RECK、基质金属蛋白酶-9和血管内皮生长因子在子痫前期患者胎盘组织中的表达

目的检测子痫前期患者胎盘组织中RECK、基质金属蛋白酶-9(MMP-9)、血管内皮生长因子(VEGF)的基因表达,探讨它们与胎盘滋养细胞浸润过程的调控关系。方法采用RT-PCR、Western blotting、免疫组织化学检测120例妊娠足月剖宫产(正常妊娠、轻度子痫前期、中度子痫前期、重度子痫前期各30例)胎盘组织中RECK、MMP-9、VEGF的基因表达。结果 3组子痫前期患者胎盘组织中MMP-9及VEGF的mRNA表达水平均显著低于正常妊娠组(P0.05);重度子痫前期组中RECK mRNA的表达显著高于正常妊娠组(P0.05);3组子痫前期患者胎盘组织中MMP-9及VEGF蛋白表达均显著低于正常妊娠组(P0.05),中度和重度子痫前期组中RECK蛋白表达显著高于正常妊娠组(P0.05)。结论子痫前期患者胎盘中RECK与MMP-9、VEGF之间存在负相关性,它们可能参与了胎盘滋养细胞浅浸润过程的调控。     

子痫前期胎盘低氧诱导因子1α的表达及其与血清胎盘生长因子的相关性

目的检测正常晚期妊娠和子痫前期患者胎盘低氧诱导因子1α(H IF-1α)和血清胎盘生长因子(P lGF)的水平,探讨它们的相关性及与子痫前期发病的关系。方法免疫组织化学SP法检测40例子痫前期患者及20例正常晚期妊娠胎盘H IF-1α表达,酶联免疫吸附试验(ELISA)检测血清P lGF的水平。结果轻度子痫前期组与重度子痫前期组胎盘H IF-1α表达高于正常晚期妊娠组,两组血清P lGF低于正常晚期妊娠组,差异均有显著性意义(P<0.05)。胎盘H IF-1α的表达与血清P lGF水平呈负相关关系。结论子痫前期患者血清P lGF水平依赖于胎盘H IF-1α表达,两者可能与子痫前期的发病有一定关系。     

子痫前期患者胎盘中人表皮生长因子受体1的表达研究

目的通过检测子痫前期患者胎盘滋养细胞人表皮生长因子受体1（ErbB1）的表达情况,探讨胎盘滋养细胞ErbB1表达与子痫前期的关系。方法采用RT-PCR法及免疫组织化学法检测20例正常妊娠妇女（正常妊娠组）与34例子痫前期患者（子痫前期组）胎盘ErbB1的表达。结果在子痫前期患者胎盘中,ErbB1表达明显高于正常妊娠组,两者相比差异有统计学意义（P〈0.05）。结论胎盘中ErbB1表达的升高与子痫前期的发生密切相关。     

MMP-2、TIMP-2和PPARγ在子痫前期患者胎盘中的表达及意义

目的探讨MMP-2、TIMP-2和PPARγ在子痫前期患者胎盘中的表达及其临床意义。方法采用免疫组化SP法检测正常妊娠晚期、轻度子痫前期及重度子痫前期各30例患者胎盘底板中间型滋养细胞MMP-2、TIMP-2及PPARγ的表达。结果 MMP-2在正常妊娠晚期组、轻度子痫前期组及重度子痫前期组的表达强度呈减弱趋势,在重度子痫前期组的表达明显低于正常妊娠晚期组及轻度子痫前期组(P0.05);TIMP-2、PPARγ在正常妊娠晚期组、轻度子痫前期组及重度子痫前期组的表达强度呈增强趋势,各组间差异有显著性(P0.05);子痫前期组患者胎盘组织中MMP-2、TIMP-2及PPARγ的表达呈负相关(P0.05)。结论子痫前期组患者胎盘组织中MMP-2表达下调,TIMP-2、PPARγ表达上调,提示MMP-2、TIMP-2和PPARγ的表达异常可能在滋养细胞的浸润过程中起主导作用;MMP-2、TIMP-2及PPARγ的表达呈负相关,提示三者可能在滋养细胞浸润过程中相互影响,共同参与子痫前期的发病。     

E-钙粘蛋白在胎盘组织中的表达与子痫前期的关系

目的检测E-钙粘蛋白（E-cadherin,E-cad）在正常妊娠和子痫前期妊娠胎盘中的表达情况,探讨E-cad表达水平与子痫前期的关系。方法取临床标本,14例子痫前期患者（子痫前期组）与10例正常妊娠妇女（正常妊娠组）的胎盘组织,用免疫组织化学方法检测胎盘中E-cad的表达。结果子痫前期组孕妇胎盘中,E-cad表达水平明显高于正常妊娠组,两组差异有统计学意义（P〈0.05）。结论胎盘滋养细胞中E-cad表达的水平与子痫前期的发生密切相关。     

