PLASMA FACTORS THAT DETERMINE ENDOTHELIAL-CELL LIPID TOXICITY IN-VITRO CORRECTLY IDENTIFY WOMEN WITH PREECLAMPSIA IN EARLY AND LATE PREGNANCY

Objective: We proposed that women who develop preeclampsia have a low ratio of ''protective'' toxicity preventing activity (TxPA) to ''toxic '' very low density lipoproteins (VLDL) late in pregnancy. Having conf irmed this hypothesis, we then tested whether this low ratio would man ifest itself early in the pregnancy of women who develop preeclampsia. Methods: Serially collected plasma from women who developed preeclamp sia and from matched controls was assayed blind for TxPA, triglyceride s, cholesterol, high-density lipoproteins, albumin, and nonesterified fatty acids (NEFA). Main Outcome Measures: Plasma concentrations of li pids, NEFA, and proteins which bind NEFA (TxPA and albumin) were measu red in normal and preeclamptic women. These parameters were formulated prior to data collection because of the low albumin/triglyceride rati os and the elevated NEFA levels reported to occur in preeclampsia. Res ults: In late pregnancy, TxPA was lower (1.82 +/- 0.63 vs. 2.30 +/- 0. 40 g/dL, P = 0.008) and VLDL higher (292 +/- 130 vs. 206 +/- 60 mg/dL, P = 0.013) in preeclamptics than in controls. Discrimination analysis (TxPA and triglyceride), correctly classified 95% of the preeclamptic s and 79% of the controls in late pregnancy. The ratio of TxPA to non- TxPA and triglyceride correctly classified 92% of the preeclamptics an d 85% of the controls in early pregnancy. Conclusions: The ratio of Tx PA to VLDL accurately distinguishes preeclamptic from normal pregnant women, suggesting that both these factors are involved in the developm ent of preeclampsia.