Effect of transient TCDD exposure on immortalized human trophoblast-derived cell lines.

Low level, antenatal exposure to dioxins is associated with low birth weight, which in turn is associated with long-term sequelae. We exposed the human extravillous cytotrophoblast (EVT) lines HTR-8/SV40 and TCL1 to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and assessed cell growth, invasion, and differentiation. TCDD had no effect on cell proliferation, invasion, or tube formation in Matrigel. The EVT-derived cells expressed a functional aryl hydrocarbon receptor protein; however, TCDD exposure did not alter expression levels of proteins involved in EVT differentiation in early pregnancy, including hypoxia-inducible factor 1A (HIF1A), vascular endothelial growth factor (VEGF), Integrin A1, A6, and AVB3. These results suggest that the reduction in fetal weight induced by dioxin is not the result of vascular remodeling via EVT dysfunction.

Gene expression profiles by microarray analysis during matrigel-induced tube formation in a human extravillous trophoblast cell line: comparison with endothelial cells.

Endovascular differentiation of extravillous cytotrophoblasts (EVT) during placentogenesis induces remodeling of spiral arteries that increases blood flow toward the intravillous space and is required for maintaining pregnancy. To address the molecular mechanisms involved in this differentiation, we investigated the gene expression profile during matrigel-induced tube formation in TCL1 cells, a human immortalized EVT cell line, and HUV-EC-C, human umbilical vessel endothelial cells, and compared their profiles. The numbers of genes that showed significant up-regulation (>3-fold expression at both 3 and 6h, and/or >5-fold expression at either 3 or 6h) during tube formation and significant down-regulation (0.33-fold expression at both 3 and 6h, and/or less than 0.2-fold expression at either 3 or 6h), were 969 and 659 in TCL1, respectively. In HUV-EC-C, the numbers of genes that showed significant up-regulation and down-regulation were 86 and 65, respectively. Only 73 of 1628 genes that showed significant expression changes in TCL1 were common with HUV-EC-C. The genes showing significant expression change specifically in TCL1 were associated with cellular, metabolisms, proliferation, anti-apoptosis, proteolysis adhesion, and some known to be involved in EVT differentiation or related to angiogenesis. The gene expression profile in EVT during tube formation is very different from that of endothelial cells. Further investigations based on the current data may help to elucidate mechanisms of normal and abnormal placentogenesis.

Hypoxia inducible factor 1 alpha regulates matrigel-induced endovascular differentiation under normoxia in a human extravillous trophoblast cell line.

Extravillous trophoblast (EVT) cells mimic endothelial cells during angiogenesis, inducing remodeling of the spiral arteries that increases blood flow toward the intravillous space. We have previously shown that signals involving the vascular endothelial growth factor (VEGF) axis are essential for endovascular differentiation through integrin signaling from the extracellular matrix: This was accomplished with use of the human EVT cell line TCL1, which shows tube formation that specifically recalls morphological changes in endothelial cells. To investigate endovascular differentiation in EVT further, we investigated the role of hypoxia inducible factor (HIF)1A, a subunit of HIF1 transcription factor that regulates not only adaptive responses to hypoxia, but also many cellular functions under normoxia, which was up-regulated in DNA microarray analysis during matrigel-induced endovascular differentiation under normoxia. HIF1A induces VEGF and ITGAV/ITGB3 aggregation, actions known to be important for cellular survival and endovascular differentiation in EVT. Inhibition of HIF1A up-regulation using siRNA introduction or chemical inhibition suppressed hypoxia-responsive element transcriptional activity, VEGF induction, ITGAV/ITGB3 aggregation accompanied by the inhibition of tube formation in TCL1 cells. These results suggest that HIF1A has a crucial role in regulating EVT behavior including matrigel-induced endovascular differentiation under normoxia.

Spontaneous rupture of sacrococcygeal teratoma associated with acute fetal anemia.