血清可溶性Fas与胎盘组织胎盘生长因子的表达在早发型重度子痫前期发病中的作用

目的:探讨血清可溶性Fas与胎盘组织胎盘生长因子在早发型重度子痫前期发病中的作用。方法:采用ELISA和免疫组化法分别检测20例早发重度子痫前期患者、35例晚发重度子痫前期患者和40例正常晚期妊娠患者血清可溶性Fas(Soluble Fas,sFas)和胎盘组织胎盘生长因子(placental growth factor,PlGF)的表达。结果:正常妊娠组、早发重度组、晚发重度组血清sFas水平分别为(1.17±0.53)、(6.68±0.97)和(3.17±0.74)mg/L,早发重度组、晚发重度组均显著高于正常对照组,差异有显著性(P<0.05)。早发重度组又明显高于晚发重度组,差异有显著性。正常妊娠组胎盘组织PlGF表达的平均灰度值显著高于早发型及晚发型重度子痫前期组,其中早发型子痫前期重度组表达最低。早发重度组中血清sFas与PlGF呈负相关,相关系数-0.748。结论:重度子痫前期患者血清sFas表达升高,且早发重度组表达显著高于晚发重度组,并与PlGF呈负相关,说明其异常表达可能是早发重度子痫前期发病的主要原因。     

基质金属蛋白酶-9和血管内皮生长因子在子痫前期患者胎盘组织中的表达

目的 检测子痫前期患者胎盘组织中RECK、基质金属蛋白酶-9（MMP-9）、血管内皮生长因子（VEGF）的基因表达,探讨它们与胎盘滋养细胞浸润过程的调控关系。 方法 采用RT-PCR、Western blotting、免疫组织化学检测120例妊娠足月剖宫产（正常妊娠、轻度子痫前期、中度子痫前期、重度子痫前期各30例）胎盘组织中RECK、MMP-9、VEGF的基因表达。结果 3组子痫前期患者胎盘组织中MMP-9及VEGF的mRNA表达水平均显著低于正常妊娠组（P<0.05）;重度子痫前期组中RECK mRNA的表达显著高于正常妊娠组（P<0.05）;3组子痫前期患者胎盘组织中MMP-9及VEGF蛋白表达均显著低于正常妊娠组（P<0.05）,中度和重度子痫前期组中RECK蛋白表达显著高于正常妊娠组（P<0.05）。结论 子痫前期患者胎盘中RECK与MMP-9、VEGF之间存在负相关性,它们可能参与了胎盘滋养细胞浅浸润过程的调控。     

HMGB1、TLR4和NF-B在子痫前期患者胎盘组织及血浆中升高

目的探讨高迁移率族蛋白(HMGB1)、TOLL受体4(TLR4)和NF-B信号通路在子痫前期中的相关作用。方法轻度子痫前期患者10例、重度子痫前期患者20例和同期正常妊娠者30例。免疫组织化学(SP法)检测胎盘中HMGB1、TLR4和NF-κB P65蛋白的表达变化及在组织中的定性、定位;用ELISA法检测血清中HMGB1、TLR4和NF-κB P65蛋白浓度。结果子痫前期患者胎盘中HMGB1、TLR4、和NF-κB P65蛋白表达高于正常对照组(P0.05);轻度和重度子痫前期患者间无差异。子痫前期患者血清中HMGB1、TLR4和NF-κB P65的含量较正常组明显升高(P0.05);且重度子痫前期患者血清中HMGB1、TLR4、和NF-κB P65蛋白表达高于轻度子痫前期患者(P0.05)。结论 HMGB1、TLR4及NF-κB P65蛋白表达水平在子痫前期患者胎盘及血清中显著升高,可能参与了子痫的发病过程。     

KiSS-1在子痫前期患者胎盘组织中的表达及意义

目的探讨肿瘤转移抑制基因KiSS-1是否是子痫前期的发病机制。方法采用免疫组化SP法检测25例正常足月妊娠妇女(正常妊娠组)与40例子痫前期患者(子痫前期组,其中轻度子痫前期15例、重度子痫前期25例)胎盘组织中KiSS-1的表达。结果KiSS-1主要位于胎盘绒毛小叶的合体滋养细胞。子痫前期组胎盘组织中KiSS-1的平均光密度为(0.137±0.010),其中轻度子痫前期为(0.132±0.004),重度子痫前期为(0.140±0.012);均明显高于正常妊娠组的(0.124±0.010),P值分别为P<0.01、P<0.05(P=0.019)、P<0.01。结论胎盘组织中KiSS-1的表达水平随病情程度的加重而增高,可能与子痫前期的发病有关。     

