Anatomic analysis of blood vessels in germinal matrix, cerebral cortex, and white matter in developing infants

The germinal matrix (GM) located in the thick subependymal cell layer of the thalamostriate groove is a major site of cerebral hemorrhage in premature infants. Comparing the morphology of vasculature among GM, gray and white matter of the brain may help in understanding the pathogenesis of GM hemorrhage and also of periventricular leukomalacia. The objective of the present study was to determine the morphology of blood vessels in the GM, gray matter, and white matter and to examine maturational changes in the morphology of these vessels as a function of gestational age. We measured vessel density, percentage of blood vessel area, mean surface area, length, breadth, perimeter, radius, and shape of blood vessels in coronal sections of the GM, gray matter, and white matter in postmortem human brain samples for 17 fetuses and premature infants of gestational age 16-40 wk and 2 adults. We performed immunohistochemical staining using anti-laminin primary antibody, confocal microscopy to acquire images, and analysis using Metamorph version 6.1. Vessel density and the percentage of blood vessel area increased as a function of gestational age in the GM, gray matter, and white matter (p < 0.001 each). The blood vessel density and the percentage of blood vessel area were largest in the GM followed by gray matter and then white matter in all of the gestational age categories (p < 0.001 for all comparisons). Increased vascularity of the GM compared with gray and white matter may play a role in GM hemorrhage, whereas a relatively low vascularity of white matter may increase the propensity for the occurrence of periventricular leukomalacia in premature infants     

Maturational changes in laminin, fibronectin, collagen IV, and perlecan in germinal matrix, cortex, and white matter and effect of betamethasone

Germinal matrix is selectively vulnerable to hemorrhage in premature infants, and use of prenatal betamethasone is associated with a lower occurrence of germinal matrix hemorrhage. Because the major components of extracellular matrix of the cerebral vasculature-laminin, fibronectin, collagen IV, and perlecan-provide structural stability to blood vessels, we examined whether the expression of these molecules was decreased in the germinal matrix and affected by betamethasone. In both human fetuses and premature infants, fibronectin was significantly lower in the germinal matrix than in the cortical mantle or white matter anlagen. Conversely, laminin alpha1 gene expression was greater in the human germinal matrix compared with the cortical mantle or white matter. Expression of alpha1- and alpha2(IV) collagen chains increased with advancing gestational age. Low-dose prenatal betamethasone treatment enhanced fibronectin level by 1.5-2-fold whereas a high dose reduced fibronectin expression by 2-fold in rabbit pups. Because fibronectin provides structural stability to the blood vessels, its reduced expression in the germinal matrix may contribute to the fragility of germinal matrix vasculature and the propensity to hemorrhage in premature neonates.     

Lung mitochondria in experimental asbestosis

Alterations in lung mitochondria were followed in guinea pigs at different periods after a single intratracheal injection of chrysotile dust. Cytochrome c oxidase and succinic dehydrogenase activities showed gradual increase after 90 days, whereas monoamine oxidase remained unaffected throughout the study. There was an increase in glutamate dehydrogenase activity in postmitochondrial as well as in mitochondrial fractions, the latter being accompanied by decreased latency of the enzyme. Mitochondria from asbestotic lung appeared to be more swollen than in normal animals at and after 90 days of exposure. There were fluctuations in the contents of different phospholipids as a result of asbestosis. Beyond 90 days, collagen and mucopolysaccharides also increased. The results confirm the contention that pulmonary mitochondria are among the major target sites in asbestosis.     

Difference in target cell recognition of naive and activated human natural killer cells: role of Haymaker (p38.5) in tumoricidal activity

The human Haymaker gene, at 19q13.2 in the Leukocyte Receptor-Receptor-Related Complexes, encodes a 38.5-kDa non-MHC protein found on the plasma membrane of tumor cell lines that are highly susceptible to lysis by naive (unstimulated) natural killer (nNK) cells. We hypothesized that Haymaker might act as a ligand in the tumoricidal activity of nNK cells because this molecule was absent from the surface of malignant cell lines that were resistant to their cytolytic activity. We examined the capacity of this protein to act as a ligand in the tumoricidal activity of freshly isolated nNK cells and IL-2 activated natural killer (NK) cells (aNK cells) by performing blocking studies with recombinant Haymaker (r-Haymaker) and peptide-specific anti-Haymaker antibodies. These competition studies demonstrated that both r-Haymaker and anti-Haymaker antibodies inhibited the tumoricidal function of nNK but not aNK cells. We conclude that Haymaker likely plays an essential role as an activating ligand in nNK-cell-mediated cytotoxicity, whereas the tumoricidal activity of aNK cells is, for the most part, induced by other molecules.     

