Zeitschrift für klinische und zelluläre Immunologie
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Prediction of Preeclampsia with Novel Biomarkers at Second Trimester of Pregnancy

Ahmed Abdel Samie Omran, Ashraf Mohammed Mohammed Osman, Yasser Makram ElSherbeeny, Maged Salah, Amel Mahmoud Kamal Eldin, Ahmed Kotb and Mahmoud Mohammed Moussa

Objective: To evaluate the ability of the soluble vascular endothelial growth factor receptor (sFlt-1), neutrophilflt- 1, monocyte-flt-1, pentraxin 3 (PTX3), nitric oxide (NO) and alpha fetoprotein (AFP) measurements at gestational weeks 14-18 to predict preeclampsia (PE).
Subjects & Methods: Fifty pregnant females at second trimester of pregnancy divided into 25 normotensive pregnant females who remained normotensive till delivery (group I) and 25 high risk pregnant females who subsequently developed PE (group II). Twenty five healthy non-pregnant females served as control (group III). Maternal blood samples were collected at 14-18 gestational weeks. EDTA samples were investigated for both neutrophil- and monocyte-flt-1 by flow cytometer. Plasma samples were used to estimate PTX3, along with stored serum samples which were analyzed for sFlt-1, NO and AFP all by ELISA.
Results: Alpha fetoprotein, sFlt-1 and pentraxin 3 were found to be statistically significantly increased in group II when compared with group I (P-value=0.024, <0.001 and 0.006) and group III (P-value ≤ 0.001). However, there was statistically significant decrease in neutrophil-flt-1 and nitric oxide in group II when compared with group I (P-value ≤ 0.001 and 0.016). Group II had significant negative correlation between soluble flt-1 and both neutrophil- and monocyte-flt-1 (P-value ≤ 0.001 and 0.009) and between neutrophil-flt-1 and PTX3 (P-value=0.007). Soluble flt-1 was found to have the highest predictive value for predicting preeclampsia (AUC=0.941 and P-value ≤ 0.001)
Conclusion: soluble Flt-1 was found to be the best single biomarker in predicting preeclampsia at first half of the second trimester with the best diagnostic sensitivity and specificity. Soluble flt-1 was significantly negatively correlated with neutrophil-flt-1 and monocyte-flt-1. So, the predictive utility of sFlt-1 could be strengthened when combined with both neutrophil- and monocyte-flt-1. This may be an approach to develop a novel predictive model for preeclampsia combining the three biomarkers with better sensitivity and specificity.