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Cited by 36Pregnancy and preeclampsia studiesReproductive System and PregnancyNeurological Complications and Syndromes

Acute atherosis lesions at the fetal-maternal border: current knowledge and implications for maternal cardiovascular health

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Pitz Jacobsen, Daniel, Fjeldstad, Heidi Elisabeth, Johnsen, Guro Mørk, Fosheim, Ingrid Knutsdotter, Moe, Kjartan, Alnæs-Katjavivi, Patji, Dechend, Ralf, Sugulle, Meryam +1 more·2021·Frontiers in Immunology
DOI 10.3389/fimmu.2021.791606PMC PMC8712939
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Abstract

Decidua basalis, the endometrium of pregnancy, is an important interface between maternal and fetal tissues, made up of both maternal and fetal cells. Acute atherosis is a uteroplacental spiral artery lesion. These patchy arterial wall lesions containing foam cells are predominantly found in the decidua basalis, at the tips of the maternal arteries, where they feed into the placental intervillous space. Acute atherosis is prevalent in preeclampsia and other obstetric syndromes such as fetal growth restriction. Causal factors and effects of acute atherosis remain uncertain. This is in part because decidua basalis is challenging to sample systematically and in large amounts following delivery. We summarize our decidua basalis vacuum suction method, which facilitates tissue-based studies of acute atherosis. We also describe our evidence-based research definition of acute atherosis. Here, we comprehensively review the existing literature on acute atherosis, its underlying mechanisms and possible short- and long-term effects. We propose that multiple pathways leading to decidual vascular inflammation may promote acute atherosis formation, with or without poor spiral artery remodeling and/or preeclampsia. These include maternal alloreactivity, ischemia-reperfusion injury, preexisting systemic inflammation, and microbial infection. The concept of acute atherosis as an inflammatory lesion is not novel. The lesions themselves have an inflammatory phenotype and resemble other arterial lesions of more extensively studied etiology. We discuss findings of concurrently dysregulated proteins involved in immune regulation and cardiovascular function in women with acute atherosis. We also propose a novel hypothesis linking cellular fetal microchimerism, which is prevalent in women with preeclampsia, with acute atherosis in pregnancy and future cardiovascular and neurovascular disease. Finally, women with a history of preeclampsia have an increased risk of premature cardiovascular disease. We review whether presence of acute atherosis may identify women at especially high risk for premature cardiovascular disease.

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  • Limited trophoblast invasion leads to inadequate placentation and a shallow placenta, with less frequent transformation of peripheral and deeper myometrial parts of the spiral arteries and development of atherosis.

    “A limited trophoblast invasion leads to inadequate placentation and a shallow placenta, with features illustrated in Fig. 3. The peripheral parts as well as the deeper myometrial parts of the spiral arteries are less often transformed and develop atherosis, a feature with many similar­ ities to atherosclerotic lesions (Pitz et al., 2021).”

    From Pregnancy-related maternal physiological adaptations and fetal chemical exposure (2023) · cites this paper as Pitz et al., 2021

    The Acute Atherosis Etiology section (page unavailable) links poor spiral-artery remodeling to acute atherosis and says the lesions share morphological features with early atherosclerosis. It also says atherosis is mainly found downstream at the tips of decidual spiral arteries, whereas the major remodeling problems occur upstream in the myometrium; atherosis can occur without remodeling defects. The source therefore does not support the claim that the less-transformed peripheral and deeper myometrial parts themselves generally develop atherosis. (LLM, conf=0.87)

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Authors
Pitz Jacobsen, D., Fjeldstad, H. E., Johnsen, G. M., Fosheim, I. K., Moe, K., Alnæs-Katjavivi, P., Dechend, R., Sugulle, M., & Staff, A. C.
Affiliations
  • Oslo University Hospital (NO)
  • Max Delbrück Center (DE)
ORCID
Venue
Frontiers in Immunology
Publisher
Frontiers Media SA
Published
2021-12-14
Volume
12
Pages
791606-791606
ISSN
1664-3224 (ISSN-L)
DOI
10.3389/fimmu.2021.791606
PMC
PMC8712939
OpenAlex
W4200324095
Cited by
36
References
3
Citations by year
2026: 2 · 2025: 11 · 2024: 14 · 2023: 5 · 2022: 4
FWCI
1.06
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Immunology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • MDC Repository (Max-Delbrueck-Center for Molecular Medicine) (acceptedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
Funders
  • Norges Forskningsråd (313568)
  • Helse Sør-Øst RHF (2017007, 2019012)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
  • Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
  • Health Sciences › Medicine › Psychiatry and Mental health › Neurological Complications and Syndromes
Keywords
acute atherosis, decidua basalis, preeclampsia, fetal growth restriction, ischemia-reperfusion injury, systemic inflammation, microbial infection, fetal microchimerism, cardiovascular risk in pregnancy, foam cells, maternal cardiovascular health
MeSH terms
Arteries, Biopsy, Cardiovascular Diseases, Decidua, Disease Susceptibility, Endometritis, Female, Humans, Immunohistochemistry, Isoantigens, Organ Specificity, Placenta, Pregnancy, Biomarkers, Postpartum Period, Atherosclerosis, Translational Research, Biomedical

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