Molecular subclasses of preeclampsia: potential clinical applications for early detection and personalized prevention

The syndromic nature of preeclampsia has been a major limitation to early and effective screening and disease prevention. The current clinical distinction between preeclampsia subtypes (i.e. early- vs. late-onset) is arbitrary and does not reflect the true heterogeneity of the clinico-pathology in preeclamptic women. The recent application of ‘omics’ technologies and systems biology approaches has enabled a deeper insight into the molecular pathways associated with certain clinical subtypes. In addition, our untargeted analysis of big data from proteomics studies on maternal blood collected either in the first trimester or throughout pregnancy allowed the identification of four molecular subclasses of preeclampsia with distinct disease pathways. In the subclass with the largest number of recurrent preeclampsia cases, maternal anti-fetal rejection mechanism was recognized as a central pathway. The presentation will summarize key findings and their potential implications. Insights from these and future studies are expected to promote the development of novel diagnostic tools, enabling early molecular subclass identification and personalized preventive treatments as integrated part of patient care.