内皮型一氧化氮合酶运输介导物在子痫前期患者胎盘组织中的定位及定量研究

目的探讨内皮型一氧化氮合酶运输介导物(endothelial n itric oxide synthase traffic inducer,NOSTR IN)在子痫前期(pre-ec lampsia,PE)患者胎盘血管内皮细胞中表达的变化及其在子痫前期发病过程中的作用。方法HE染色后镜下观察胎盘组织及血管的病理变化,免疫组织化学方法及W estern b lot检测子痫前期患者胎盘组织中NOSTR IN的表达。结果HE染色显示子痫前期患者胎盘绒毛血管变细,数目减少,血管合体膜增厚,纤维素样坏死明显多于正常妊娠;免疫组织化学显示正常妊娠和子痫前期患者胎盘血管内皮细胞中都有NOSTR IN的表达,但子痫前期患者胎盘血管内皮细胞胞浆染色较正常妊娠明显增强;W estern b lot显示子痫前期患者胎盘组织中NOSTR IN的表达显著高于正常妊娠(P<0.01)。结论胎盘组织中NOSTR IN表达增加可能是子痫前期发病机制的重要环节之一。     

KIR2DL4 expression rather than its single nucleotide polymorphisms correlates with pre-eclampsia

Objective: To evaluate the single nucleotide polymorphisms and expression of KIR2DL4 (killer cell immunoglobulin-like receptors) gene in pre-eclampsia patients. Methods: KIR2DL4 gene polymorphisms were detected in 100 patients with pre-eclampsia and 100 healthy pregnant women, respectively, by using PCR-SS. Then, the expression of KIR2DL4 was measured in 5 cases of placentas tissues with pre-eclampsia and normal pregnancies by using qRT-PCR. Results: Compared with healthy controls, 16 loci of single nucleotide polymorphisms (SNP) were identified in pre-eclampsia patients, including 7 new polymorphisms loci. But, no significant difference was found in genotype distributions and allele frequencies in pre-eclampsia and controls (P>0.05). However, qRT-PCR results showed that KIR2DL4 mRNA in placenta tissues with pre-eclampsia was significantly lower than those with normal pregnancy, and the difference was statistically significant. Conclusion: Decreased level of KIR2DL4 rather than its SNP is correlated with the susceptibility of pre-eclampsia.     

脂蛋白脂酶基因在子痫前期胎盘中的变化及意义

目的研究脂蛋白脂酶(lipoproteinlipase,LPL)mRNA在于痫前期患者胎盘组织中的表达与定位,探讨其在子痫前期病理生理过程中的作用。方法利用cDNA表达谱芯片检查子痫前期胎盘组织与正常胎盘组织之间的差异表达基因;根据筛选结果,采用半定量RT-PCR检测子痫前期患者胎盘组织(研究组)和正常孕妇胎盘组织(对照组)中LPLmRNA的表达;以原位杂交方法进行定位。结果在4轮杂交过程中,共筛选出22条有差异表达的基因,其中LPL基因为表达降低基因之一;正常胎盘组织和子痫前期胎盘组织中均存在LPLmRNA,子痫前期胎盘组织中LPLmRNA表达明显低于正常胎盘组织(0.208±0.067vs0.524±0.139,P<0.05);LPLmRNA分布在胎盘绒毛滋养细胞胞浆。结论胎盘组织中LPL的低表达可能参与子痫前期的发病过程。     

Immunohistochemical adrenomedullin expression is decreased in the placenta from pregnancies with pre-eclampsia

The purpose of the present study was to investigate whether placental immunohistochemical adrenomedullin expression in normal normotensive pregnancies is different from that in pregnancies with pre-eclampsia. Placental tissues were obtained from seven normal normotensive pregnancies and 12 pregnancies with pre-eclampsia. The intensity of adrenomedullin staining in syncytiotrophoblasts was evaluated by means of immunohistochemistry and the ratio of the number of intact tertiary villi to that of total tertiary villi (intact/total villi ratio) was determined. The intensity of adrenomedullin expression in the placenta obtained from pregnancies with pre-eclampsia was significantly decreased compared with expression in placentas from uncomplicated normotensive pregnancies (P < 0.005). The intact/total villi ratio in placentas obtained from pregnancies with pre-eclampsia was significantly lower than that in placentas from normal normotensive pregnancies (P < 0.0001). In the amnion and extravillous trophoblast cells in both groups, no difference for the intensity of adrenomedullin expression was noted. These results suggest that adrenomedullin synthesis in the villous syncytiotrophoblasts is decreased in pregnancies with pre-eclampsia.     