Sacrococcygeal teratoma (SCT) is the most common congenital tumor, with affected fetuses having a high risk of perinatal complications and death. We report a case of a fetus with an SCT that developed acute anemia due to spontaneous rupture of the tumor in utero. The fetus was referred at 25 weeks' gestation for evaluation of a large solid and cystic mass in the sacral region. There were no signs of hydrops or placentomegaly. At 33 weeks' gestation, loss of variability in the fetal heart rate pattern was recorded. Doppler ultrasonography showed increased middle cerebral artery peak systolic velocity, suggesting fetal anemia. Markedly bloody amniotic fluid, with 82% hemoglobin F, was observed on amniocentesis, suggesting rupture of the SCT with active fetal bleeding. An emergency Cesarean section was performed. At delivery, the tumor was bleeding actively and the neonatal hemoglobin concentration was 3.1 g/dL. There were no findings of hemorrhage or necrosis within the tumor. The neonate received a blood transfusion, and surgical resection of the tumor was carried out on the first day after delivery. Postoperatively, the baby did well. We suggest that fetal SCTs run the risk of inducing acute fetal anemia due to intrauterine hemorrhage of the tumor, a finding which could lead to an earlier and more appropriate management of this condition.

Basal membrane localization of MRP1 in human placental trophoblast.

The placental trophoblast is considered to act as a barrier between mother and fetus, mediating the exchange of various materials across the placenta. ATP-binding cassette (ABC) transporters such as P-glycoprotein (P-gp) and multidrug-resistance protein (MRP) are expressed in the placenta and function as efflux transport systems for xenobiotics. In the present study, we aimed to determine the localization of MRP1 in the human placenta in comparison with that of P-gp. Western blotting analysis with human placental membrane vesicles indicated that P-gp and MRP1 are localized on the brush-border membranes and basal membranes, respectively. Immunohistochemical analysis with human normal full-term placenta showed that anti-P-gp monoclonal antibody F4 stained the brush-border side of the trophoblast cells, whereas anti-MRP1 monoclonal antibody MRPr1 stained the basal side. These results confirm that P-gp and MRP1 are located on the brush-border membranes and basal membranes, respectively, of human full-term placental trophoblast. MRP1 was also detected on the abluminal side of blood vessels in the villi. Accordingly, MRP1 may play a role distinct from that of P-gp, which is considered to restrict the influx of xenobiotics into the fetus.

Cytotoxic effects of soluble factor in preeclamptic sera on human trophoblasts.

Evidence indicating abnormal biological behavior of trophoblasts has been seen in preeclamptic patients, but the mechanism is still unknown. We have previously shown that endothelial injury and neutrophil activation are induced by certain factors in preeclamptic sera. We investigated the effect of sera from eight preeclamptic and 11 normal pregnant women on cellular proliferation and viability of trophoblasts using 3H-thymidine incorporation and the trypan-blue dye exclusion test, respectively. Five of eight preeclamptic sera, but none of the normal pregnant sera, inhibited 3H-thymidine incorporation. The trypan-blue test revealed the sera reduced cellular viability. Gel permeation showed that the greatest growth-inhibitory activity corresponded to a molecular weight of 50 kDa. The serum-mixing test revealed this permeation and inhibitory preeclamptic sera suppressed the growth-promoting activity of normal pregnant sera in a dose-dependent manner. These results suggested the presence of certain factors in some preeclamptic sera that can affect cellular behavior of human trophoblasts.

The characterization of superoxide production of human neonatal neutrophil.

