Sphingosine-1-Phosphate, a Marker of Endothelial Injury and Disease Severity in Preeclampsia

Preeclampsia is a hypertensive pregnancy disorder marked by endothelial damage. Healthy endothelium is covered by a protective glycocalyx layer, which, when degraded, releases detectable products into the blood. Sphingosine-1-phosphate (S1P) is a cardiovascular biomarker involved in glycocalyx preservation, linked to placentation and preeclampsia development. The study aimed to test the hypothesis that plasma S1P is altered alongside glycocalyx degradation products in severe preeclampsia compared with controls.

We included 121 females: 41 with severe preeclampsia requiring treatment in the intensive care unit, 40 with preeclampsia but no need of intensive care unit treatment, and 40 with normotensive pregnancies. Plasma levels of S1P and glycocalyx degradation products-hyaluronic acid, SDC-1 (syndecan-1), and HSPG2 (heparan sulfate proteoglycan-2)-were analyzed from blood samples taken within 27 hours postpartum.

Postpartum plasma S1P was significantly lower in the intensive care unit cohort compared with both preeclampsia controls and normotensive controls (P<0.001). Hyaluronic acid and SDC-1 levels were elevated in the intensive care unit group versus normotensive controls (P=0.009 and P=0.023), while HSPG2 was lower (P<0.001). Plasma S1P correlated with hyaluronic acid and blood pressure.

Intensive care patients with severe preeclampsia have lower plasma S1P levels and higher concentrations of glycocalyx degradation products, indicating more pronounced endothelial damage. These findings suggest that S1P is associated with preeclampsia severity and may serve as a biomarker to assess vascular damage in this patient population. Further studies are needed to explore the potential role of S1P in long-term cardiovascular risk assessment for patients with preeclampsia.