Inositol phosphoglycan P-type in healthy and preeclamptic pregnancies

An association between inositol phosphoglycan P-type (P-IPG) and preeclampsia has been demonstrated over recent years. This molecule can mediate many of the metabolic and growth promoting effects of insulin. Dysregulation of the mediator family is associated with insulin resistance. An increased concentration of P-IPG has been reported in preeclamptic placenta, although its precursor (GPI) was undetectable in those placental samples. Insulin administration, that induces P-IPG release in normal human placenta, was shown not to cause production/release of the mediator from preeclamptic placental tissue as a consequence of a disturbed insulin signalling. Amniotic fluid is enriched of this mediator, with further increase during preeclampsia. We have found that the fetus released increasing amounts of P-IPG in the urine between 13 and 18 weeks of gestation, reaching a plateau beyond 20 weeks. Cord blood of infants of preeclamptic mothers showed an increased content of soluble P-IPG compared to controls and to the mother.     

Inositol phosphoglycan P-type in infants of preeclamptic mothers

Background. Inositol phosphoglycan P-type (P-IPG) has consistently found to be elevated during active preeclampsia, although the biosynthetic source has to be identified yet. This multicenter prospective cross-sectional case-control study evaluated the fetus/newborn as the source of P-IPG.

Methods. A urine specimen was collected longitudinally for three consecutive days after delivery from 90 newborns and their mothers, and ordered according to clinical diagnosis of preeclampsia, gestational hypertension, or healthy pregnancy.

Results. The urinary excretion of P-IPG on day 0 was higher in the mothers in all groups (p?<?0.05) with higher levels in preeclamptic women (p?<?0.01) in the mothers compared to their newborns in the preeclamptic group (p<0.01). The difference persisted at least two days post partum.

Conclusion. Findings of this study confirm the specificity of the increase in urinary excretion of P-IPG in preeclamptic mothers at day of birth compared to healthy pregnancy and GH, but does not extend to their newborns.     

Surface-active material in human amniotic fluid

Surface-active fractions similar to the biochemical constituents of the pulmonary surfactant system can be isolated from human amniotic fluid and lung tissue from week 10 of gestation through term. Amniotic fluid yielded 10 mg. per 100 ml. surface-active material at 10 to 28 weeks' gestation and 330 mg. per 100 ml. at term. Fetal lung at 10 weeks of gestation gave 1,233 mg. per 100 ml. and 1,670 mg. per 100 ml. at 4 days after birth. The constituent PC of these surface-active fractions from amniotic fluid and lung contained in excess of 60 per cent palmitoyl residues. PC associated with the surface-active fraction accounted for no more than 15 per cent of the total amniotic fluid concentration of this compound. Minimum surface tensions obtained with these preparations from amniotic fluid ranged from 2.5 dynes per centimeter at 33 weeks to 8.3 dynes per centimeter at 40 weeks. At 14 to 28 weeks, the surface-active fraction from lung gave a minimum surface tension of 18.1 dynes per centimeter and 7.0 dynes per centimeter by 4 days after birth. These findings are consistent with the observation that an increase in the activity or concentration of the fetal lung surfactant system takes place in the last 4 weeks of gestation. Some constituents of this system, or their derivatives which have possibly been altered as a result of biochemical changes, are found in amniotic fluid. We infer that the majority of PC in amniotic fluid is not directly associated with the biochemical constituents of the fetal lung surfactant system.     

Neurogenic cells in human amniotic fluid

OBJECTIVE: The purpose of this study was to determine whether human amniotic fluid contains cells that harbor the potential to differentiate into neurogenic cells. STUDY DESIGN: Amniotic fluid cells (uncultivated or cultivated in standard or in neurogenic differentiation medium) were analyzed for morphologic neurogenic differentiation and for expression of cluster of differentiation 133 (marker for neuronal stem cells), nestin (neuronal progenitor cells), neurofilament (neurons), the p75 common neurotrophin receptor, the brain-derived neurotrophic factor and neurotrophin-3 and cyclic nucleotide phosphodiesterase (oligodendrocytes). RESULTS: The appearance of neurogenic cells was not detected in uncultivated cells, was sporadic after cultivation in standard medium but strongly increased in neurogenic differentiation medium, and was accompanied by the induction of the expression of the analyzed marker genes. CONCLUSION: For the first time, this study provides evidence that human amniotic fluid contains cells that express markers for neuronal stem and progenitor cells, which harbor the potential to differentiate into neurogenic cells.     

