The role of follistatin and granulocyte-colony stimulating factor in HIV-associated pre-eclampsia

KwaZulu-Natal has a high burden of HIV infection and high blood pressure, specifically pre-eclampsia (PE) in pregnancy. Follistatin (FS) and granulocyte-colony stimulating factor (G-CSF) are two glycoproteins involved in PE pathogenesis. In light of the high maternal mortality and morbidity in South Africa (SA), we investigated the expression of FS and G-CSF in the duality of HIV-associated PE. Serum samples of normotensive and pre-eclamptic women were analysed using the Bio-Plex Multiplex Immunoassay. FS expression was significantly reduced in pre-eclamptic (median = 372.0, IQR = 719.2) compared to normotensive (median = 1569.0, IQR = 2043.0) (p < 0.0001). Furthermore, we detected significant FS expression across all study groups. There was a significant difference between HIV -ve normotensive (median = 9.0, IQR = 7.0) vs HIV +ve normotensive (median = 12.0, IQR = 5.0) groups. Additionally, G-CSF expression was notably higher in HIV +ve normotensive when compared to all study groups. This study demonstrated a downregulation of FS and G-CSF expression in PE, compared to normotensive pregnancies. This finding may be attributed to oxidative stress and its immunoregulatory role in the hyperinflammatory milieu of PE. HIV status had no effect on both analytes, albeit upregulated due to immune reconstitution emanating from highly active antiretroviral therapy. Our novel findings suggest that FS and G-CSF may have a potential predictor test value in early pregnancy, hence work on this is ongoing.