胎儿生长受限时使用抗氧化剂保护心血管:系统回顾

IF 6 2区 医学 Q1 BIOCHEMISTRY & MOLECULAR BIOLOGY
Charmaine R Rock, Suzanne L Miller, Beth J Allison
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引用次数: 0

摘要

胎儿生长受限(FGR)会增加罹患心血管疾病的风险。目前尚无治疗方案,但抗氧化剂已显示出改善与 FGR 相关的心血管缺陷的潜力。本系统综述旨在确定产前抗氧化剂干预是否能有效保护 FGR 胎儿心血管系统的发育。我们使用MEDLINE和Embase(PROSPERO:CRD42024503756)检索了1946年1月1日至2024年9月9日期间发表的使用产前抗氧化剂干预改善FGR心脏和/或血管预后的干预性研究。使用 SYRCLE 对偏倚风险进行了评估。根据抗氧化剂治疗后心脏和/或血管功能缺损恢复的百分比,对研究进行心血管保护评估。研究结果显示了较强的心血管保护作用(恢复≥50%)、轻度心血管保护作用(>0%,但仅有抗氧化剂作用(这不包括对照组,因为与FGR相比,对照组在抗氧化剂干预后出现了变化)或无心血管保护作用(0%恢复)。有 38 篇文献符合纳入标准,包括 43 项研究,调查了 15 种抗氧化剂干预措施。此外,43 项研究中有 29 项(71%)报告称,抗氧化剂干预至少恢复了一项心脏或血管缺陷,43 项研究中有 21 项(51%)被归类为具有较强的心血管保护作用。七项研究对动脉功能进行的体外分析表明,生长受限的后代存在内皮功能障碍,而抗氧化剂干预可在所有情况下恢复内皮功能。此外,四项研究表明,抗氧化剂降低了过亚硝酸盐介导的氧化应激。值得注意的是,只有 13/43 的研究(32%)将抗氧化剂的使用推迟到诱发 FGR 之后。产前抗氧化剂干预有望为 FGR 患者提供心血管保护。褪黑素是最常被研究的干预措施,其次是nMitoQ、维生素C和N-乙酰半胱氨酸,所有这些干预措施都显示出较强的降低氧化应激和改善生长受限后代心血管系统一氧化氮生物利用率的能力;然而,本系统综述强调了临床前研究中存在的关键知识差距和不一致性,这阻碍了我们确定哪些抗氧化疗法目前适合临床转化的能力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Use of Antioxidants for Cardiovascular Protection in Fetal Growth Restriction: A Systematic Review.

Fetal growth restriction (FGR) increases the risk of cardiovascular disease. There are currently no treatment options available; however, antioxidants have shown potential to improve cardiovascular deficits associated with FGR. This systematic review aimed to determine whether antenatal antioxidant intervention can effectively protect the developing cardiovascular system in FGR. We searched for interventional studies that used an antenatal antioxidant intervention to improve cardiac and/or vascular outcomes in FGR published between 01/1946 and 09/2024 using MEDLINE and Embase (PROSPERO: CRD42024503756). The risk of bias was assessed with SYRCLE. The studies were assessed for cardiovascular protection based on the percentage of cardiac and/or vascular deficits that were restored with the antioxidant treatment. Studies were characterised as showing strong cardiovascular protection (≥50% restoration), mild cardiovascular protection (>0% but <50% restoration), an antioxidant-only effect (this did not include control group which showed a change with antioxidant intervention compared to FGR) or no cardiovascular protection (0% restoration). Thirty-eight publications met the inclusion criteria, encompassing 43 studies and investigating 15 antioxidant interventions. Moreover, 29/43 studies (71%) reported the restoration of at least one cardiac or vascular deficit with antioxidant intervention, and 21/43 studies (51%) were classified as strong cardiovascular protection. An ex vivo analysis of the arterial function in seven studies revealed endothelial dysfunction in growth-restricted offspring and antioxidant interventions restored the endothelial function in all cases. Additionally, four studies demonstrated that antioxidants reduced peroxynitrite-mediated oxidative stress. Notably, only 13/43 studies (32%) delayed antioxidant administration until after the induction of FGR. Antenatal antioxidant interventions show promise for providing cardiovascular protection in FGR. Melatonin was the most frequently studied intervention followed by nMitoQ, vitamin C and N-acetylcysteine, all of which demonstrated a strong capacity to reduce oxidative stress and improve nitric oxide bioavailability in the cardiovascular system of growth-restricted offspring; however, this systematic review highlights critical knowledge gaps and inconsistencies in preclinical research, which hinder our ability to determine which antioxidant treatments are currently suitable for clinical translation.

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来源期刊
Antioxidants
Antioxidants Biochemistry, Genetics and Molecular Biology-Physiology
CiteScore
10.60
自引率
11.40%
发文量
2123
审稿时长
16.3 days
期刊介绍: Antioxidants (ISSN 2076-3921), provides an advanced forum for studies related to the science and technology of antioxidants. It publishes research papers, reviews and communications. Our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible. There is no restriction on the length of the papers. The full experimental details must be provided so that the results can be reproduced. Electronic files and software regarding the full details of the calculation or experimental procedure, if unable to be published in a normal way, can be deposited as supplementary electronic material.
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