Maternal and amniotic fluid steroids throughout human pregnancy.

Concentrations of testosterone, dihydrotestosterone, androstenedione, progesterone, 17 alpha-hydroxyprogesterone, and estradiol were measured by radioimmunoassay in the amniotic fluid and maternal peripheral blood obtained from normal pregnancies between 14 and 40 weeks of gestation. There was a sex difference in the levels of all the androgenic steroids in the amniotic fluid before 20 weeks with higher levels in pregnancies with male fetuses. Amniotic fluid 17 alpha-hydroxyprogesterone levels were significantly elevated in a pregnancy with the fetus affected with congenital adrenal hyperplasia. The levels of all the steroids in the amniotic fluid were significantly elevated in the pregnancy with molar degeneration of the placenta. There was a sex difference in the levels of dihydrotestosterone in the maternal peripheral blood before 20 weeks with higher levels in pregnancies with male fetuses. There was no correlation between the steroid levels in the maternal serum and amniotic fluid even though most of the samples of maternal serum were drawn at the same time as amniocentesis.     

Fetal intestinal microvilli in human amniotic fluid

The intestinal microvilli of fetal origin in human amniotic fluid were purified by Ca2+ precipitation of contaminating organelles followed by differential centrifugation of microvillar membranes. In the purified preparation, the specific activity of the microvillar marker-enzymes maltase and sucrase increased about 77-fold over that in cell-free amniotic fluid. Significant contamination of the purified preparation by endoplasmic reticulum (microsomes) and lysosomes was ruled out on the basis of a low content of the marker enzymes glucose-6-phosphatase (microsomes) and acid phosphatase (lysosomes). Amniotic fluid microvilli contain typical enzymes of the fetal intestine including maltase, sucrase, trehalase, alkaline phosphatase and gamma-glutamyltransferase, and their morphology by electron microscopy resembles that of vesiculated intestinal microvilli. Prenatal detection of genetic diseases due to a deficiency of a protein expressed in these membranes or associated to abnormal microvilli seems feasible.     

Isoelectric focusing pattern of human amniotic fluid alpha-fetoprotein.

Isoelectric focusing (IEF) of amniotic fluid alpha-fetoprotein (AFP) in thin-layer polyacrylamide gels containing 8 M urea followed by immunoblotting reveals at least nine bands, band I lying next to the cathode. Compared with 298 amniotic fluid samples from normal pregnancies, we found that the density of band V was increased in seven cases of fetal death. In 16 amniotic fluid samples from pregnancies with open neural tube defects (ONTD), band V disappeared or was markedly decreased. In seven cases with elevated AFP and positive acetylcholinesterase (AChE) due to contamination with fetal blood, no difference in pattern was observed compared with samples from normal pregnancies. It is suggested that IEF of AFP and subsequent immunoblotting are an apparently diagnostic test for ONTD and intrauterine fetal death (IUFD).     

Phosphoenolpyruvate carboxykinase activity in human amniotic fluid

Amniotic fluid samples obtained from normal pregnancies during gestation were used to quantitate the levels of phosphoenolpyruvate carboxykinase (PEPCK) activity. It is concluded that: (1) PEPCK activity was highest in the amniotic fluid cells of midtrimester pregnancies as compared to those of pregnancies close to term; (2) the activity of PEPCK seen in the amniotic fluid supernatant was about one fourth to one half of that seen in the amniotic cells; (3) the amniotic fluid supernatant PEPCK activity fluctuated very little during the entire gestation.     

gamma-Glutamyl transpeptidase of human amniotic fluid

gamma-Glutamyl transpeptidase (GGTP) activity in normal amniotic fluids and corresponding maternal sera obtained at various gestational periods was measured. The ontogenic pattern of enzyme activity in amniotic fluid is very similar to alpha fetoprotein (AFP). However, the levels of these two proteins behaved differently in corresponding maternal sera. Also, in amniotic fluids obtained from pregnancies with neural tube defects (NTD), only AFP concentration was abnormally high whereas GGTP activity was normal.     

