胎盘组织中尿皮素和促肾上腺皮质激素释放激素2β受体表达变化与先兆子痫发病的关系

目的探讨先兆子痫患者胎盘组织中尿皮素(UCN)和促肾上腺皮质激素释放激素2β受体(CRH R2β)表达与先兆子痫发病的关系。方法应用半定量RT PCR技术测定20例先兆子痫患者(先兆子痫组)和20例正常妊娠妇女(对照组)胎盘组织中UCNmRNA和CRH R2βmRNA的水平;采用免疫组化方法对UCN进行蛋白定位和半定量分析。结果(1)先兆子痫组胎盘组织中UCNmRNA的表达水平为1 14±0 26,高于对照组的0 78±0 46,两组比较,差异有统计学意义(P<0 05)。(2)先兆子痫组胎盘组织中CRH R2βmRNA的表达水平为0 89±0 33,与对照组的0 93±0 50比较,差异无统计学意义(P>0 05)。(3)免疫组化定位结果显示,两组产妇的UCN蛋白表达主要位于合体滋养细胞,少量表达于细胞滋养细胞和血管内皮细胞。蛋白半定量结果显示,UCN在先兆子痫组胎盘合体滋养细胞中的表达强度高于对照组,两组比较,差异有统计学意义(P<0 05 )。结论先兆子痫患者胎盘组织中UCN表达水平升高,而CRH R2β水平则无明显变化,因此UCN的作用加强。这可能是胎盘组织对母体和胎儿应激状态的一种继发性代偿反应,并参与先兆子痫的病理生理过程。     

子痫前期孕妇外周血中游离胎儿DNA含量变化

目的探讨正常妊娠不同孕周及子痫前期孕妇外周血中游离胎儿DNA含量的变化。方法对2009年8月至2010年9月西安交通大学第二附属医院外周血样本90例(包括健康未孕10例,正常妊娠40例,子痫前期40例),应用甲基特异性PCR的原理及荧光定量PCR的方法,相对定量法检测u-maspin基因的含量。结果 (1)10例健康未孕样本未检出u-maspin基因;(2)40例正常妊娠样本有34例检出u-maspin基因,各孕期u-maspin基因检出量差异具有统计学意义(P<0.05),u-maspin基因的含量中孕是早孕的4.43倍,晚孕是早孕的5.13倍;(3)40例子痫前期样本均检出u-maspin基因,u-maspin基因的含量子痫前期轻度是正常晚孕的2.39倍,子痫前期重度是正常晚孕的5.78倍。结论孕妇外周血中游离胎儿DNA的含量随着妊娠进展而增加,能够反映子痫前期患病的严重程度。     

Ontogeny of corticotropin-releasing hormone binding in anterior pituitaries of fetal sheep

OBJECTIVES: Previous studies have shown that anterior pituitary expression of corticotropin-releasing hormone type 1 receptor (CRH-R1) decreases during late gestation. This study sought to determine whether this reduction is from a decrease in the number of cells expressing CRH receptors or a decrease in the number of CRH receptors per cell. METHODS: Fetuses were studied at 100 days' gestational age (100 dGA), 120 dGA, or 140 dGA. Dispersed anterior pituitary cells were incubated with or without fluorescein-conjugated CRH (FL-CRH). FL-CRH binding was assessed by flow cytometry. RESULTS: The number of CRH receptors per cell decreased at 120 dGA and 140 dGA. However, because of an increase in the percentage of cells expressing CRH receptors at 120 dGA, the total receptor index was similar at 100 dGA and 120 dGA. The receptor index tended to decrease at 140 dGA. CONCLUSION: FL-CRH binding was decreased at 140 dGA due to a decrease in the percentage of cells binding CRH and the number of CRH receptors per cell. This could contribute to the decrease in CRH-stimulated adrenocorticotropin release during late gestation in fetal sheep.     

Anti-phospholipid and anti-DNA antibodies are not associated with the elevated release of circulatory fetal DNA in pregnancies affected by preeclampsia.

