The role of AT1 autoantibodies in preeclampsia and SARS-CoV-2 infection during pregnancy

Preeclampsia (PE) is a hypertensive disorder of pregnancy that is one of the leading causes of maternal and fetal morbidity and mortality. PE is characterized by chronic inflammation consisting of activated B cells, producing agonistic autoantibodies against the angiotensin II type 1 receptor (AT1-AA). This autoantibody contributes to vascular dysfunction, cerebral damage, and inflammation in PE. AT1-AA is also present in maternal circulation for years postpartum and could be involved in the increased risk for diseases such as hypertension or dementia in postpartum PE women. AT1-AA has been identified in patients with Coronavirus disease 2019 (COVID-19). It is produced during the inflammatory response and plays a role in the dysregulation of the renin–angiotensin system in COVID-19 patients. Pregnant women who experience a COVID-19 infection are at higher risk of developing PE, and AT1-AA may be contributing to this increased risk. Therapies targeting AT1-AA during and after PE and/or COVID-19 may reduce the risks and burdens of cardiovascular and neurological disease.