Expression of androgen receptor in human placentas from normal and preeclamptic pregnancies

Background: Human placenta is a diary of all the prenatal events and it’s study may provide valuable insight into pathophysiology of many diseases. One such disease preeclampsia (PE) is a leading contributor of maternal/fetal mortality and morbidity. In a quest to improve the treatment protocols, newer etiologies are researched, the latest being Androgen Receptor (AR) expression in PE placentae.
Methodology: Study was conducted in a tertiary care hospital in Bengaluru over a period of 18 months. Placentae (15) from singleton pregnancies with PE formed the study group while placentae (5) from normotensive pregnancies were the control group. Gross and histopathological findings followed by immunohistochemistry of AR was performed on all placentae and categorized based on the percentage of villi stained. Intracellular localisation and the type of cells staining were also recorded.
Results: Mean age was 28 years, majority (73%) of PE were in 28-32 weeks gestation group, with 46% being primigravidae. Past history of PE was observed in 75% while 53% had family history of PE. Decreased placental weight, increased syncytial knots, accelerated villous maturation and stromal fibrosis, fibrinoid necrosis and mural hypertrophy of arterioles were statistically significant findings in PE group. AR staining was seen in 16/20 (80%) with 11/15 PE cases showing 2+ and 3+ staining. Cytoplasmic staining was commonly seen in Syncytiotrophoblast, Cytotrophoblast & stromal cells in both groups.
Conclusion: AR expression was seen both in PE and non-PE placentae, although AR expression is increased in the former. Stillbirths were associated with positive AR despite clinically classified as mild PE, while negative AR was associated with live births. AR expression could be a new marker for PE with adverse outcome especially in recurrent cases.