Categories: For Midwives For Parents Pregnancy

In July 2006, in The New Yorker magazine, Jerome Groopman wrote a fascinating article about preeclampsia* and a young researcher who appears to have found the cause.  This is huge.

Preeclampsia has been known, described, and feared for millennia, and countless theories about its cause as well as possible therapies have been described. The researcher, Ananth Karumanchi, working essentially alone in a nephrology lab at Boston's Beth Israel Deaconess Medical Center, isolated a soluble protein named FLT in the blood of women suffering from pre-eclampsia.  In women with severe disease, the amount of FLT was higher.  Karumanchi couldn't believe his success.  "I was sifting though all of these data, and I said to myself, 'It can't be this obvious,'" he recalled.  "'It can't be the predominant factor in preeclampsia, because people would have discovered it by now.'  This couldn't be just waiting for me."

 But apparently it was.  In addition, Karumanchi found another protein that seems to be associated with the development of HELLP syndrome, a severe complication of preeclampsia.  Karumanchi had more difficulty persuading others of his find.  There is a large literature on theories about the cause of preeclampsia, and there have been well-funded clinical trials by important researchers, all leading to dead-ends.  No one believed that a novice researcher with no experience in pregnancy conditions could have achieved the results he was claiming.  Eventually, however, Karumanchi and his colleagues managed to have their results published in the New England Journal of Medicine.  Since then, Karumanchi and other researchers have expanded his theory and replicated his main findings many times.  Several drug companies are trying to develop diagnostic tests and treatments from his research.   

The story in The New Yorker (July 24, 2006) also includes a history of preeclampsia and efforts to solve its mystery through the ages.  It is well-written and entertaining enough to read at the beach or keep on the bedside stand.  However, for those of us who have experienced the effects of preeclampsia first-hand as care providers or as patients, the article can only be a prelude to the actual research findings.  For these, I would recommend that you start with a Medline search.  A link to the New Yorker story and several article citations follow:

http://www.newyorker.com/fact/content/articles/060724fa_fact

Levine RJ. Karumanchi SA. Circulating angiogenic factors in preeclampsia. [Review] [83 refs] Clinical Obstetrics & Gynecology. 48(2):372-86, 2005 Jun.

Levine RJ. Maynard SE. Qian C. Lim KH. England LJ. Yu KF. Schisterman EF. Thadhani R. Sachs BP. Epstein FH. Sibai BM. Sukhatme VP. Karumanchi SA. Circulating angiogenic factors and the risk of preeclampsia.[see comment]. New England Journal of Medicine. 350(7):672-83, 2004 Feb 12. 

 

*Preeclampsia is a pregnancy-induced condition that affects about 5% of pregnant women.  The diagnosis is made when a woman develops high blood pressure and either protein in the urine (the main reason for all those urine specimens) and/or significant swelling, particularly in the face and hands.  Symptoms may be non-existent, or may include headaches, drowsiness, and a general malaise that feels like the flu.  Preeclampsia involves many organ systems, including the kidneys, the liver, and the brain.  Complications include eclampsia or seizures and changes in the blood clotting factors.   The risk of stillbirth to the baby is high if these complications occur.  Currently, the only "cure" for these conditions is delivery of the baby.  Preeclampsia remains one of the three main causes of maternal mortality in both the developed and the developing world, along with hemorrhage and infection.