OBJECTIVES: We have previously shown that the levels of circulatory fetal DNA are elevated in preeclampsia and that these increases correspond to disease severity. Several reports have indicated that increased levels of antiphospholipid (anti-PL) and anti-DNA antibodies may be associated with preeclampsia, in particular with the severe forms of the disorder. Since the release of cell-free DNA by the placenta is attributed to some form of cell death or damage and as anti-PL and anti-double-stranded DNA (dsDNA) antibodies have been proposed to lead to placental damage, we have studied the relationship between these parameters in preeclampsia. METHODS: Circulating fetal DNA levels in samples taken from pregnant women with mild (n = 12) or severe (n = 12) preeclampsia and from normal pregnant controls (n = 35) were quantified using a Taqman real-time Polymerase Chain Reaction (PCR) assay. The Anti-PL antibodies (IgG and IgM) were assayed by anticardiolipin ELISA and by commercial anti-beta2-Glycoprotein I (GPI) ELISA kits. Anti-dsDNA antibodies (IgG and IgM) were analyzed by a commercially available anti-dsDNA ELISA kit. RESULTS: No correlation could be drawn with the quantity of circulatory fetal DNA in the samples analyzed and corresponding anti-PL or anti-dsDNA antibody levels. Furthermore, no significant difference existed between the levels of these antibodies in the two study groups and the control cohort. CONCLUSION: Our data suggest that the mechanism leading to the increased release of cell-free circulatory DNA from the placenta does not involve trophoblast damage mediated by these agents. Our analysis also questions the reported involvement of anti-PL and anti-DNA antibodies in preeclampsia.     

Biologically active corticotropin-releasing hormone in maternal and fetal plasma during pregnancy

Corticotropin-releasing hormone was measured in the plasma of 110 pregnant women and in the umbilical cord plasma of 25 premature infants and 43 infants born at term. Mean maternal plasma corticotropin-releasing hormone was undetectable (less than 41 pg/ml) until mid-second trimester, rose to a mean of 204 +/- 24 pg/ml by 30 weeks' gestation, to 326 +/- 41 by 35 weeks, and then rose sharply near term, with a mean of 2930 pg/ml at 38 to 40 weeks' gestation. Sequential measurements in seven pregnant women confirmed that plasma corticotropin-releasing hormone rose in a predictable pattern, with a dramatic increase in the final weeks of pregnancy. There was little hour-to-hour variability in maternal plasma concentrations. Corticotropin-releasing hormone was also detectable in umbilical cord plasma; mean corticotropin-releasing hormone was 194 +/- 44 in the preterm infants and 150 +/- 19 in the term infants. The corticotropin-releasing hormone extracted from both the maternal and fetal circulation was biologically active in vitro and caused the dose-dependent release of adrenocorticotropic hormone and beta-endorphin from cultured rat anterior pituitary cells. A significant correlation was found between maternal plasma corticotropin-releasing hormone and cortisol levels the morning after betamethasone administration, a finding that supports a physiologic role for maternal plasma corticotropin-releasing hormone. We conclude that the placenta secretes large amounts of biologically active corticotropin-releasing hormone into both the maternal and fetal circulation during pregnancy. We demonstrate that this corticotropin-releasing hormone is secreted into the maternal plasma in a reproducible pattern during normal term pregnancy and suggest that sequential corticotropin-releasing hormone measurements may prove to be of clinical utility. In addition, placental corticotropin-releasing hormone may be an important modulator of the hypothalamic-pituitary-adrenal axis during pregnancy.     

Hypocalciuria of preeclampsia is independent of parathyroid hormone level.