To assess the role of neutrophil in neonatal host defense against microbial infection, we characterized the superoxide anion (O(2-)) production of neonatal neutrophil on a biochemical basis. After taking an appropriate informed consent, neutrophils were obtained from cord blood immediately after transvaginal delivery and divided into two groups: the Preterm group, 15 neonates (27-36 weeks' gestation) and the Term group, 15 neonates (37-41 weeks' gestation). Eleven healthy adults served as controls in the Adult group. The value of N-formyl-methionyl-leucyl-phenylalanin (fMLP)-induced O(2-) production activity of neutrophils in the Preterm group using chemiluminescence assay was significantly lower than those values in both the Term and Adult groups (5.77+/-0.53x10(6) vs. 11.1+/-0.94x10(6) and 10.7+/-0.63x10(6) cpm; mean+/-S.E.M., p<0.05). In phorbol 12-myristate 13-acetate (PMA)-stimulation, the values of O(2-) production activity of neutrophils in both the Preterm and Term groups were significantly lower than that in the Adult group (13.0+/-1.66x10(6) and 18.0+/-1.44x10(6) vs. 27.3+/-1.45x10(6) cpm, p<0.05). Scatchard analysis of [(3)H]fMLP binding to neutrophil demonstrated a two-receptor model in each group, and the number of high-affinity receptors per neutrophil in the Preterm group was significantly lower than those in other groups (p<0.05). However, cord blood levels of proinflammatory cytokines, such as interleukin (IL)-6, -8, and tumor necrosis factor-alpha (TNF-alpha) did not differ in either neonatal group. These results indicated that the fMLP-induced O(2-)production activity of neutrophils in the term neonates was enhanced at the level of the receptor and suggested that this enhanced production contribute to the neonatal host defense against microbial infection.

Uptake mechanism of valproic acid in human placental choriocarcinoma cell line (BeWo).

Valproic acid is an anticonvulsant widely used for the treatment of epilepsy. However, valproic acid is known to show fetal toxicity, including teratogenicity. In the present study, to elucidate the mechanisms of valproic acid transport across the blood-placental barrier, we carried out transcellular transport and uptake experiments with human placental choriocarcinoma epithelial cells (BeWo cells) in culture. The permeability coefficient of [3H]valproic acid in BeWo cells for the apical-to-basolateral flux was greater than that for the opposite flux, suggesting a higher unidirectional transport in the fetal direction. The uptake of [3H]valproic acid from the apical side was temperature-dependent and enhanced under acidic pH. In the presence of 50 microM carbonyl cyanide p-trifluoromethoxylhydrazone, the uptake of [3H]valproic acid was significantly reduced. A metabolic inhibitor, 10 mM sodium azide, also significantly reduced the uptake of [3H]valproic acid. Therefore, valproic acid is actively transported in a pH-dependent manner on the brush-border membrane of BeWo cells. Kinetic analysis of valproic acid uptake revealed the involvement of a non-saturable component and a saturable component. The Michaelis constant for the saturable transport (K(t)) was smaller under acidic pH, suggesting a proton-linked active transport mechanism for valproic acid in BeWo cells. In the inhibitory experiments, some short-chain fatty acids, such as acetic acid, lactic acid, propanoic acid and butyric acid, and medium-chain fatty acids, such as hexanoic acid and octanoic acid, inhibited the uptake of [3H]valproic acid. The uptake of [3H]valproic acid was also significantly decreased in the presence of 4,4'-diisothiocyanatostilbene-2,2'-disulfonic acid, salicylic acid and furosemide, which are well-known inhibitors of the anion exchange system. Moreover, p-aminohippuric acid significantly reduced the uptake of [3H]valproic acid. These results suggest that an active transport mechanism for valproic acid exists on the brush-border membrane of placental trophoblast cells and operates in a proton-linked manner.

Outcome of fetal cystic hygroma and experience of intrauterine treatment.

