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Obstetrics and Gynegology2021№8
The complement system in preeclampsia-complicated...

The complement system in preeclampsia-complicated pregnancy

DOI
https://dx.doi.org/10.18565/aig.2021.8.5-12

Sidorova I.S., Nikitina N.A., Unanyan A.L., Ageev M.B., Kokin A.A.

1) Obstetrics and Gynecology Department One, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of the Russian Federation, Moscow, Russia; 2) Anesthesiology and Intensive Care Unit, Maternity Hospital, Branch, V.V. Veresaev Moscow City Clinical Hospital, Moscow Healthcare Department, Moscow, Russia
The paper analyzes the results of studies published in recent years on the complement system in preeclampsia and other pregnancy complications. It presents data on changes in complement factors and its regulatory proteins in placental disorders. The results of the studies suggest that uncontrolled complement activation leads to impaired placentation, affects fetal development, and is an important component of the pathogenesis of complications, such as preeclampsia, HELLP syndrome, spontaneous miscarriage, and premature birth. Dysregulation of the alternative complement pathway in the presence of mutations in the genes of regulatory factors H and I, CD46, factor B. and others is known to be associated with atypical hemolytic uremic syndrome, less often with membranoproliferative glomerulonephritis. The similar mutations have been found in patients with severe preeclampsia and HELLP syndrome. Recent studies have shown a pronounced activation of the complement system in 100% of patients with HELLP syndrome and in 90% of those with severe preeclampsia with the formation of the C5b-9 membrane-attack complex and its deposits on activated endothelial cells. C5b-9 transmembrane integrates into the target cell, forming an asymmetric cylindrical channel, through which water molecules and electrolytes freely penetrate the cell, which causes its osmotic lysis. This is one of the most important mechanisms of endothelial damage in preeclampsia. The paper also presents modern therapeutic strategies for blocking excessive activity of the complement system. It is concluded that serious studies are needed to predict pregnancy complications caused by the imbalanced complement system, pharmacological correction, and safety and efficacy of the drugs used.
Conclusion. In addition to the above-mentioned problems, the most important question of what exactly the direct inducer of excessive complement activation is in preeclampsia needs to be solved.

Keywords

complement system
complement activation
pregnancy
preeclampsia
HELLP-syndrome
eculizumab
Full text (in Russian)

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Received 18.03.2021

Accepted 02.04.2021

About the Authors

Iraida S. Sidorova, Dr. Med. Sci., Professor, Academician of the RAS, Merited Scholar of the Russian Federation, Department of Obstetrics and Gynecology No. 1,
N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First MSMU, Ministry of Health of Russia (Sechenov University). E-mail: sidorovais@yandex.ru.
ORCID: 0000-0003-2209-8662. 119991, Russia, Moscow, Trubetskaya str., 8-2.
Natalya A. Nikitina, Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First MSMU, Ministry of Health of Russia (Sechenov University). E-mail: natnikitina@list.ru. ORCID: 0000-0001-8659-9963. 119991, Russia, Moscow, Trubetskaya str., 8-2.
Ara L. Unanyan, Dr. Med. Sci., Professor at the Department of Obstetrics and Gynaecology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First MSMU, Ministry of Health of Russia (Sechenov University). E-mail: 9603526@mail.ru. ORCID: 0000-0002-2283-2356. 119991, Russia, Moscow, Trubetskaya str., 8-2.
Mikhail B. Ageev, Ph.D., Teaching Assistant at the Department of Obstetrics and Gynecology No. 1, N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First MSMU, Ministry of Health of Russia (Sechenov University). E-mail: mikhaageev@yandex.ru. 119991, Russia, Moscow, Trubetskaya str., 8-2.
Albert A. Kokin, Head of the Department of Anesthesiology and Intensive Care, Maternity Hospital affiliated to the V.V. Veresaev Clinical Hospital of Moscow City Health Department. E-mail: Alberkokin@yandex.ru. 127247, Russia, Moscow, 800th anniversary of Moscow str., 22.

For citation: Sidorova I.S., Nikitina N.A., Unanyan A.L., Ageev M.B., Kokin A.A. The complement system in preeclampsia-complicated pregnancy.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2021; 8: 5-12 (in Russian)
https://dx.doi.org/10.18565/aig.2021.8.5-12

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№2 / 2024
Belokrinitskaya T.E., Frolova N.I., Vyzhlova E.N., Malinovskaya V.V.
Interferons in pregnancy
№1 / 2024
Nitchenko A.V., Troshin P.V., Pyregov A.V., Kozachenko I.F. Belov A.V., Filippovich G.V., Pismensky S.V.
Perioperative management of pregnant women in non-obstetric surgery
№12 / 2023
Ziganshina M.M., Muminova K.T., Khodzhaeva Z.S., Oshkhunova M.S., Baranov I.I.
Paradigm shift in pharmacotherapy for late-onset preeclampsia: advantages of two-component antihypertensive therapy compared to monotherapy based on analysis of vasoactive status data in pregnant women
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