Preeclampsia/Eclampsia Part 3 (an autopsy study): Microvascular Disease of the Lung in Preeclampsia/ Eclampsia with Special Reference to Hypoxia and Sleeping ... Breathing (Preclampsia/Eclampsia Updated)

After reporting on inflammation of mesenteric adipose tissue and lymph nodes in preeclampsia/eclampsia of a young woman (Lin CS, 2014, Amazon Book store), the author found that the production of pro-inflammatory cytokines (TNF-alpha and IL-6) and free fatty acid as well as the systemic release of circulating activated monocytes and macrophages to systemic end-organs results in important secondary patho-physiologic effects (e.g., such as utero-placental insufficiency in the uterus, HELLP syndrome, renal microvascular changes with proteinuria in kidneys, increased CRP levels and atherogenic lipoproteins in liver), and extensive microvascular changes in the brain, heart, thyroid, and lung. The author feels that there is a priority to publish the fact that lung tissue changes may give rise to intermittent hypoxia to the target end-organs, aggravating any pre-existing organ dysfunction (see supplement). Herein the author emphasizes that the hypoxia starting from lung can aggravate lipolysis and inflammation of mesenteric adipose tissue of obesity resulting in a vicious cycle within the entire body from the author’s observation and histopathologic findings (see references of crosstalk of hypoxia and viscera). In PubMed, the reader may find many related articles, and the author gives a list of recommended reading at the end of this e-book. The author found Vgontzas’ article: Does obesity play a major role in the pathogenesis of sleep apnoea and its associations via inflammation, visceral adiposity, and insulin resistance? (Arch Physiol Biochem 2008;114: 211-213), a keen speculation of the causal relationship of inflammation of visceral adiposity and sleep disordered breathing (SDB)/obstructive sleep apnea (OSA), however the underlying histo-pathogenetic mechanism has not yet been elucidated. Perhaps this experienced pathologist author can provide demonstration of authentic lung changes to explain this causal relationship from visceral adipose tissue inflammation to the target end-organ lung. Currently, the clinical studies of the causal relationship of obesity to the SDB and/or OSA is a hot topic. There is also a high incidence of SDB in pregnancy and preeclampsia, especially in obese women. This book may help obstetricians to understand this association between preeclampsia of obese women and SDB or OSA.The human lung is a highly vascularized organ (total capillary endothelial surface estimated at 140 m2, Hsia et al, 2005) and has a great functional reserve. Therefore, minor lung tissue changes may not be noticed clinically. Shortness of breath, dyspnea, and pulmonary edema may occur in PE/E. The association of sleep disordered breathing or apnea with obesity was first recorded in human medical history 2,000 years ago, and the clinical study of SDB began 40 years ago. Currently, continuous positive airway pressure (CPAP) is the treatment of choice, but it is not very effective if the underlying microvascular changes are irreversible (Basner RC. N Engl J Med. 2014;370:2339-41). A new treatment method was just published: Upper-airway stimulation by implantation of a device in the chest wall for OSA based on anatomic and physiologic anomaly (Strollo PJ Jr, et al. N Engl J Med. 2014;370:139-149).Histopathological studies of the lung are rarely published. So-called diabetic lung or lung changes of metabolic syndrome do show fibrous thickening of alveolar capillary septa, and macrophages are seen in alveolar capillaries and alveolar spaces. Impaired lung function with intermittent hypoxia has been documented in the literature recently.The purpose of this publication is to share the author’s immuno- histopathologic observations with obstetricians, internists, and scientists who are interested in this field. So far, potential molecular mechanisms have been proposed without basis on lung tissue changes. The readers are encouraged to read the recommended references for background.---Ching-Shen Lin, M.D. August 26, 2014 Read more