OBJECTIVE: To review our cases of fetal cystic hygroma and to examine the prognostic factors with the goal of establishing criteria for the intrauterine treatment for cystic hygroma. PATIENTS AND METHODS: Thirty-one cases of fetal cystic hygroma were managed by us from January 1988 to December 1997, and 21 cases were available for analysis. Three prognostic factors, namely chromosomal abnormality, structural anomaly and hydrops fetalis, were evaluated. We treated 2 cases of cystic hygroma associated with hydrops fetalis in utero using OK-432 injection under ultrasound guidance. RESULTS: The fetuses without any of the prognostic factors listed above showed a good prognosis throughout the fetal and neonatal periods. However, in this group, 2 infants with large tumors died of hemorrhage from the tumor at 6 months and 3 years of age, respectively. Cases with hydrops fetalis without chromosomal abnormalities or structural anomalies (5 cases) resulted in either intrauterine fetal death (IUFD, 2 cases) or early perinatal neonatal death (early PND, 3 cases). The cause of early PND was circulatory failure. Most of the hydrops cases with either a chromosomal abnormality or structural anomaly resulted in IUFD before 22 weeks of gestation. The size of the cyst decreased in 1 of 2 cases treated in utero. CONCLUSIONS: The fetal cases of cystic hygroma showing hydrops fetalis without chromosomal abnormalities or structural anomalies are considered to be possible candidates for intrauterine therapy. Those with very large cystic hygroma without any of the three prognostic factors are also thought to be candidates for fetal treatment. Based on our clinical experience, sclerotherapy using OK-432 is considered to be a treatment option in selected cases with fetal cystic hygroma.

Fetal germinal matrix and intraventricular haemorrhage diagnosed by MRI.

Subependymal germinal matrix haemorrhage and intraventricular haemorrhage (GMIVH) is a common complication of delivery in preterm neonates but has rarely been observed in the fetus. We report two cases of GMIVH in fetuses of 36 weeks gestation, clearly demonstrated by antenatal MRI. In both cases progressive ventriculomegaly was observed, and ventriculoperitoneal shunts were placed at 19 and 6 months of age, respectively. Prenatal GMIVH may be a cause of congenital hydrocephalus, for which no aetiology has yet been found.

Human placental transport of vinblastine, vincristine, digoxin and progesterone: contribution of P-glycoprotein.

To elucidate the role of P-glycoprotein in human placenta, we examined its expression in placenta, and the transcellular transport and uptake of P-glycoprotein substrates in cultured human placental choriocarcinoma epithelial cells (BeWo cells). The uptake of [(3)H]vinblastine and [(3)H]vincristine into BeWo cells was increased in the presence of a metabolic inhibitor, sodium azide. The basolateral-to-apical transcellular transport of [(3)H]vinblastine, [(3)H]vincristine and [(3)H]digoxin was greater than the apical-to-basolateral transcellular transport. In the presence of cyclosporin A, the basolateral-to-apical transcellular transport of [(3)H]vinblastine, [(3)H]vincristine and [(3)H]digoxin was significantly increased, and the apical-to-basolateral transcellular transport was decreased. The uptake of [(3)H]vinblastine, [(3)H]vincristine and [(3)H]digoxin into BeWo cells was significantly enhanced in the presence of several inhibitors, such as verapamil or mouse monoclonal antibody anti-P-glycoprotein MX-MDR (MRK16) as well as cyclosporin A. Although progesterone significantly enhanced the uptake of [(3)H]vinblastine, [(3)H]vincristine and [(3)H]digoxin into BeWo cells, the uptake of [(3)H]progesterone was not affected by these inhibitors. Immunoblot analysis revealed that P-glycoprotein with a molecular weight of 172 kDa was expressed in BeWo cells and isolated trophoblast cells. Furthermore, P-glycoprotein was detected in human placental brush-border membrane vesicles, but not in human placental basolateral membrane vesicles. In conclusion, these data suggest that P-glycoprotein is expressed on the brush-border membrane (maternal side) of human placental trophoblast cells. P-Glycoprotein is considered to regulate the transfer of several substances including vinblastine, vincristine and digoxin from mother to fetus, and to protect the fetus from toxic substances.

Fetal stabilization for antenatally diagnosed diaphragmatic hernia.

