HIV Associated Pre-eclampsia: Evaluation of Lymphangiogenesis in Placental Bed Samples.

Introduction The role of angiogenesis in pre-eclampsia pathogenesis is widely studied, however despite the lymphatic vessels complementary role to the blood vascular system, studies on their morphology in the placenta and placental bed are lacking. Methods Eighty-seven placental bed specimens were utilised, which were grouped into normotensive pregnant (n = 28), early onset pre-eclampsia (n = 31), late onset pre-eclampsia (n = 28) and further stratified by HIV status. Tissue was immuno-stained with podoplanin antibody. The lymphatic capillaries density and luminal areas within the placental bed were morphometrically assessed. Results Lymphatic micro-vessel density and mean area /lumen in the pre-eclampsia group were higher and larger than the normotensive group respectively ( p  = 0.01 and p  = 0.001). A correlation between blood pressure levels and lymphatic micro-vessel density was observed ( r  ≥ 0.272; p  ≤ 0.032). Significant differences were observed between the mean micro-vessel density of normotensive HIV uninfected and HIV infected [(5.9 ± 2.3 vs 7.5 ± 2.8, p = 0.01 ) and late onset pre-eclampsia HIV uninfected and HIV infected groups (7.1 ± 3.9 vs 7.8 ± 2.7, p = 0.01 )]. The mean area /lumen between normotensive HIV uninfected and HIV infected and late onset pre-eclampsia HIV uninfected and HIV infected groups were significantly different ( p = 0.03 and p = 0.001 ). Small lymphatic capillaries were significantly abundant in late onset pre-eclampsia HIV infected ( p  = 0.03) and normotensive HIV infected ( p  = 0.0001) compared to uninfected groups. Conclusion Lymphatic capillary density and area/lumen upregulation was observed in the placental bed of HIV infected women, with a positive correlation between maternal blood pressure and lymphatic micro-vessel density, potentially affecting birthweight in the pre-eclampsia group.