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The Roche Column

Long-awaited breakthrough in the diagnosis of preeclampsia

Measuring the sFlt-1/PlGF ratio with Roche’s Elecsys Immunoassay

With the vast number of biological and physiological factors that can influence the health of a pregnant woman and her unborn child, accurate monitoring throughout the pregnancy is essential. One of the conditions that can affect a mother and child during pregnancy is preeclampsia, a hypertensive disorder that complicates 3-5% of pregnancies¹. The challenge facing clinicians with preeclampsia today is its similarities with other conditions such as pregnancy-induced hypertension. Although preeclampsia can be potentially life-threatening for both mother and fetus, recent medical advancements in the last decade have paved the way for improved accuracy in its diagnosis.

Characterized by both hypertension and proteinuria, which are leading detectable risk factors for stillbirth, preeclampsia is a leading cause of maternal and infant illness and mortality. Certain factors can put some women at greater risk for developing preeclampsia, according to PD Dr. med. Michaela Jaksch, General Manager of Freiburg Medical Laboratory Middle East LLC and Associate Professor with the Munich University in Germany. “Pre-existing conditions such as high blood pressure, type 2 diabetes, renal or autoimmune disease can increase the likelihood of a women developing preeclampsia. Probability can also increase if the mother had preeclampsia in a previous pregnancy, has a high body mass index, or has her first pregnancy over the age of 40,” said Dr. Jaksch. Early onset of preeclampsia, the more severe case, can appear from week 20 of the pregnancy and late onset is usually after week 34.

Unmet medical needs in diagnosis

The growing need for a rapid and accurate aid in diagnosing preeclampsia to facilitate effective clinical management and improve outcome for mother and fetus has long been evident. Typically diagnosed on the basis of high blood pressure and protein in the urine, the cause of preeclampsia is not yet clearly identified and its variable symptoms have made it difficult for clinicians to diagnose. High-blood pressure and proteinuria, for example, can both be linked to other conditions such as bacterial infections or pregnancy- associated hypertension, respectively.

However, Dr. Jaksch points out that recent evidence demonstrates that angiogenic growth factors such as placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) have a major role in the development of preeclampsia. PlGF is required to stimulate blood vessel growth in the placenta to support the fetus’s nutritional needs. In preeclampsia, the placenta releases more soluble sFlt-1 than it should, which bind to the PlGF and decrease PlGF levels. “Detecting an imbalance of these two biomarkers can help clinicians diagnose cases of preeclampsia, where sFlt-1 levels are raised and PlGF levels are decreased,” said Dr. Jaksch.

“I would always suggest testing for both angiogenic growth factors together instead of only one to assist in the diagnosis of preeclampsia,” recommends Dr. Jaksch. Roche’s Elecsys sFlt-1/PlFG immunoassay, the first available and approved automated diagnostic test, could allow clinicians to make a major advance in the diagnosis of preeclampsia, which has remained unchanged for years. With a simple laboratory test, the Elecsys Immunoassays helps optimize clinical management for an improved outcome by giving physicians more to rely on than the low sensitivity and specificity measurement of blood pressure and urine protein sampling. In addition to the test’s availability, highlighting the importance of testing for the sFlt-1/ PlGF ratio among the medical community is essential to improve detection.

In regular pregnancy management, testing the sFlt-1/PlGF ratio helps identify women who are most at need for intensified care by creating a precise, consistent, and reliable picture for an accurate diagnosis and timely intervention, and measuring both the sFlt-1 and PlGF levels has shown to be more useful than either measurement individually, forming an objective tool to substantiate signs of preeclampsia.

1. Roberts, J. M., & Cooper, D. W. (2001). Pathogenesis and genetics of pre-eclampsia. The Lancet, 357, 53-56.


The Durbin Column

Spend some time in the sun – for your mood and your bones

The UK media recently reported some worrying news of children being diagnosed with rickets, an ‘old-fashioned’ disease that died out after the Second World War. Bone disorders such as rickets have been linked to a deficiency vitamin D, and some have blamed the aggressive sun awareness campaigns that highlight the dangers of the sun. Of course, the sun has some great health benefits too and it’s a shame that we sometimes forget to mention this. As well as brightening our mood, the sun is a great source of vitamin D – vital for healthy bones. The vitamin is made by our body under the skin in reaction to summer sunlight and helps to absorb calcium into our bones.

Upon further reading, I discovered the rate of women suffering from osteoporosis is also rising at alarming levels. Whilst the link between vitamin D and osteoporosis is still under examination, it’s undeniably a growing concern for women all over the world.

Osteoporosis is a lifestyle disease, not to be confused with age-related, degenerative diseases osteoarthritis and rheumatoid arthritis. It affects the whole skeleton, causing pain and limited mobility. In simple terms, osteoporosis occurs when the bones do not regenerate quickly enough to replace deteriorating bones, leaving them brittle and fragile. Osteoporosis is known as the ‘silent disease’ because diagnosis doesn’t usually occur until after a first fracture.

In the UAE, it’s estimated that 1 in 3 women over the age of 50 will suffer from osteoporosis. Recent figures also suggest that 58% of Saudi women currently suffer from the disease compared with just 2% of Saudi men. The National Osteoporosis Foundation says that women are four times more likely to develop osteoporosis than men because of the reduced levels of the oestrogen hormone during menopause and the consequential effect this has on bone density.

There are also lifestyle and cultural reasons. Conservative dress codes in the Middle East mean many women aren’t exposing their skin to the sunlight, and therefore not getting enough vitamin D. Sedentary lifestyles have also been blamed as a lack of exercise is a great contributing factor to weakening bones.

Although there is no cure for the disease, there are several medications available to prevent and treat osteoporosis. In addition, a well-balanced diet rich in calcium and vitamin D, regular weight-bearing exercise and a healthy lifestyle can prevent or lessen the effects of the disease.

The International Osteoporosis Foundation has a number of campaigns and initiatives to raise awareness of osteoporosis. One campaign is the world-wide ‘Capture the Fracture’, which aims to set an internationally endorsed standard of healthcare for dealing with fractures, focusing particularly on preventing secondary fractures. Last year, RAK Hospital in the UAE held a ‘Love Your Bones’ event which offered women and men bone density scans. These scans determined whether osteoporosis was a risk, enabling the patient to make changes to their lifestyle, and consequently delaying or even preventing the risk of osteoporosis.

Prevention of osteoporosis still remains the most effective ‘cure’ and thankfully it’s possible to reduce the risk of developing the disease. Spending 10-15 minutes a day in the sunshine and a balanced diet with oily fish and eggs will increase vitamin D levels, and exercises such as swimming, jogging or tennis will help maintain bone health. It’s also recommended that post-menopausal women or women over the age of 50 get regular bone density scans to keep an eye on their bone health. All of these basic changes will not only help minimise the chances of getting osteoporosis, but will also improve your general health too. So when the sun does come out, enjoy it. It does wonders, not just for your mood but for your physical health too.

Durbin PLC is a British company based in South Harrow, London. Established in 1963, the company specialises in supplying quality assured pharmaceuticals, medical equipment and consumable supplies to healthcare professionals and aid agencies in over 180 countries. As well as reacting rapidly to emergency situations, Durbin PLC responds to healthcare supply needs from local project level to national scale programmes. Web address: www.durbin.co.uk Email: L.morgan@durbin.co.uk
 

 Date of upload: 12th May 2014

 

                                  
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