BACKGROUND/PURPOSE: Infants with congenital diaphragmatic hernia have pulmonary hypoplasia resulting in persistent pulmonary hypertension of neonates (PPHN), which is the main contributor to both high mortality and morbidity. The pulmonary artery bed in patients with congenital diaphragmatic hernia (CDH) is underdeveloped and is very sensitive to slight stimuli. It is, therefore, vital to avoid any factors that might increase pulmonary vascular resistance during the perinatal treatment of these patients. Recently, fetal anesthesia for perinatal stabilization in patients with CDH has been reported. However, the efficacy of this method remains controversial. The aim of this study is to analyze the benefits of fetal stabilization using fetal anesthesia in patients with CDH. METHODS: The authors have seen 9 cases of antenatally diagnosed CDH and attempted fetal stabilization. The indication for fetal stabilization was a lung thoracic ratio of less than 0.2, without any severe associated anomalies. The protocol for fetal stabilization was (1) monitoring the fetal respiratory movement and heart beat by ultrasonography, (2) the administration of morphine (20 to 30 mg) and diazepam (5 mg) to the mother, (3) the confirmation of any interruptions in fetal movement followed by a cesarean section, (4) pancuronimum (0.5 mg) was given through the umbilical vessels, (5) intubation before clamping of the umbilical cord, and (6) high-frequency oscillatory ventilation (HFO) without bagging. RESULTS: The lung-thratic ratio (LTR) was between 0.06 to 0.17 (average, 0.10+/-0.04). Operation was performed in 7 of 9 patients at between 2.5 and 27 hours after birth. The overall survival rate was 66.7% (6 of 9). All of the patients who underwent operation within 5 hours after birth survived. CONCLUSIONS: Perinatal stabilization using fetal anesthesia was found to be effective in preventing PPHN and shortening the period of preoperative stabilization. It also improved the survival rate of patients with severe CDH.

Diffusion-weighted images and vasogenic edema in eclampsia.

BACKGROUND: In eclampsia, it is mandatory to recognize specific cerebrovascular complications before initiation of treatment. Diffusion-weighted magnetic resonance imaging (MRI) is a new technique that differentiates between cerebral infarction and hypertensive encephalopathy with vasogenic edema. CASE: A 23-year-old primigravida developed eclampsia at 29 weeks' gestation. Focal neurologic signs and neuroimaging findings by computed tomography and MRI were consistent with acute infarction or vasogenic edema. Diffusion-weighted MRI did not show an abnormal signal, indicating vasogenic edema. Control of the severe hypertension without anticoagulation therapy was begun. After delivery, the woman's neurologic abnormalities disappeared. CONCLUSION: Diffusion-weighted MRI differentiated between cerebral infarction and vasogenic edema, helping in the management of eclampsia.

Is there a critical gestational age in neutrophil superoxide production activity?

We studied superoxide (O2-) production in neutrophils from 78 normal pregnant women at 7 to 39 weeks' gestation to determine whether there is a critical gestational age in O2- production activity of maternal neutrophils. The O2- production was measured by determining the rate of superoxide dismutase-inhibitable reduction of ferricytochrome c at 550 to 540 nm. A scattergram of neutrophil O2- production value versus gestational age was analyzed using the least median of squares regression, leading to a statistical stratification in which the median values of O2- production for outlying and nonoutlying points were 6.60 nmol/10(6) cells and 2.72 nmol/10(6) cells, respectively. All of the outlying points were concentrated at 19 to 22 gestational weeks. There was the significant difference in FMLP-induced O2- production in neutrophils of nonpregnant subjects when incubated with the sera from 10 cases (selected among 60 cases with nonoutlying points) (3.86 +/- 0.77 nmol/10(6) cells) compared with 5 cases with outlying points (5.62 +/- 1.19 nmol/10(6) cells) (P < .05) These results suggest that during the normal course of pregnancy, the production of O2- from the function of circulating neutrophils can be dissociated from such neutrophil functions as adherence, chemotaxis, and phagocytosis.

Venous distensibility during pregnancy. Comparisons between normal pregnancy and preeclampsia.