Hypocalciuria is a feature of preeclampsia. The roles of parathyroid hormone (PTH) and vitamin D 1,25(OH)2D3 (calcitriol) in its pathogenesis have not yet been determined. Fourteen preeclamptic women were compared with 12 women with chronic hypertension and 11 normotensives, all in the third trimester. Preeclamptics had the lowest urinary calcium excretion rate (62.1 +/- 32.8 mg/24 hours) compared with chronic hypertensive women (162.6 +/- 97.8 mg/24 hours) and normotensive controls (225.6 = 146.9 mg/24 hours) (P less than .05). Serum PTH was lowest in preeclamptics (9.8 +/- 5.5 pg/mL), in contrast to the chronic hypertensives (18.5 +/- 2.7 pg/mL) and normotensives (16.4 +/- 3.2 pg/mL) (P less than .005). Similarly, urinary cyclic adenosine monophosphate (cAMP) excretion was 2.9 +/- 1.4 mumol/24 hours in the preeclamptics, 5.1 +/- 1.7 mumol/24 hours in the chronic hypertensives, and 4.6 +/- 1.3 mumol/24 hours in the normotensive group (P less than .05). These data suggest that the mechanism of hypocalciuria in preeclampsia is independent of the PTH-calcitriol axis. Therefore, it is suggested that the hypocalciuria of preeclampsia is due to intrinsic renal tubular dysfunction.     

母血中胎儿DNA与子痫前期关系的研究

目的:探讨孕妇外周血中胎儿DNA的浓度水平与子痫前期之间的关系。方法:留取第一次常规产前检查的472例孕妇的外周血并随访。设置阴性对照后,采用实时PCR方法定量检测怀男性单胎并发展为子痫前期的17例孕妇及34例怀男性单胎正常孕妇的血浆胎儿DNA的SRY基因浓度。结果:发展为子痫前期患者的外周血浆胎儿DNA浓度明显高于正常孕妇,中位数分别为165.41copies/ml和48.75copies/ml,有显著的统计学差异(P<0.001)。结论:发展为子痫前期患者外周血中的胎儿DNA明显增高,而浓度水平与子痫前期的严重程度似乎无关。     

Placental growth hormone is increased in the maternal and fetal serum of patients with preeclampsia

Objectives. Placental growth hormone (PGH) is a pregnancy-specific protein produced by syncytiotrophoblast and extravillous cytotrophoblast. No other cells have been reported to synthesize PGH Maternal. PGH Serum concentration increases with advancing gestational age, while quickly decreasing after delivery of the placenta. The biological properties of PGH include somatogenic, lactogenic, and lipolytic functions. The purpose of this study was to determine whether the maternal serum concentrations of PGH change in women with preeclampsia (PE), women with PE who deliver a small for gestational age neonate (PE + SGA), and those with SGA alone.

Study design. This cross-sectional study included maternal serum from normal pregnant women (n = 61), patients with severe PE (n = 48), PE + SGA (n = 30), and SGA alone (n = 41). Fetal cord blood from uncomplicated pregnancies (n = 16) and PE (n = 16) was also analyzed. PGH concentrations were measured by ELISA. Non-parametric statistics were used for analysis.

Results. (1) Women with severe PE had a median serum concentration of PGH higher than normal pregnant women (PE: median 23,076 pg/mL (3473–94 256) vs. normal pregnancy: median 12 157 pg/mL (2617–34 016); p < 0.05), pregnant women who delivered an SGA neonate (SGA: median 10 206 pg/mL (1816–34 705); p < 0.05), as well as pregnant patients with PE and SGA (PE + SGA: median 11 027 pg/mL (1232–61 702); p < 0.05). (2) No significant differences were observed in the median maternal serum concentration of PGH among pregnant women with PE and SGA, SGA alone, and normal pregnancy (p > 0.05). (3) Compared to those of the control group, the median umbilical serum concentration of PGH was significantly higher in newborns of preeclamptic women (PE: median 356.1 pg/mL (72.6–20 946), normal pregnancy: median 128.5 pg/mL (21.6–255.9); p < 0.01). (4) PGH was detected in all samples of cord blood.

Conclusions. (1) PE is associated with higher median concentrations of PGH in both the maternal and fetal circulation compared to normal pregnancy. (2) Patients with PE + SGA had lower maternal serum concentrations of PGH than preeclamptic patients without SGA. (3) Contrary to previous findings, PGH was detectable in the fetal circulation. The observations reported herein are novel and suggest that PGH may play a role in the mechanisms of disease in preeclampsia and fetal growth restriction.     

