Future "treatment" of pre-e, HELLP

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atvlady
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Re : Future "treatment" of pre-e, HELLP

Postby atvlady » Fri Aug 20, 2010 10:59 pm

Thanks Caryn and that was awesome!

So is preeclampsia a total immune response?

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caryn
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Re : Future "treatment" of pre-e, HELLP

Postby caryn » Fri Aug 20, 2010 10:51 pm

There's a way to avoid it now -- don't get pregnant. But that way sucks.

Honestly, I do not think there will ever be a cure, because this is a critical thing for humans -- a negotiation between the mother's genes and the father's over how big the fetus will be allowed to grow. At the moment, the working hypothesis goes like this: Bigger fetuses have better survival odds once they're out. Smaller fetuses are more likely to fit through our upright pelvis. Discussion between conflicting interests (or arms race coupled to a targeting problem) results. The father's genes, on a fundamental level, *do not care* if this one fits out or not, because so very little in the way of paternal resources have been invested. But we really care about not dying. Sometimes the way we respond to the paternal signals is to make the implantation more shallow, so the fetus will get less blood than the paternal genes think it ought to, and boom --> preeclampsia.

This is also why our babies are so helpless when they are born; they have to be born very early indeed so that they will fit out, and rather than stop walking upright or stop having smart babies we opted to have our babies earlier and earlier. (There's more about this in the "recent articles and studies" link in my .sig.)

But a treatment -- not a cure, but a treatment? There might be a treatment beyond delivery. At some point. Probably it would be something to alter the effects of sFlt-1, since that is what causes the majority of the maternal symptoms. But that is tricky too, because the placenta is raising blood pressure for a reason -- not enough blood is flowing across the placenta. If therapies are used to lower maternal blood pressure significantly one risk is that the fetus will stop growing. That's why women on meds are scripped a very narrow range of meds by docs who are used to scripping these drugs and are familiar with the range of possible outcomes.

So how to block sFlt-1 but still get enough blood to the placenta? And how to experiment with this ethically, since every pregnant woman with it will volunteer for hazard duty and is inherently coerced? Can docs take us seriously when we volunteer to risk our lives? Do we really understand that they mean it when they say that this disease could kill us if we don't deliver and volunteer for this study instead? Are they going to get sued by our families after we are dead because it's possible we didn't understand what we were agreeing to do?

It is also just generally very difficult to study when things go wrong during implantation. The ball of cells -- the blastocyst -- that implants into the uterus to start to grow a placenta and a fetus is only a few hundred cells big. And it's in your uterus. Somewhere. No idea where, though, really... but somewhere in there. It's like finding a football in the Grand Canyon.

What researchers would like (or at least, what some researchers said to me that they would like, when I went to Saving Grace in 2008) is to have a population of women who are willing to live in the lab and have blood drawn every hour, while they are trying to get pregnant and during the first few weeks of pregnancy. They wouldn't be able to see implantation, but they would be able to see the changes in our bloodwork and the immune response, and if they could figure out what was different in the bloodwork of the women who went on to develop preeclampsia, they might be able to tweak things.

"Might" being the key word.

Because of Caesareans, it doesn't really *matter* if the babies grow too big to fit out -- so theoretically they could give us drugs to alter implantation and then use Caesareans as needed. But at the moment, our bodies are responding -- or, in the case of IUGR babies, overresponding -- to the genetic signals that tell us how this one won't fit out...

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Re : Future "treatment" of pre-e, HELLP

Postby sarah0381 » Tue Aug 17, 2010 11:27 pm

I just recently read that it is a DNA issue and they hope that soon they can develop a test to check mothers if they have this particular gene. I wish I saved the article so I could attach it here...it seemed like they are on to something. Here's to hoping!!!

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Re : Future "treatment" of pre-e, HELLP

Postby sam10 » Tue Aug 17, 2010 10:23 pm

I am hoping for some updates and news about the study which is currently done in Cologne, Germany.
http://www.preeclampsia.org/forum/viewtopic.php?t=39344

The treatment includes filtering out protein sFlt1 out of the patient's blood by hemodialysis.

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Re : Future "treatment" of pre-e, HELLP

Postby riehlism » Sun Aug 15, 2010 03:22 am

I agree Kerisue. It really doesn't look like and end to PE is happening any time soon. Part of the research barrier is ethics. It's awful hard to run human clinic trials when the lives of mom and baby are implicated. For that reason alone, finding "cause" is quite a challenge. We can only hope for a wondrous accident, like the post-it people did.

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Re : Future "treatment" of pre-e, HELLP

Postby kerisue » Fri Aug 13, 2010 07:37 pm

Just a side note about your post Jasmin- it's ridiculous that insurance companies won't pay for the blood tests. I've seen the insurance statements for Millie's 3 weeks of life: over $200,000. You'd think $200 worth of blood tests would be preferable, but apparently not!

Delissa, one of the barriers I see to prevention is that not one thing alone causes PE. From what I can tell from my research the "causes" may be several different things and different from woman to woman. This confounds testing possible treatments. Call me a pessimist, but I don't see a cure in our lifetime. Hopefully in the future though.

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riehlism
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Re : Future "treatment" of pre-e, HELLP

Postby riehlism » Fri Aug 13, 2010 06:24 pm

That's a tough question, Delissa. I guess the first thing that would have to happen is to really understand the cause. We all know the different working theories: poor implantation, a possible immune response that activates hypercoagulants in the blood, a possible role of predisposing factors like chronic hypertension, or any combination of the above. There was that promising study released last month that's been going around on this site about the role of baby aspirin. Aside from positive results from aspirin, the study also highlighted that the results helped to support the poor implantation theory as a cause. Notice I said support...it's not a done deal in terms of its role a cause. Science guys are always to cautious to use definitive words like "cause."

Let's pretend a cause was found, and let's pretend it was determined as a coagulant problem. n terms of your question about a possible vacccine or something to avoid it altogether, those who are more likely to have it first have to be identified.Those of us who have been through the thrombophila panel know that it's expensive, and some insurance companies won't even cover the cost of running the panel. That may be a barrier.

Now let's say insurance is ok with it, treatment will probably be the same: baby aspirin, or Lovenox. As of now we know that women can still have PE with baby aspirin and Lovenox. So that leads us back to step 1: finding the cause(s).

This is all kind of a roundabout way of saying: we need to find out what's going on first...but that's my best guess. I'd like to see what others think as well.

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Future "treatment" of pre-e, HELLP

Postby atvlady » Fri Aug 13, 2010 05:16 pm

What do you think the future treatment of pre-e, HELLP will be? Like a type of vaccination to prevent it before pregancny or a pill to ward it off during pregnancy. Do you think there will ever be a way to avoid it? Treat me? I am interested in others thoughts, especially our Gurus' :P


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