al. [36] |
| Activin A | 0 | ⊖ Mitogen-induced DNA synthesis, ⊕ apoptosis in hepatocytes, ↑ tubulogenesis of LSECs induced by VEGF, ↑ survival of LSECs | Mylonas et al. [35], Endo et al. [37], Rodgarkia-Dara et al. [38], Florio et al. [39], Muttukrishna et al. [36] |
| Inhibin B | 0 | ↓ FSH release | Mylonas et al. [35], Vassalli et al. [40], Cook et al. [41] |
| Activin B | ↑ | ↑ FSH release, promotes labor | Mylonas et al. [35], Vassalli et al. [40], Muttukrishna et al. [36] |
| Apoptosis/necrosis-related factors | |||
| FasL/Fas | ↑↑ | ⊕ Apoptosis | Abildgaard et al. [6], Strand et al. [42], Gibbens et al. [43] |
| Hsp70 | ↑↑ | Marker of tissue damage, ⊕ proinflammatory immune response, ⊕ endothelial injury | Molvarec et al. [44,45] |
| PP 13 | ↑ | Development of fetal/maternal interface, immune regulation | Than et al. [46] |
VEGF—vascular endothelial growth factor; sFlt1—soluble fms-like tyrosine kinase 1; sEng—soluble endoglin; Gal-1—galectin-1; ET-1—endothelin-1; Angs-2—angiotensin-2; ADMA—asymmetric dimethylarginine; ↑—higher than pregnant controls; ↑↑—higher than ↑; 0—no significant difference compared with controls; ⊕—stimulates; ⊖—inhibits; ↓—decreases.