N-terminal peptide of pro-opiomelanocortin in human amniotic fluid

N-terminal peptide of pro-opiomelanocortin (N-POMC) was measured in the human amniotic fluid. At the gestational age of 16 to 20 weeks, the radioimmunoassay with three different antibodies demonstrated the respective values of 2.39 +/- 0.78, 4.69 +/- 2.27, and 5.92 +/- 2.66 ng/ml. These values are approximately 10 times higher than the measurements in the plasma of women at the corresponding gestational period. The amniotic fluid collected during the delivery had significantly lower concentrations of N-POMC than the amniotic fluid at 16 to 20 weeks' gestation. However, the plasma values of N-POMC had increased approximately three times when measured at delivery and compared with the plasma values at 16 to 20 weeks' gestation. Adrenocorticotropic hormone, measured simultaneously with N-POMC in some of the samples, showed changes similar to those in N-POMC. The N-POMC immunoreactivity from the amniotic fluid has the same retention time on reversed-phase high-performance liquid chromatographic separation as the peptide purified from the human pituitary gland, thus indicating the identity of both peptides.     

The amniotic fluid index in normal human pregnancy

The four-quadrant sum of amniotic fluid pockets (amniotic fluid index) was studied prospectively in 791 normal pregnancies. Interobserver and intraobserver variation was 3.1% and 6.7%, respectively. Logarithmic transformations were used to establish the mean and 90% confidence intervals for the amniotic fluid index at each week of gestation. In term pregnancies, the boundaries of the amniotic fluid index were 115 mm (mean), 68 to 196 mm (5th to 95th percentiles). In postdates pregnancies greater than 42 weeks, the values were 108 mm (mean), 67 to 174 mm (5th to 95th percentiles), p less than 0.0001. However, the values for each week were statistically distinct, indicating the need to reference amniotic fluid index measurements to week-specific normative tables for accurate interpretation. This study provides normative data for the amniotic fluid index throughout pregnancy.     

Correlation of subjective assessment of amniotic fluid with amniotic fluid index.

We assessed the correlation between abnormal amniotic fluid volumes as defined by the two techniques of (1) subjective evaluation and (2) the amniotic fluid index. Ultrasound evaluation of amniotic fluid volume was conducted on 420 pregnant women with known gestational age greater than twenty weeks but less than 42 weeks. Amniotic fluid was evaluated subjectively and placed into one of three categories: normal, oligohydramnios or polyhydramnios. After fetal biometry was performed, the amniotic fluid volume was assessed semi-quantitatively by the amniotic fluid index technique and assigned to similar categories. We analyzed the data with 2 x 2 contingency tables, using amniotic fluid index as the 'gold standard test'. Our study demonstrates that there was moderate agreement (kappa.5) between both amniotic fluid techniques in the identification of oligohydramnios. However, agreement between the techniques was poor for the identification of polyhydramnios (kappa.16).     

Aggregation of human platelets by amniotic fluid

Summary. Twenty-four amniotic fluid samples were examined for their effects on human platelets. All samples caused irreversible platelet aggregation. The active material precipitated with high-speed ultracentrifugation and was completely inhibited by prior incubation with purified collagenase. The presence of free collagen in amniotic fluid was further confirmed by polyacrylamide-gel electrophoresis and hydroxyproline assays. Beside platelet-aggregating activity, amniotic fluid samples were also shown to significantly shorten the recalcification time of normal plasma. This procoagulant activity appears to be related to the presence of thromboplastin, collagen and other as yet unidentified procoagulant material in amniotic fluid. The presence of activators of platelets and clotting factors in amniotic fluid would account for the strong clotpromoting activity of this fluid. These studies suggest that the ideal management of the coagulopathy of pregnancy should include a combination of anticoagulant and antiplatelet drugs.