Am J Perinatol 2010; 27(4): 299-305
DOI: 10.1055/s-0029-1241739
© Thieme Medical Publishers

The Treatment of Preeclampsia in a Rat Model Employing Digibind®

Enoch Agunanne1 , Darijana Horvat1 , Mohammad N. Uddin1 , Jules Puschett1
  • 1The Nephrology/Hypertension Division, Department of Medicine, Texas A&M Health Science Center/Scott & White, Temple, Texas
Further Information

Publication History

Publication Date:
12 October 2009 (online)

ABSTRACT

Preeclampsia (PE) is a disorder that results in significant fetomaternal morbidity and mortality with yet no definitive pharmacological intervention. It involves the development of de novo hypertension and proteinuria after 20 weeks of pregnancy. All too often, intrauterine growth restriction (IUGR) occurs. Evidence has accrued that implicates the cardiac glycosides (the cardenolides and the bufadienolides) as potentially involved in the pathophysiology of PE. These compounds act by inhibiting Na+/K+ ATPase. Digibind® (digoxin immune Fab) antagonizes this action of the cardenolides. It also has cross-reactivity against the bufadienolides, including marinobufagenin. This study investigated the effects of Digibind® in a rat model of PE. We induced a syndrome in rats, which includes many of the phenotypic characteristics of human PE. Digibind®, in escalating doses, was given on days 10 to 20 of pregnancy. Digibind® produced significant lowering of the blood pressure and reduced proteinuria in our rat model of PE. However, it also did not avert IUGR. In view of these findings, in our experimental model of human PE, further studies in the quest for effective treatment of PE need to focus on pharmaceuticals that can remedy the syndrome without compromising the fetus.

