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Angiogenic balance and diagnosis of pre-eclampsia: selecting the right VEGF receptor

Journal of Human Hypertension volume 26, pages 207–210 (2012)Cite this article

We read with great interest the comments to our article1 by Jha et al.2 regarding the role of vascular endothelial growth factor (VEGF) and sVEGFR-2 in pre-eclampsia (PE). We agree with the observations made by Jha et al. that our data (with respect to VEGF) seem only apparently dramatically opposite and we would like to provide our view to explain these differences in the results and their interpretation.

In our article1 a total of 540 pregnant women were enrolled and we evaluated the concentrations of VEGF and sVEGFR-2 by enzyme-linked immunosorbent assay analysis in gestational hypertension (GH, n=90), PE, (n=180), eclampsia (n=90) and control (n=180) pregnancy at different gestations and reported increased VEGF levels in PE and eclampsia. However, Jha et al. mentioned that in their investigations, they found undetectable circulating VEGF levels in PE/eclampsia. They have not mentioned the details of their enzyme-linked immunosorbent assay kit and the number of samples in which the analysis was done. Although, in our current publication, we have already mentioned that only controversial data are available with regard to gestational VEGF concentration in early and late-onset of pregnancy-induced hypertension patients. Several authors showed increased VEGF levels3, 4 whereas others reported decreased VEGF levels in PE as compared with normal pregnant women.5 Some studies could not report any differences between PE and normotensive pregnancies, as most of the concentrations obtained by analysis using a commercially available R&D ELISA kit (R&D Systems, Inc., Minneapolis, MN USA) were below detection limit.6, 7 However, other laboratories using the same kit have reported lower concentrations in established PE as compared with normotensive pregnancies5, 8, 9, 10, 11 whereas, others12, 13, 14 using the same commercially available assay, actually found free elevated VEGF in established PE group. The differences in study design, limited statistical power and differences in population characteristics such as maternal age, race and ethnicity, severity of PE and gestational age of blood collection are likely to have contributed to the variability of results in various studies. Other technical differences in laboratory analytical procedures and reagents,10 may also have contributed to inconsistencies in results. In our investigations, we measured free VEGF levels using commercially available ELISA kit (R & D systems) and observed that there was no change in VEGF levels in the control group, early weeks of GH and PE group, but these free VEGF levels were significantly elevated in late GH (P=0.0001), late PE (P=0.0001), and early (P=0.0001) and late (P=0.0001) eclampsia pregnant groups as compared with the control group, suggesting altered VEGF concentrations according to severity of these disorders. Our results corroborate to those studies that found significant increased circulating VEGF levels in PE compared with normotensive pregnancy (using the same commercially available assay), in established PE.3, 12, 13, 14 Indeed we are not the first authors reporting discrepancies in free VEGF levels in pregnancy-induced hypertensive disorders including PE patients.

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  1. Department of Anatomy, VMMC & Safdarjang Hospital, New Delhi, India

    G Rath & R Tripathi

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Correspondence to G Rath.

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Rath, G., Tripathi, R. Angiogenic balance and diagnosis of pre-eclampsia: selecting the right VEGF receptor. J Hum Hypertens 26, 207–210 (2012). https://doi.org/10.1038/jhh.2011.90

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