The etiological role of allogeneic fetal rejection in pre-eclampsia

PROBLEM: It has been demonstrated that allogeneic fetal rejection in normal pregnancy is prevented by placental indoleamine 2,3-dioxygenase (IDO). Further, an immunological etiology has been implicated in pre-eclampsia. METHOD OF STUDY: We examined the differences in placental IDO activity between normal and pre-eclamptic pregnancies. RESULTS: IDO mRNA expression and enzyme activity levels in the placenta were low in patients with severe pre-eclampsia. The enzyme activity also inversely correlates with the blood pressure of the patients. In the placentas from severe pre-eclampsia, IDO immunoreactivity was low, whereas regional T-cell infiltration was observed reciprocally proportional to the IDO activity. CONCLUSION: Our findings implicate a potential role for IDO activity and a maternal immunological reaction against an allogeneic fetus in the etiology of pre-eclampsia.     

The novel inflammatory cytokine high mobility group box protein 1 (HMGB1) is expressed by human term placenta

High mobility group box protein 1 (HMGB1) was previously considered a strict nuclear protein, but lately data are accumulating on its extranuclear functions. In addition to its potent proinflammatory capacities, HMGB1 has a prominent role in a number of processes of specific interest for the placenta. Our overall aim was to investigate the expression of HMGB1 in human term placenta and elucidate a potential difference in HMGB1 expression comparing vaginal deliveries with elective Caesarean sections. In addition, placentas from normal pregnancies were compared with placentas from pregnancies complicated by pre-eclampsia. Twenty-five placentas, 12 from normal term pregnancies and 13 from pregnancies complicated by pre-eclampsia were analysed with immunohistochemistry for HMGB1 and its putative receptors; receptor for advanced glycation end-products (RAGE), Toll-like receptor 2 (TLR2) and TLR4. We present the novel finding that in addition to a strong nuclear HMGB1 expression in almost all cells in investigated placentas, an individual variation of cytoplasmic HMGB1 expression was detected in the syncytiotrophoblast covering the peripheral chorionic villi, by cells in the decidua and in amnion. Production of HMGB1 was confirmed by in situ hybridization. Although labour can be described as a controlled inflammatory-like process no differences in HMGB1 expression could be observed comparing active labour and elective Caesarean sections. However, a tendency towards a higher expression of cytoplasmic HMGB1 in the decidua from women with pre-eclampsia was demonstrated. The abundant expression of the receptors RAGE, TLR2 and TLR4 implicates a local capability to respond to HMGB1, although the precise role in the placenta remains to be elucidated.     

Tumor necrosis factor-alpha in the placenta is not elevated in pre-eclamptic patients despite its elevation in peripheral blood

PROBLEM: Tumor necrosis factor-alpha (TNF-alpha) is present in human placental and uterine cells at the early and late stages of gestation and promotes the regulation of trophoblast growth and invasion. We evaluated whether TNF-alpha levels in the placenta and blood of pre-eclamptic women differed from those with normal pregnancies. METHOD OF STUDY: The subjects were 39 pregnant women carrying single fetuses (21 normal-pregnant and 18 pre-eclamptic patients). Their average gestational age at entry was 38-39 weeks. Peripheral blood was collected before the onset of labor and separated serum was stored at -20 degrees C. A tissue segment of the placenta was cut and frozen in liquid nitrogen immediately after delivery at -80 degrees C. The frozen placental tissue was added to phosphate-buffered saline. The tissue was fully homogenized and centrifuged. Separated supernatant was stored at -80 degrees C. TNF-alpha levels in separated serum and TNF-alpha and total protein (TP) levels in separated supernatant were measured. The presence of TNF-alpha in the placenta was evaluated by immunohistochemistry in five pre-eclamptic and five normal-pregnant patients. RESULTS: Serum TNF-alpha levels were higher in pre-eclampsia than in normal pregnancies. However, TNF-alpha/TP levels in the placenta did not differ significantly between the two groups. As for TNF-alpha immunostaining of trophoblastic cells in the placenta, it was weak in three and moderate in two of the normal pregnancies, while it was absent in two, weak in one, and moderate in two in the pre-eclampsia group. CONCLUSIONS: We demonstrated no significant increase in TNF-alpha/TP levels in the placenta in pre-eclampsia despite a significant increase in serum TNF-alpha levels. There was no strong immunostaining for TNF-alpha detected by immunohistochemistry in the pre-eclampsia group. These findings suggest that TNF-alpha in the placenta is not a key cytokine to interfere with normal trophoblast invasion into the myometrium in pre-eclampsia, and that sources other than the placenta may contribute to the elevated levels of TNF-alpha found in the circulation of pre-eclamptic patients.     

