Nitroglycerin prevents coagulopathies and foetal death associated with abnormal maternal inflammation in rats

Thromb Haemost. 2012 May;107(5):864-74. doi: 10.1160/TH11-10-0730. Epub 2012 Jan 25.

Abstract

Inflammation-associated foetal loss is often linked to maternal coagulopathies. Here, we characterised the role of maternal inflammation in the development of various systemic maternal coagulopathies and foetal death during mid-to-late gestation in rats. Since nitric oxide (NO) functions as an inhibitor of platelet aggregation and anti-oxidant, we also tested whether the NO mimetic nitroglycerin (glyceryl trinitrate, GTN) prevents inflammation-associated coagulopathies and foetal death. To induce chronic inflammation, pregnant Wistar rats were injected with low-doses of lipopolysaccharide (LPS; 10-40 μg/kg) on gestational days (GD) 13.5-16.5. To determine whether the effects of inflammation are mediated by tumour necrosis factor-α (TNF-α), the TNF-α inhibitor etanercept was injected on GD 13.5 and 15.5. Controls consisted of rats injected with saline. GTN was administered to LPS-treated rats via daily application of a transdermal patch on GD 12.5-16.5. Using thromboelastography (TEG), various coagulation parameters were assessed on GD 17.5; foetal viability was determined morphologically. Reference coagulation parameters were established based on TEG results obtained from control animals. LPS-treated rats exhibited distinct systemic coagulopathies: hypercoagulability, hypocoagulability, hyperfibrinolysis, and disseminated intravascular coagulation (DIC) stages I and III. A specific foetal death coagulation phenotype was observed, implicating TEG as a potential tool to identify inflammation-induced haemostatic alterations associated with pregnancy loss. Treatment with etanercept reduced the incidence of coagulopathy by 47%, while continuous delivery of GTN prevented foetal death and the inflammation-induced coagulopathies. These findings provide a rationale for investigating the use of GTN in the prevention of maternal coagulopathies and inflammation-mediated foetal death.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Cutaneous
  • Animals
  • Blood Coagulation / drug effects*
  • Blood Coagulation Disorders / blood
  • Blood Coagulation Disorders / etiology
  • Blood Coagulation Disorders / prevention & control*
  • Etanercept
  • Female
  • Fetal Death / blood
  • Fetal Death / etiology
  • Fetal Death / prevention & control*
  • Gestational Age
  • Immunoglobulin G / pharmacology
  • Inflammation / blood
  • Inflammation / chemically induced
  • Inflammation / complications
  • Inflammation / drug therapy*
  • Inflammation Mediators / metabolism
  • Lipopolysaccharides
  • Nitroglycerin / administration & dosage
  • Nitroglycerin / pharmacology*
  • Phenotype
  • Pregnancy
  • Rats
  • Rats, Wistar
  • Receptors, Tumor Necrosis Factor
  • Thrombelastography
  • Time Factors
  • Transdermal Patch
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors
  • Tumor Necrosis Factor-alpha / metabolism

Substances

  • Immunoglobulin G
  • Inflammation Mediators
  • Lipopolysaccharides
  • Receptors, Tumor Necrosis Factor
  • Tumor Necrosis Factor-alpha
  • lipopolysaccharide, Escherichia coli O111 B4
  • Nitroglycerin
  • Etanercept