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A Narrative Review of the Renin-Angiotensin-Aldosterone System in the Placenta and Placental Bed of HIV Infected Women of African Ancestry with Preeclampsia

Authors
  • Singh, Shoohana1
  • Moodley, Jagidesa1
  • Khaliq, Olive Pearl1
  • Naicker, Thajasvarie1
  • 1 University of KwaZulu-Natal,
Type
Published Article
Journal
Current Hypertension Reports
Publisher
Springer-Verlag
Publication Date
Aug 20, 2021
Volume
23
Issue
8
Identifiers
DOI: 10.1007/s11906-021-01158-1
PMID: 34415457
PMCID: PMC8377458
Source
PubMed Central
Keywords
Disciplines
  • Preeclampsia (VD Garovic and A Kattah, Section Editors)
License
Unknown

Abstract

Purpose of Review Both HIV infection and preeclampsia (PE), a pregnancy-specific disorder of hypertension and multi-system organ involvement, have high prevalence rates especially in low-to-middle-income countries. The immunoexpression of specific renin-angiotensin-aldosterone system (RAAS) receptors in the placenta and placental bed interface may forecast the risk of PE. Recent Findings Preeclampsia is a leading risk factor for mortality worldwide and remains a challenge in HIV-infected individuals especially those on antiretroviral therapy (ART). Irregular RAAS stimulation may be linked to the pathophysiology of hypertension in HIV infection and in PE. The AT1 receptor is expressed across all trimesters of pregnancy, within placental tissue, eliciting vasoconstriction. This increased expression is associated with the severity of PE, implying that the increased expression may be involved in the pathogenesis of this pregnancy disorder. The AT2 receptor expression in normotensive pregnancies was shown to be lower as compared to non-pregnant individuals. Furthermore, in the PE placental bed, the AT2 receptor is the predominant receptor subtype and is found in extravillous trophoblast cells where they facilitate vasodilation. However, AT4R in placentae of PE pregnancies are found to be significantly reduced compared to normotensives pregnancies. Summary The data on the role played by the RAAS pathway in pregnancy is conflicting. Investigation into a tissue-based RAAS with emphasis on immune-expression within the placenta and placental bed may help resolve this conundrum.

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