Expression of vascular endothelial growth factor receptors 1, 2 and 3 in placentas from normal and complicated pregnancies

Extensive angiogenesis and invasion of the maternal decidua by trophoblasts are essential for the development and function of the placenta. Vascular endothelial growth factors (VEGF), placenta growth factor (PlGF) and their receptors VEGFR-1/Flt-1, VEGFR-2/KDR and VEGFR-3/Flt4 have important roles in vasculogenesis and angiogenesis. We have studied the localization of these proteins by immunohistochemistry and Western blotting in the placenta and of PlGF in maternal serum, and their association with diabetes, pre-eclampsia, fetal growth restriction (FGR) and fetal alcohol syndrome (FAS). VEGFR-1 and VEGFR-3 were detected mainly in the syncytiotrophoblastic layer whereas VEGFR-2 was detected in the vascular endothelial cells of the placenta. VEGFR-1, but not the other receptors, showed increased expression in placental syncytiotrophoblasts from 50% of patients with severe pre-eclampsia and FGR when compared with normal placentas. PlGF was undetectable in 38 of 44 samples of amniotic fluid of mothers with normal and complicated pregnancies. However, maternal serum PlGF concentrations were significantly lower in pre-eclamptic patients and in those with FGR when compared to diabetic women or healthy controls. These results suggest that low maternal serum PlGF and increased placental expression of its receptor VEGFR-1 are associated with pre-eclampsia and FGR.     

Distribution of sugar residues in human placentas from pregnancies complicated by hypertensive disorders

The aim of the study was to investigate the content and distribution of sugar residues in placentas from pregnancies complicated by hypertensive disorders. Placentas from women with uncomplicated pregnancies (group 1), pregnancies complicated by gestational hypertension (group 2), pregnancies complicated by pre-eclampsia (group 3), pregnancies complicated by pre-eclampsia with HELLP syndrome (hemolysis, elevated liver enzymes and low platelets) (group 4) were collected. Lectins: ConA, WGA, PNA, SBA, DBA, UEA I, GNA, DSA, MAA, SNA, in combination with chemical and enzymatic treatments, were used. Data showed a decrease and/or lack of α-d-mannose, α-d-glucose and d-galactose-(β1-4)-N-acetyl-d-glucosamine in placentas from pre-eclampsia and pre-eclampsia with HELLP syndrome compared with control and hypertension cases. N-acetyl-d-galactosamine appeared and/or increased in placentas from hypertensive disorders. A different distribution of various types of sialic acid was observed in placentas from hypertensive disorders compared with the controls. In particular, placentas from pre-eclampsia, with and without HELLP syndrome, lacked the acetylated sialic acid side-chain. These findings demonstrate various alterations of the carbohydrate metabolism in the placentas from pregnancies complicated by different types of hypertensive disorders. This indicates correlation with the placental morpho-functional changes characteristic of these complications and with the degree of clinical severity.     

Abnormal expression of plasminogen activator inhibitors in patients with gestational trophoblastic disease.

We previously reported significantly elevated levels of plasminogen activator inhibitor type 1 (PAI-1) in plasma and placenta from pregnant women with severe pre-eclampsia, and pre-eclampsia is a frequent problem in molar pregnancies. As increases in PAI-1 may contribute to the placental alterations that occur in pre-eclampsia, we have begun to investigate changes in PAI-1 as well as PAI-2 and several other components of the fibrinolytic system in patients with trophoblastic disease. Significant increases in plasma PAI-1 and decreases in plasma PAI-2 levels were observed in molar pregnancies when compared with the levels in normal pregnant women of similar gestational age. PAI-1 antigen levels also were increased, and PAI-2 levels were decreased in placenta from women with molar pregnancies compared with placenta obtained by spontaneous abortion. Immunohistochemical analysis revealed strong positive and specific staining of PAI-1 in trophoblastic epithelium in molar pregnancies and relatively weak staining of PAI-2. No association between the distribution of PAI-1 and vitronectin was found, and no specific signal for tissue type PA, urokinase type PA, tumor necrosis factor-alpha, or interleukin-1 was detected. In situ hybridization revealed an increase in PAI-1 but not PAI-2 mRNAs in placenta from molar pregnancies in comparison with placenta from abortions. These results demonstrate increased PAI-1 protein and mRNA in trophoblastic disease and suggest that localized elevated levels of PAI-1 may contribute to the hemostatic problems associated with this disorder.