REFERENCES

  • 1 Pridjian G, Puschett J B. Preeclampsia. Part 1: clinical and pathophysiologic considerations.  Obstet Gynecol Surv. 2002;  57 598-618
  • 2 Pridjian G, Puschett J B. Preeclampsia. Part 2: experimental and genetic considerations.  Obstet Gynecol Surv. 2002;  57 619-640
  • 3 Cetin I, Foidart J M, Miozzo M et al.. Fetal growth restriction: a workshop report.  Placenta. 2004;  25 753-757
  • 4 Wu C S, Sun Y, Vestergaard M et al.. Preeclampsia and risk for epilepsy in offspring.  Pediatrics. 2008;  122 1072-1078
  • 5 Szymonowicz W, Yu V Y. Severe pre-eclampsia and infants of very low birth weight.  Arch Dis Child. 1987;  62 712-716
  • 6 Mosca L, Appel L J, Benjamin E J American Heart Association et al. Evidence-based guidelines for cardiovascular disease prevention in women.  Circulation. 2004;  109 672-693
  • 7 Pilote L, Dasgupta K, Guru V et al.. A comprehensive view of sex-specific issues related to cardiovascular disease.  CMAJ. 2007;  176 S1-S44
  • 8 Lykke J A, Langhoff-Roos J, Sibai B M, Funai E F, Triche E W, Paidas M J. Hypertensive pregnancy disorders and subsequent cardiovascular morbidity and type 2 diabetes mellitus in the mother.  Hypertension. 2009;  53 944-951
  • 9 Irgens H U, Reisaeter L, Irgens L M, Lie R T. Long term mortality of mothers and fathers after pre-eclampsia: population based cohort study.  BMJ. 2001;  323 1213-1217
  • 10 Ray J G, Vermeulen M J, Schull M J, Redelmeier D A. Cardiovascular health after maternal placental syndromes (CHAMPS): population-based retrospective cohort study.  Lancet. 2005;  366 1797-1803
  • 11 Smith G C, Pell J P, Walsh D. Pregnancy complications and maternal risk of ischaemic heart disease: a retrospective cohort study of 129,290 births.  Lancet. 2001;  357 2002-2006
  • 12 Ridker P M. High-sensitivity C-reactive protein: potential adjunct for global risk assessment in the primary prevention of cardiovascular disease.  Circulation. 2001;  103 1813-1818
  • 13 Adair C D, Buckalew V, Taylor K et al.. Elevated endoxin-like factor complicating a multifetal second trimester pregnancy: treatment with digoxin-binding immunoglobulin.  Am J Nephrol. 1996;  16 529-531
  • 14 Vu H, Ianosi-Irimie M, Danchuk S et al.. Resibufogenin corrects hypertension in a rat model of human preeclampsia.  Exp Biol Med (Maywood). 2006;  231 215-220
  • 15 Horvat D, Severson J, Uddin M N, Mitchell B, Puschett J B. Resibufogenin prevents the manifestations of preeclampsia in an animal model of the syndrome.  Hypertens Pregnancy. 2009;  1-9
  • 16 Maternal adaptation to pregnancy. In: Cunningham FG, Hauth JC, Leveno KJ, et al Williams' Obstetrics. Chapter 8, 21st Ed. New York; McGraw-hill 2001: 184-185
  • 17 Hamlyn J M, Ringel R, Schaeffer J et al.. A circulating inhibitor of (Na++K+)ATPase associated with essential hypertension.  Nature. 1982;  300 650-652
  • 18 Songu-Mize E, Bealer S L, Caldwell R W. Effect of DOCA-salt treatment duration and anteroventral third ventricle lesions on a plasma-borne sodium pump inhibitor in rats.  J Hypertens. 1987;  5 461-467
  • 19 Hamlyn J M, Blaustein M P, Bova S et al.. Identification and characterization of a ouabain-like compound from human plasma.  Proc Natl Acad Sci U S A. 1991;  88 6259-6263
  • 20 Gonick H C, Ding Y, Vaziri N D, Bagrov A Y, Fedorova O V. Simultaneous measurement of marinobufagenin, ouabain, and hypertension-associated protein in various disease states.  Clin Exp Hypertens. 1998;  20 617-627
  • 21 Juhaszova M, Blaustein M P. Na+ pump low and high ouabain affinity alpha subunit isoforms are differently distributed in cells.  Proc Natl Acad Sci U S A. 1997;  94 1800-1805
  • 22 Schoner W, Scheiner-Bobis G. Endogenous and exogenous cardiac glycosides: their roles in hypertension, salt metabolism, and cell growth.  Am J Physiol Cell Physiol. 2007;  293 C509-C536
  • 23 Go K T, Bhandary K K. Structural studies on the biosides of Digitalis lanata: bisdigitoxosides of digitoxigenin, gitoxigenin and digoxigenin.  Acta Crystallogr B. 1989;  45(Pt 3) 306-312
  • 24 Mostad A. Crystal and molecular structure of dihydrodigoxigenin hydrate.  Acta Chem Scand. 1982;  36B 635-639
  • 25 Kartha G, Go K. Oleandrin, C32H48O9 .  Cryst Struct Commun. 1981;  10 1323-1327
  • 26 Go K, Kartha G, Chen J P. Structure of digoxin.  Acta Crystallogr B. 1980;  36 1811-1819
  • 27 Messerschmidt A. Ouabain, C29H44O12.8H2O.  Cryst Struct Commun. 1980;  9 1185-1194
  • 28 Bateman D N. Digoxin-specific antibody fragments: how much and when?.  Toxicol Rev. 2004;  23 135-143
  • 29 Lopatin D A, Ailamazian E K, Dmitrieva R I et al.. Circulating bufodienolide and cardenolide sodium pump inhibitors in preeclampsia.  J Hypertens. 1999;  17 1179-1187
  • 30 Averina I V, Tapilskaya N I, Reznik V A et al.. Endogenous Na/K-ATPase inhibitors in patients with preeclampsia.  Cell Mol Biol (Noisy-le-grand). 2006;  52 19-23
  • 31 Bagrov A Y, Fedorova O V, Dmitrieva R I, French A W, Anderson D E. Plasma marinobufagenin-like and ouabain-like immunoreactivity during saline volume expansion in anesthetized dogs.  Cardiovasc Res. 1996;  31 296-305
  • 32 Deray G, Pernollet M G, Devynck M A et al.. Plasma digitalislike activity in essential hypertension or end-stage renal disease.  Hypertension. 1986;  8 632-638
  • 33 Sagnella G A, Jones J C, Shore A C, Markandu N D, MacGregor G A. Evidence for increased levels of a circulating ouabainlike factor in essential hypertension.  Hypertension. 1986;  8 433-437
  • 34 Delva P, Capra C, Degan M et al.. High plasma levels of a ouabain-like factor in normal pregnancy and in pre-eclampsia.  Eur J Clin Invest. 1989;  19 95-100
  • 35 Vu H V, Ianosi-Irimie M R, Pridjian C A et al.. Involvement of marinobufagenin in a rat model of human preeclampsia.  Am J Nephrol. 2005;  25 520-528
  • 36 Puschett J B. The role of excessive volume expansion in the pathogenesis of preeclampsia.  Med Hypotheses. 2006;  67 1125-1132
  • 37 Pullen M A, Brooks D P, Edwards R M. Characterization of the neutralizing activity of digoxin-specific Fab toward ouabain-like steroids.  J Pharmacol Exp Ther. 2004;  310 319-325
  • 38 Krep H, Price D A, Soszynski P, Tao Q F, Graves S W, Hollenberg N K. Volume sensitive hypertension and the digoxin-like factor. Reversal by a Fab directed against digoxin in DOCA-salt hypertensive rats.  Am J Hypertens. 1995;  8 921-927
  • 39 Krep H H, Graves S W, Price D A et al.. Reversal of sodium pump inhibitor induced vascular smooth muscle contraction with digibind. Stoichiometry and its implications.  Am J Hypertens. 1996;  9 39-46

Jules PuschettM.D. F.A.C.P. F.A.S.N. F.A.H.A. F.A.A.A.S. 

Professor of Medicine, Vice Dean Program Development, The Nephrology/ Hypertension Division, Department of Medicine, Texas A&M Health Science Center/Scott & White

Medical Education Building 407 L, 2401 S. 31st St., Temple, TX 76508

Email: jpuschett@swmail.sw.org

    >