Preeclampsia is associated with increased peripheral resistance. This study was performed to determine whether an increase of venous distensibility occurs as well in preeclampsia. We obtained venous distensibility by measuring the venous pressure-volume relation in the forearm with a water-filled plethysmograph. Twenty-one women with normal pregnancy, 12 women with severe preeclampsia, and 8 women with mild preeclampsia were studied during the third trimester and/or 6 weeks after the delivery. Ten nonpregnant normotensive women were also studied. Venous distensibility was greater (P < .01) in normal pregnant women and smaller (P < .01) in women with preeclampsia during pregnancy than postpartum. The magnitude of the decrease of venous distensibility correlated with the severity of preeclampsia. Venous distensibility was similar between normotensive nonpregnant women, women with normal pregnancy during the postpartum period, and women with preeclampsia during the postpartum period. Thus, venous distensibility increased during normal pregnancy. In preeclampsia, the decrease of venous distensibility occurred during pregnancy but was reversed postpartum. These results may suggest that a decrease of venous distensibility occurs during preeclampsia. These venous abnormalities may contribute to impaired control of hemodynamics in preeclampsia during pregnancy.

Possible mechanism of vascular damage in pre-eclampsia.

To clarify the pathophysiological changes of pre-eclampsia, we investigated the injurious effect of sera from women with pre-eclampsia on cultured endothelial cells, vascular smooth muscle cells and fibroblasts. We obtained serum samples from 32 Japanese women, including 10 healthy nonpregnant women, 12 normal pregnant women and 10 women with pre-eclampsia. Cell injury was measured by the release of radiolabelled chromium from the cells into the culture medium. The mean values +/- SD of percentage chromium release from endothelial cells in normal nonpregnant, normal pregnant and pre-eclamptic subjects were 8.5 +/- 2.4, 8.8 +/- 2.1 and 19.7 +/- 3.6%, respectively. Sera from women with pre-eclampsia demonstrated significantly greater endothelial cell injury than did sera from normal pregnant and nonpregnant subjects. However, normal pregnant and pre-eclamptic subjects did not differ with respect to both vascular smooth muscle cell injury and fibroblast injury. These results indicate that a serum cytotoxic to endothelial cells is present in pre-eclampsia and that this activity has a cellular specificity for endothelial cells.

The superoxide generation of neutrophils in normal and preeclamptic pregnancies.

OBJECTIVE: To determine whether preeclampsia enhances superoxide generation of neutrophils. METHODS: Samples were obtained from 12 normal nonpregnant, 15 normal pregnant, and 11 preeclamptic women. The superoxide production of neutrophils was measured by the superoxide dismutase-inhibitable reduction of ferricytochrome C at 550-540 nm using a dual-wavelength spectrophotometer. RESULTS: N-formyl-methionyl-leucyl-phenylalanine (FMLP)-induced superoxide production of neutrophils was significantly higher in preeclamptics than in normal nonpregnant and pregnant subjects, whereas phorbol 12-myristate 13-acetate-induced superoxide production did not differ among them. When neutrophils prepared from normal nonpregnant women were preincubated with sera from the study groups, sera from preeclamptics enhanced the FMLP-induced superoxide production to about twice that of the other subjects. The serum-enhancing factor appeared to be a heat-labile protein, different from other known activators. CONCLUSION: Preeclampsia is characterized by the presence of a neutrophil activator that enhances superoxide production. This enhanced production may contribute to the pathophysiologic changes observed in preeclampsia.

Prenatal evaluation and obstetrical management of fetuses at risk of developing lung hypoplasia.

The aim of this study was to measure the fetal lung area of normal human fetuses using ultrasound and them to test the predictive values of a nomogram in the identification of fetal lung hypoplasia. A nomogram for ultrasound-measured fetal lung area were constructed from 264 normal fetuses from 17 to 39 weeks of gestation. In 19 cases running the risk of developing lung hypoplasia, the sensitivity, specificity, and positive and negative predictive values of lung area measurements below the mean -2 SD were 75%, 100%, 94% and 100%, respectively, with total lung area showing a significant relation to the combined lung weight (Y = -1.05 + 2.06 X, r2 = 0.88). These results indicate that lung area measured by ultrasound is a good indicator of lung weight, and this nomogram of lung area may be useful in evaluating lung growth prenatally, as well as in the direct obstetrical management of fetuses at risk of developing lung hypoplasia.