Accreta complicating complete placenta previa is characterized by reduced systemic levels of vascular endothelial growth factor and by epithelial-to-mesenchymal transition of the invasive trophoblast

Mark J. Wehrum, Irina A. Buhimschi, Carolyn Salafia, Stephen Thung, Mert O. Bahtiyar, Erica F. Werner, Katherine H. Campbell, Christine Laky, Anna K. Sfakianaki, Guomao Zhao, Edmund F. Funai, Catalin S. Buhimschi

Research output: Contribution to journalArticlepeer-review

56 Scopus citations

Abstract

Objective: We sought to characterize serum angiogenic factor profile of women with complete placenta previa and determine if invasive trophoblast differentiation characteristic of accreta, increta, or percreta shares features of epithelial-to-mesenchymal transition. Study Design: We analyzed gestational age-matched serum samples from 90 pregnant women with either complete placenta previa (n = 45) or uncomplicated pregnancies (n = 45). Vascular endothelial growth factor (VEGF), placental growth factor, and soluble form of fms-like-tyrosine-kinase-1 were immunoassayed. VEGF and phosphotyrosine immunoreactivity was surveyed in histological specimens relative to expression of vimentin and cytokeratin-7. Results: Women with previa and invasive placentation (accreta, n = 5; increta, n = 6; percreta, n = 2) had lower systemic VEGF (invasive previa: median 0.8 [0.02-3.4] vs control 6.5 [2.7-10.5] pg/mL, P = .02). VEGF and phosphotyrosine immunostaining predominated in the invasive extravillous trophoblasts that coexpressed vimentin and cytokeratin-7, an epithelial-to-mesenchymal transition feature and tumorlike cell phenotype. Conclusion: Lower systemic free VEGF and a switch of the interstitial extravillous trophoblasts to a metastable cell phenotype characterize placenta previa with excessive myometrial invasion.

Original languageEnglish (US)
Pages (from-to)411.e1-411.e11
JournalAmerican journal of obstetrics and gynecology
Volume204
Issue number5
DOIs
StatePublished - May 2011
Externally publishedYes

Keywords

  • angiogenesis
  • invasion
  • myometrium
  • trophoblast
  • vascular endothelial growth factor

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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