Fluctuation of maternal and fetal free extracellular circulatory DNA in maternal plasma

OBJECTIVE: To examine whether concentrations of free extracellular fetal circulatory DNA in maternal plasma are stable or fluctuate. METHODS: Consecutive blood samples were drawn from 13 healthy nonpregnant volunteers and from 16 healthy pregnant women over 3 days. DNA was isolated from the plasma fraction and quantified by real-time polymerase chain reaction (PCR). RESULTS: In nonpregnant controls the total amount of cell free DNA fluctuated by an average of 13.5-fold. In samples obtained from pregnant women the amount of maternal cell free DNA varied by an average of 21.5-fold. Because ten of those women were pregnant with male fetuses, the concentration of free fetal DNA in these cases was determined by a real-time PCR assay for the Y chromosome. The mean variation in free fetal DNA levels in male fetuses was 2.2-fold. CONCLUSION: The degree of variation in free fetal DNA concentrations observed in this study was similar to published values, so these results imply that care should be exercised when considering quantitation of this fetal material for potential diagnostic or screening purposes.     

Two-stage elevation of cell-free fetal DNA in maternal sera before onset of preeclampsia

Objective

The purpose was to determine whether preeclampsia (PE) is caused by microfragments of syncytial trophoblast shed into the maternal circulation that stimulate an exaggerated inflammatory response.

Study design

A nested case control study was performed within the Calcium for Preeclampsia Prevention trial cohort of healthy nulliparous women. Each preeclampsia case was matched to 1 normotensive control. One hundred twenty pairs were randomly chosen for analysis of serum cell-free fetal DNA (cffDNA), a marker of placental debris, and C-reactive protein (CRP), a marker of inflammation, in all 658 specimens obtained before labor.

Results

At 29 to 41 weeks of gestation, cffDNA concentrations were significantly higher after preeclampsia than before (219 vs 112 genome equivalents [GE]/mL, P<.001). Before preeclampsia, cffDNA in cases exceeded controls at 17 to 28 weeks (36 vs 16 GE/mL, P<.001), but at 29 to 41 weeks, only within 3 weeks before preeclampsia (176 vs 75 GE/mL, P<.001). CRP serum concentrations were neither associated with cffDNA nor elevated before preeclampsia.

Conclusion

Preeclampsia is accompanied by a 2-stage elevation of fetal DNA, but not by elevation of CRP. Elevated cffDNA at 17 to 28 weeks may be due to placental necrosis and apoptosis. Subsequent elevations may reflect impaired DNA elimination. The 2-stage elevation suggests the possibility of measurement of fetal DNA both to screen for preeclampsia and to indicate impending clinical disease.     

Placental growth hormone is increased in the maternal and fetal serum of patients with preeclampsia.

OBJECTIVES: Placental growth hormone (PGH) is a pregnancy-specific protein produced by syncytiotrophoblast and extravillous cytotrophoblast. No other cells have been reported to synthesize PGH Maternal. PGH Serum concentration increases with advancing gestational age, while quickly decreasing after delivery of the placenta. The biological properties of PGH include somatogenic, lactogenic, and lipolytic functions. The purpose of this study was to determine whether the maternal serum concentrations of PGH change in women with preeclampsia (PE), women with PE who deliver a small for gestational age neonate (PE + SGA), and those with SGA alone. STUDY DESIGN: This cross-sectional study included maternal serum from normal pregnant women (n = 61), patients with severe PE (n = 48), PE + SGA (n = 30), and SGA alone (n = 41). Fetal cord blood from uncomplicated pregnancies (n = 16) and PE (n = 16) was also analyzed. PGH concentrations were measured by ELISA. Non-parametric statistics were used for analysis. RESULTS: (1) Women with severe PE had a median serum concentration of PGH higher than normal pregnant women (PE: median 23,076 pg/mL (3473-94 256) vs. normal pregnancy: median 12 157 pg/mL (2617-34 016); p < 0.05), pregnant women who delivered an SGA neonate (SGA: median 10 206 pg/mL (1816-34 705); p < 0.05), as well as pregnant patients with PE and SGA (PE + SGA: median 11 027 pg/mL (1232-61 702); p < 0.05). (2) No significant differences were observed in the median maternal serum concentration of PGH among pregnant women with PE and SGA, SGA alone, and normal pregnancy (p > 0.05). (3) Compared to those of the control group, the median umbilical serum concentration of PGH was significantly higher in newborns of preeclamptic women (PE: median 356.1 pg/mL (72.6-20 946), normal pregnancy: median 128.5 pg/mL (21.6-255.9); p < 0.01). (4) PGH was detected in all samples of cord blood. CONCLUSIONS: (1) PE is associated with higher median concentrations of PGH in both the maternal and fetal circulation compared to normal pregnancy. (2) Patients with PE + SGA had lower maternal serum concentrations of PGH than preeclamptic patients without SGA. (3) Contrary to previous findings, PGH was detectable in the fetal circulation. The observations reported herein are novel and suggest that PGH may play a role in the mechanisms of disease in preeclampsia and fetal growth restriction.     

