Modern concepts of preeclampsia development and prediction

Preeclampsia (PE) is a gestational neuroimmunocomplex endotheliosis that develops as a fundamental stereochemical process in which the trigger that activates complement along an abnormal pathway and launches a cytokine cascade are neurospecific proteins of the fetal neocortex in the antenatal period of its development. The most well-known clinical consequences of PE are not only FGR, but also prematurity, as well as a significantly more frequent development of individual pathological conditions of the early neonatal period. The development of parameters in the field of PE prediction is an important and necessary stage in the formation of a risk group and personalization of the pregnancy management strategy, and high reliability of the forecast can help to reduce the frequency of hyperdiagnosis. In this regard, a different concept of the nature and essence of preeclampsia is presented, not only as a hypertensive condition during pregnancy combined with placental insufficiency, but as a general pathological specific neuroimmunocomplex gestational endotheliosis, in which neurospecific proteins of the developing fetal brain during the period of formation, construction, active growth and isolation of the neocortex are considered as an antigen that disrupts the activation of complement proteins and stimulates the release of proinflammatory cytokines. Analysis of numerous studies has shown the high diagnostic potential of various biomarkers and their combination with instrumental and clinical examination methods. This concept of PE allows us to propose a new pathogenetic approach to the management of patients with this pregnancy complication. Considering PE as a gestational immune complex complement-mediated endotheliosis, it is possible to plan further studies on the effectiveness and safety of targeted therapy blocking unrestrained uncontrolled activation of the complement system.

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