Pharmacokinetics of betamethasone in twin and singleton pregnancy

OBJECTIVE: The aims of the study were to compare the pharmacokinetics of betamethasone in singleton pregnancy with the pharmacokinetics in twin pregnancy and to assess the adrenal suppression produced by betamethasone. STUDY DESIGN: We measured serial betamethasone and cortisol levels in 30 singleton and 21 twin pregnancies after the first dose of betamethasone and calculated the pharmacokinetic parameters for betamethasone including volume of distribution, half-life, and clearance. We also measured cord and maternal blood levels of betamethasone at the birth of infants of 13 singleton and 9 twin pregnancies. RESULTS: The half-life of betamethasone in mothers with twin pregnancies was significantly shorter than that in mothers with singleton pregnancies (7.2 +/-2.4 versus 9.0 +/- 2.7 hours; P <.017). Clearance of betamethasone in the twin pregnancies appeared greater than in singleton pregnancies (8.4 +/- 6.4 versus 5.7+/- 3.1 L/h; P =.06) but did not reach statistical significance. Volume of distribution was similar in the two groups. Because the time between the last dose of betamethasone and birth varied widely (range, 2-158 hours), mothers with a longer interval after treatment tended to have a higher cord-to-maternal betamethasone ratio than did mothers with a shorter interval in both twin and singleton pregnancies. This finding indicated delayed fetal clearance, but the correlation was weak (R (2) = 0.29 for twins and 0.08 for singletons). CONCLUSION: The shorter half-life of betamethasone in twin pregnancy than in singleton pregnancy may cause the level of betamethasone to be subtherapeutic for lung maturation in twin pregnancy.     

Effect of hyperoxic resuscitation on propensity of germinal matrix haemorrhage and cerebral injury

C. O. Chua, G. Vinukonda, F. Hu, N. Labinskyy, M. T. Zia, J. Pinto, A. Csiszar, Z. Ungvari and P. Ballabh (2010) Neuropathology and Applied Neurobiology 36, 448–458
Effect of hyperoxic resuscitation on propensity of germinal matrix haemorrhage and cerebral injury Aims: Intraventricular haemorrhage (IVH) and cerebral injury are major neurological disorders of premature infants. The effect of hyperoxic resuscitation on the occurrence of IVH and cerebral injury is elusive. Therefore, we asked whether hyperoxia during neonatal resuscitation increased the incidence and severity of IVH and cerebral injury in premature newborns. Methods: Premature rabbit pups, delivered by C‐section, were sequentially assigned to receive 100%, 40% or 21% oxygen for 15 or 60 min at birth. The pups were treated with intraperitoneal glycerol at 24‐h postnatal age to determine the incidence and severity of glycerol‐induced IVH. Vascular endothelial growth factor and angiopoietin‐2 genes and protein expression, endothelial proliferation as well as free radical levels and antioxidants were assessed in the germinal matrix, white matter and cortex of pups exposed to 100% oxygen and to 21% oxygen. Results: Exposure with 100% oxygen for 1 h did not adversely exacerbate the incidence of glycerol‐induced IVH in premature rabbit pups. Compared with room air, 100% oxygen enhanced mRNA expression of both vascular endothelial growth factor and angiopoietin‐2 as well as reactive oxygen species levels in the germinal matrix. Hyperoxia did not affect endothelial proliferation, apoptosis or neuronal degeneration in the forebrain. Conclusion: Our data suggest that 100% oxygen exposure for 1 h does not increase the risk of IVH or cerebral injury in premature rabbit pups. Although extrapolating rabbit neural developmental data into humans has obvious limitations, we speculate that hyperoxia of short duration at birth in premature infants may not result in major neurological adverse effects.     

Development of integrins in the vasculature of germinal matrix,cerebral cortex,and white matter of fetuses and premature infants

Germinal matrix (GM) vasculature is selectively vulnerable to hemorrhage in premature infants during the first 48 hr of life. This is attributed to rapid angiogenesis of this brain region, resulting in formation of nascent vessels that show a paucity of pericytes and immaturity of extracellular matrix. Integrins are key regulators of angiogenesis and contribute to stabilization of cerebral vasculature by providing endothelial– and astrocyte–matrix adhesion. Therefore, we asked whether GM exhibited a distinct regional pattern of integrin expression that was dissimilar from that of the cerebral cortex and white matter in human fetuses and premature infants. To this end, we measured protein and gene expression of integrins in the GM, cortex, and white matter of human fetuses (15–22 weeks), premature infants (23–35 weeks), and mature infants (36–40 weeks). We found that protein levels of α5β1 integrin were greater in the GM than in the cortex or white matter by 1.6‐fold for both fetuses and premature infants. α5β1 integrin mRNA expression was higher in the GM than in the cortex or white matter by 2‐fold for fetuses but not for premature infants. αVβ3, αVβ5, αVβ8, and α4β1 integrin expression were comparable among GM, cortex, and white matter in fetuses and premature infants. Because α5β1 integrin is a central regulator of angiogenesis, its elevation in the GM of fetuses and premature infants indicates that this might be a key activator of endothelial proliferation in this brain region. We speculate that selective α5β1 integrin inhibition might suppress angiogenesis in the GM and thus prevent brain hemorrhage in premature infants. © 2009 Wiley‐Liss, Inc.