ДИСФУНКЦИЯ ПЛАЦЕНТЫ ПРИ МАТЕРИНСКОМ ОЖИРЕНИИ — КЛЮЧЕВОЙ МЕХАНИЗМ ФЕТАЛЬНОГО ПРОГРАММИРОВАНИЯ МЕТАБОЛИЧЕСКОГО СИНДРОМА У ПЛОДА
Аннотация
Плацента является важнейшим связующим звеном между организмом матери и плода и, следовательно, центральным органом, подлежащим изучению в контексте фетального программирования метаболического синдрома. Ожирение вызывает дисфункцию плаценты за счет различных механизмов, включая нарушение экспрессии генов — переносчиков жирных кислот, ферментов этерификации и депонирования липидов. Формирующаяся при этом липотоксичная среда за счет повышения уровня ряда провоспалительных маркеров как в материнской плазме, так и в плаценте, активации плацентарной передачи сигналов воспаления, а также усиления регуляции провоспалительных генов, определяет внутриплацентарные функциональные нарушения и программирует долгосрочные метаболические нарушения у плода. Регистрируются данные о повышении уровня плацентарных активных форм кислорода (АФК), нитрозилировании белков, изменении концентрации цитокинов, усилении перекисного окисления липидов с последующей эндотелиальной дисфункцией плацентарной сосудистой сети. Результаты исследований по определению уровня гормонов как в тканях плаценты, так и в пуповинной крови плода у женщин с ожирением демонстрируют различные метаболические сдвиги. Особый интерес представляет рассмотрение полового диморфизма в контексте фетального программирования. Показано, что существует определенный каскад различий генетического, метаболического, воспалительного профиля в зависимости от пола плода. Эти изменения представляют собой механизмы, способствующие плацентарной дисфункции и программированию у плода ожирения и метаболических заболеваний, которые реализуются в более позднем возрасте. При этом многие аспекты дисфункции плаценты при ожирении у матери требуют дальнейшего изучения.
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