Toll-like receptor 4 inhibition by pyridostigmine is associated with a reduction in hypertension and inflammation in rat models of preeclampsia

J Hypertens. 2025 Feb 1;43(2):336-350. doi: 10.1097/HJH.0000000000003911. Epub 2024 Nov 2.

Abstract

Background: Preeclampsia (PE) is marked by hypertension and detrimental sterile inflammatory response. Despite the reported anti-inflammatory effect of pyridostigmine bromide (PYR) in different models, its anti-inflammatory mechanism in PE is unclear. This study assessed whether such an anti-inflammatory effect involves inhibition of placental Toll-like receptor 4 (TLR4) signaling.

Methods: Placental TLR4 expression and its signaling were assessed respectively in PE women and Sprague-Dawley rats with reduced uterine perfusion pressure (RUPP) induced on gestational day14 (GD14). RUPP and lipopolysaccharides (LPS, 5 μg/kg)-induced PE rats were treated with a selective TLR4 signaling inhibitor (TAK-242, 2.5 mg/kg/day). The effect of PYR (20 mg/kg/day) on TLR4 expression and signaling was also assessed in RUPP or LPS-infused rats. On GD19, rats' mean arterial pressure (MAP) and samples were collected and processed. At the cellular level, the effect of acetylcholine (ACh), the indirect by-product of PYR activity, on LPS-stimulated HTR-8/SVneo cells was assessed.

Results: Both PE women and RUPP rats had increased (P < 0.05) placental TLR4 expression and elevated (P < 0.05) MAP. Selective inhibition of TLR4 signaling with TAK-242 blunted (P < 0.05) RUPP-elevated MAP. Activation of TLR4 induced PE-like symptoms in dams, which were prevented by TAK-242. PYR reduced (P < 0.05) MAP and downregulated placental TLR4 expression and TLR4/TRAF6/NF-κB signaling-mediated inflammation in RUPP and in response to TLR4 selective activation. ACh inhibited the same signaling pathway in LPS-stimulated HTR-8 in vitro.

Conclusion: Our data support that PYR attenuates placental TLR4 expression and inhibits TLR4/TRAF6/NF-κB signaling pathway-mediated inflammation in RUPP, clarifying the anti-inflammatory mechanisms of PYR in the PE rat model.

MeSH terms

  • Adult
  • Animals
  • Disease Models, Animal*
  • Female
  • Humans
  • Hypertension / drug therapy
  • Inflammation* / drug therapy
  • Lipopolysaccharides
  • Placenta* / drug effects
  • Placenta* / metabolism
  • Pre-Eclampsia* / drug therapy
  • Pre-Eclampsia* / metabolism
  • Pregnancy
  • Pyridostigmine Bromide* / pharmacology
  • Rats
  • Rats, Sprague-Dawley*
  • Signal Transduction / drug effects
  • Sulfonamides
  • Toll-Like Receptor 4* / antagonists & inhibitors
  • Toll-Like Receptor 4* / metabolism

Substances

  • Toll-Like Receptor 4
  • Pyridostigmine Bromide
  • ethyl 6-(N-(2-chloro-4-fluorophenyl)sulfamoyl)cyclohex-1-ene-1-carboxylate
  • Lipopolysaccharides
  • Tlr4 protein, rat
  • Sulfonamides