Investigation of Nrf2-Keap1 pathway, Sestrin 2 and oxidative stress in serum of patients with plasenta acreata

Objective: Placenta accreta spectrum is an important disease group with risks such as maternal bleeding, hysterectomy and death, which expresses the pathological adhesion of the placenta to the uterine myometrium, including placenta accreta, increta and percreta. Based on the hypothesis that increased angiogenesis in PAS may be related to an imbalance between oxidant and antioxidant mechanisms, we aimed to investigate the levels of maternal serum Nrf2-Keap-1 pathway, sestrin-2 and some oxidant/antioxidant system parameters in pregnant women with placenta accreta. Method: 57 PAS patients, including 38 placenta percreta, 3 placenta increta and 16 placenta accreta patients, who applied to Gaziantep University Hospital Gynecology and Obstetrics outpatient clinic, and 26 healthy pregnant women were included in the study. Serum Sestrin 2, Nrf2, Keap1, GSK-3ß, MDA-LDL, SOD and GSH-Px values were performed in Gaziantep University Biochemistry Laboratory. Results: Nrf2, Keap1, GSK-3ß, MDA-LDL levels, SOD and GSH-Px activities were statistically significantly different in the patient group compared to the control group in the comparison made between the PAS participating in the study and the control group. While MDA-LDL values were found to be high in the patient group, Nrf2, Keap1, GSK-3ß levels, SOD and GSH-Px activities were significantly higher in the control group. Although Sestrin 2 values were numerically higher than the values of the patient group, they were not statistically significant. In addition, when we grouped them according to the degree of invasion, we found that the Nrf2 level was lower and the Keap1 level was higher. Conclusion: As a result, we determined that the oxidant/antioxidant balance was impaired in the direction of increased oxidative stress in PAS disorder and we thought that Nrf2 and Keap1 parameters could be useful in determining the degree of placental invasion. There is a need for more extensive studies to reveal the role of oxidative stress in the etiopathogenesis of PAS and in determining the degree of invasion. Keywords: Placenta accreta spectrum, oxidative stress, Nrf2-Keap1 pathway, Sestrin2