Elevated ratio of maternal plasma ApoCIII to ApoCII in preeclampsia

Preeclampsia is a hypertensive disorder unique to pregnancy. Although the pathogenesis of the disease begins with aberrant spiral artery invasion in the first trimester, clinical symptoms usually do not present until late in pregnancy. Apolipoprotein CII (ApoCII) and its negative regulator, apolipoprotein CIII (ApoCIII), have recently been described as atherogenesis biomarkers in models of cardiovascular disease. Given the similarities in pathology, etiology, and clinical presentation between cardiovascular disease and preeclampsia, we hypothesized that the ratio of ApoCIII to ApoCII in maternal first trimester plasma would predict preeclampsia later in pregnancy. To test this hypothesis, plasma was prospectively collected from 311 nulliparas at 8 to 12 weeks gestation. After delivery, patients were divided into cohorts based on preeclampsia diagnosis. Conditioning monocytes with preeclamptic plasma potentiated monocyte adhesion to endothelial cells in an in vitro model. The ratio of ApoCIII to ApoCII was significantly elevated in patients with severe preeclampsia relative to normotensive and gestational hypertensive individuals (P < .05) as determined by mass spectrometry and competitive enzyme-linked immunosorbent assay (ELISA) assays. These results support a predictive change in the ratio of ApoCIII to ApoCII in pregnancies complicated by severe preeclampsia.     

Maternal serum ratio of ghrelin to obestatin decreased in preeclampsia

ObjectiveGhrelin, an endogenous for the growth hormone secretagogue receptor, has been shown to participate in blood pressure regulation. Obestatin, encoded by the same gene as ghrelin, is described as a physiological opponent of ghrelin. We hypothesized that ghrelin/obestatin imbalance played a role in the pathogenesis. This study was designed to determine the alterations of ghrelin and obestatin concentrations and ghrelin/obestatin ratio in maternal serum in preeclampsia.MethodThis retrospective case–control study included 31 preeclampsia and 31 gestational week-matched normal pregnancies. Ghrelin and obestatin concentrations in maternal serum were determined by radioimmunoassay, and the ghrelin/obestatin ratio was calculated.ResultsThe ghrelin concentration and ghrelin/obestatin ratio in maternal serum were significantly lower in preeclampsia than in normal pregnancies (214.34 ± 14.27 pg/mL vs 251.49 ± 16.15 pg/mL, P = 0.041, 1.07 ± 0.09 vs 0.82 ± 0.08, P = 0.023). The obestatin concentration in maternal serum was significantly higher in preeclampsia than in normal pregnancies (276.35 ± 15.38 pg/mL vs 223.53 ± 18.61 pg/mL, P = 0.019). The systolic blood pressure in preeclampsia was negatively correlated with ghrelin concentration and ghrelin/obestatin ratio (r = −0.549, P = 0.003; r = −0.491, P = 0.004) and was positively correlated with obestatin concentrations in preeclampsia (r = 0.388, P = 0.013).ConclusionsThe findings of this study suggested disturbance of ghrelin and obestatin in maternal serum in preeclampsia, and ghrelin/obestatin imbalance might play a role in the pathogenesis of preeclampsia.     

