(Downton Abbey Spoiler Alert: skip ahead to the video if you haven’t seen Season 3!)
If you’re one of the estimated 10 million devoted Downton Abbey TV viewers, then you most probably have heard of the word “preeclampsia.” In a heart-wrenching episode from season 3 of the early 20th century British drama, one of the characters dies while giving birth due to the complications of preeclampsia.
A fan myself, I too watched in shock as the plot unfolded. But I was at least comforted by the thought that surely this disease no longer has tragic outcomes today in the early 21st century. Boy was I wrong. As CIRM-grantee Mana Parast pointed out during her Spotlight on Disease presentation to the CIRM Governing Board two weeks ago (now viewable on our website), preeclampsia and related disorders are still a widespread problem for expecting mothers:
“They complicate 5-8% of all pregnancies worldwide, and they cause multiple maternal and neonatal complications. So in fact preeclampsia is the leading cause of maternal mortality in the developed world. It’s also the leading cause of fetal growth restriction and there’s no cure … except to deliver the baby. In fact preeclampsia is the number one cause of induced preterm delivery in the U.S.”
Preeclampsia is often called “the Silent Killer” because the symptoms often arise suddenly in the second half of pregnancy. The main noticeable symptoms for the expectant mother are high blood pressure and high protein levels in the urine, or proteinuria. Silvia Michelazzi, a preeclampsia survivor, shared with the Board her daughter’s birth story:
“My pregnancy, I was thinking, was going well. I knew Mia was a little bit smaller than average but that was pretty much it. But at a doctor’s appointment, it was found out that I had high blood pressure and proteinuria and I was rushed to the hospital and the baby was delivered 48 hours later [at 29 weeks] because there’s really nothing else to do but delivery the baby. I can’t tell you how hard it was to see the baby so small. It turned out she weighed 2 pounds 8 ounces.”
Mia, now three, spent two months in the neonatal intensive care unit but is now doing remarkably well. But some babies aren’t so lucky. They can have intestinal problems, bleeding in their brain, retinopathy of prematurity (a condition that can lead to blindness), and the list goes on. Even when they survive the neonatal stage they still have an increased risk of heart disease and diabetes over the course of their lives. And all of these scary, sometimes fatal complications are basically due to, as Dr. Parast puts it, “just having a bad placenta.”
The placenta is a transient organ that only appears during pregnancy and is critical for exchange of food, blood and oxygen between the mother and fetus. Dr. Parast, a perinatal pathologist at UC San Diego, studies the development of the placenta with the ultimate hope of finding treatments for preeclampsia. If you imagine the early embryo as a tiny hollow ball of cells, it’s the outer cells called trophoblasts that ultimately form the placenta while a clump of cells inside the hollow “ball” go on to form the fetus.
Examination of a preeclamptic placenta after delivery shows that preeclampsia is a disease marked by a malfunction in trophoblast maturation leading to abnormal placenta development. The aim of Dr. Parast’s team is to mimic preeclampsia in the lab but it’s been a tricky disease to model because preeclampsia is unique to primates so experiments in mice is not an option. Instead, with the help of CIRM-funding, Parast’s lab is embarking on a project to bank tissue from preeclamptic placentas and derive trophoblasts using the induced pluripotent stem cell (iPS) technique. With these iPS-derived trophoblasts in hand, the team can screen for drugs that restore proper trophoblast maturation and placental development.
And in a strange twist that you usually only see on a TV show – it turns out that Dr. Matteo Moretto-Zito, a researcher in Parast’s lab, is the father of little Mia. Moretto-Zito had joined the lab shortly before his wife Silvia was diagnosed with preclampsia. He also spoke to the Board and had this to say about his unique perspective:
“I consider myself extremely lucky for two reasons: number one, Mia’s story ended up really well so that is great and reason number two, because I am part of a team that can make a difference.”
Here’s to hoping that Matteo and the entire Parast team make a difference and find a treatment to end preeclampsia complications for future moms and babies.