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
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
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
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
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Web address: www.durbin.co.uk
of upload: 12th May 2014