游离胎儿DNA及抗DNA抗体与子(癎)前期的关系

目的 研究孕妇外周血游离胎儿DNA(fDNA)是否与子癎前期及其严重程度相关,检测子癎前期孕妇体内抗单链DNA抗体(抗ssDNA抗体)及抗双链DNA抗体(抗dsDNA抗体)是否存在异常变化.方法 选择2005年5月至2006年11月在浙江省人民医院妇产科住院的20例轻度子癎前期孕妇(轻度子癎前期组),14例重度子癎前期孕妇(重度子癎前期组),42例无妊娠合并症及并发症的孕妇(对照组),所有孕妇均妊娠男性胎儿.抽取孕妇外周血后采用实时荧光定量PCR技术(FQ-PCR)对fDNA进行定量,同时采用ELISA技术对抗ssDNA抗体和抗dsDNA抗体定量.结果 时照组、轻度子癎前期组和重度子癎前期组的fDNA均值分别为(67.83±43.70)拷贝/mL、(172.31±127.89)拷贝/mL、(321.37±47.07)拷贝/mL,差异有统计学意义(X2=21.8514,P＜0.01);三组的抗ssDNA抗体光密度均值(OD)分别为(0.067±0.074)、(0.075±0.039)、(0.160±0.214),差异有统计学意义(X2=6.3741,P＜0.05);而不同组间抗dsDNA抗体OD均值为(0.0230±0.0102)、(0.0257±0.0099)、(0.0281±0.0119),差异无统计学意义(X2=2.6340,P＞0.05);抗ssDNA抗体与抗dsDNA抗体之间存在显著的相关性(r=0.5985,P＜0.05),抗ssDNA抗体、抗dsDNA抗体及新生儿体重与fDNA浓度均无显著的相关性(P＞0.05).结论 fDNA与子癎前期的严重程度密切相关,抗DNA抗体在子癎前期的发病过程中可能起着重要的作用.     

Effects of corticotropin-releasing hormone and adrenocorticotropin on prostaglandin output by human placenta and fetal membranes

We have examined the possibility that corticotropin-releasing hormone (CRH) and adrenocorticotropin (ACTH) might affect prostaglandin (PG) E2 and PGF2 alpha output by term placenta, amnion and decidua during short-term (48-hour) culture, and that effects of CRH might be mediated by ACTH. In all three tissues PG output was stimulated by both CRH and ACTH. These effects were inhibited in the presence of antisera to CRH and to ACTH. Moreover, in placenta, but not in amnion or decidua, the stimulatory effects of CRH on PGE2 and PGF2 alpha output were attenuated in the presence of an antibody to ACTH. Our results support the possibility of paracrine stimulation by CRH and ACTH of PG production in intrauterine tissues, and suggest that in part the effects of CRH on placental PG output might be mediated through ACTH.     

Effects of naloxone on fetal circulatory responses to hypoxemia

The effects of opiate receptor antagonism on the fetal cardiovascular response to hypoxemia were examined by means of the radionuclide-labeled microsphere technique. Heart rate, blood pressure, and cardiac output were measured during baseline perods, during hypoxemia, and before and after infusion of either naloxone (1 mg/kg) or an equivalent volume of 0.9% saline solution. Seventeen fetal sheep were subjected to maternal hypoxemia by allowing the ewes to breathe 10% oxygen (3% carbon dioxide, 87% nitrogen). The fetuses responded with bradycardia (p < 0.002 compared with control), increased blood pressure (p < 0.002 compared with control), and no significant change in combined ventricular output or placental blood flow. After naloxone, the bradycardia increased by 10% (p < 0.001), and both combined ventricular outout and placental blood flow fell by 20% (p < 0.01 and p < 0.01, respectively). The fetal bradycardic response to naloxone was reversible with atropine. In fetuses with normal oxygenation of the blood (normoxemic), naloxone had no significant effect on heart rate and blood pressure. These data indicate that endogenous opiates (e.g., endorphin and enkephalin) are important in regulating the fetal circulation during hypoxia, and that the effects of opiate receptor antagonism may be mediated through the autonomic nervous system.