Mechanisms of post-preeclampsia hypertension

Preeclampsia (PE) is a syndrome of new hypertension (HTN) with organ damage that occurs in
3-8% of pregnancies and is a leading cause of maternal mortality. Women who survive PE have
a substantially increased risk of future HTN, heart attack and stroke by unknown mechanisms.
These women have enhanced blood pressure and vasoconstriction responses to HTN stress that
persists months to years after PE. In male mice, T cells are necessary for hypertension and
effector memory T cells contribute to exacerbated responses to repetitive hypertensive stresses.
To explore mechanisms driving post-PE HTN, we modified two models of PE; one is induced by
overexpression of the anti-angiogenic soluble VEGF receptor 1 (sFlt1) during pregnancy and the
other is induced by hypoxia during pregnancy. I confirmed that both models cause increased sFlt1
and other features of PE seen in humans. Preliminary data in the sFlt1 model reveals that despite
post-partum sFlt1 levels and blood pressure normalizing: (1) post-partum microvascular
structure/function abnormalities persist; (2) post-partum HTN stimuli results in an exacerbated
blood pressure response, microvascular vasoconstriction and microvascular expression of the T-
cell chemokine, CCL5; and (3) kidney effector memory T cells are significantly increased after
HTN stimuli. Thus, I propose to test the hypothesis that experimental PE causes long-term T cell-
mediated changes in the microvasculature and kidney that increase sensitivity to post-partum
HTN stimuli. Aim 1 will examine if T cells are necessary for persistent vascular remodeling and
dysfunction after PE. T cell populations, migration and cytokine expression will be measured
during and after PE and in response to hypertensive stimuli. T cells will then be depleted and
blood pressure and vascular structure/function analyzed. Aim 2 will determine if adoptive transfer
of T cells exposed to PE is sufficient to induce the vascular and kidney changes associated with
post-PE HTN. Aim 3 will test the specific role of memory T cells in exacerbating the response to
hypertensive stimuli after PE. Completion of the aims will provide new insight into the mechanism
driving the substantial increase in HTN risk after PE, thereby supporting the NIH mission to
improve maternal health. The proposal will also allow me to gain new expertise in HTN diseases
of pregnancy and foundational immunology techniques. The mentoring team assembled on this
application, with expertise in cardiovascular immunology, nephrology, pregnancy and vascular
biology, the environment at Tufts Medical Center and Tufts University and the training plan
proposed will further strengthen my ability to become an independent investigator studying
mechanisms driving heart diseases in women.

Grant Number: 5R00HL161321-04
NIH Institute/Center: NIH
Principal Investigator: Lauren Biwer