Abstract

A considerable body of evidence links cytokeratin expression and release into the systemic circulation to preeclampsia. It has to be stated that it cannot be concluded from the available data whether cytokeratin overexpression in preeclampsia represents a functional aspect of this disease or is merely associated with or reflective of another pathophysiological event, e.g. ischemic cell damage of the cytotrophoblast. Indirect evidence, however, for a functional role of cytokeratins, e.g. CK 19, in preeclampsia is provided by the fact that women with preeclampsia showed increased CK 19 serum levels despite having significantly smaller placentae. This suggests that increased release of cytokeratins into the maternal circulation is not simply reflective of a larger maternalfetal interface, but is driven, at least in part, by underlying pathophysiological aspects of preeclampsia. Existing evidence indicates that cytokeratins 18 and 19 may be useful indicators of disease severity. With a high sensitivity and a high negative predictive value for detecting severe disease, these markers could also be used to reassure clinicians to adopt and adjust outpatient settings while monitoring pregnant women with signs and symptoms of mild preeclampsia. Prospective clinical trials involving these two markers are warranted to ultimately establish their clinical value. Data available today do not support the use of cytokeratins as a screening tool for the healthy pregnant population.
Following the concept of a primary endothelial cell involvement in preeclampsia, adhesion molecules as markers of endothelial cell activation are a well documented feature of preeclampsia. Endothelial expression of adhesion molecules may cause leukocyte-mediated endothelial damage and thus be the critical step for transforming preeclampsia from an isolated placental phenomenon to a generalized disease. Low reported sensitivities to differentiate between healthy pregnant women and women with preeclampsia, however, do not encourage larger trials to evaluate the potential of adhesion molecules as screening markers for preeclampsia. Consistency of reported results seem to establish VCAM-1 and E-selectin as the most promising candidates for monitoring and prognostic evaluation of women with preeclampsia. If the presently available encouraging results are confrrmed in larger series, these markers may ultimately be introduced into clinical routine.

DOI: Clin. Lab. 1999;45:529-534